Permit / /-/
CITY OF TIGARD ELECTRICAL PERMIT
rO PERMIT #: ELC2005 -00869
DEVELOPMENT SERVICES DATE ISSUED: 11/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171, PARCEL: 1 S136CA 02400
Lk) SITE ADDRESS: 11005 SW 79TH AVE \` C � �\
t
ZONING: R -4.5
SUBDIVISION: FRIENDLY ACRES LOT : 025 JURISDICTION: TIG
Project Description: Panel replacement.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL /PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt:. > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
•
LANDERS, MERIJEAN WILLAMETTE ELECTRIC INC
11005 SW 79TH PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 519 -1740 Phone: 503 - 624 -3631
•
FEES Reg #: LIC 75059
Description Date Amount SUP 1965S
ELE 34 -283C
[ELPRMT] ELC Permit 11/4/2005 $66.85
[TAX] 8% State Surcharge 11/4/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.19
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: ---32 L„tif.0 Permittee Signature: S7A . Pc
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
NOV 15 2005 11:19RM HP LASERJET 3200 P , 2
•
' �r�EIVED
' FOR OFFICE USE ONLY ' •
Electrical P erm it Ap ion/
City of Tigard NOV 1 5 20 A Da`� 1.. .
13125 5W Hall Blvd., Tigard, OR 97223 �,,
Plan Review Other Permit:
, Date1B See Page 2 for liNI Si Phone: o Line: 503 9 503.598.1960 - d _ - G * + 1 Date B y/BT.
Inspection Line: 503.639.4175 CITY OF 71 41.., Notrfied/M Supplemental Information
Internet wwwci tigard or us BUILDING DIV 5 614
��a-� 5 � t y i il
rf ,''� 9 ��� �iU �`n tt ti �_�� 1 � � � �Y�.��,. 4 ° �,b +�G�� t
re; � 4 ty llfi l[ I �t ;;>v,i , ,.' rs' � �P4'''' ' fl ` w . �..lease ..heck all that apply:
J N itr" oast c t
❑ New construction Addth 1 on/alteration/replacement ❑Service over 225 amps, comm'l DHazardous location
Other: ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft:,
❑ De p tnohtion [ _r [ t of I - and 2- family dwellings 4 or mare new residential
� t `[" t y ,, ;'1'tl� 5g4Ti, ,� s Ei'1 tY� ,, iN'�'.'' 4i � .i.sl 4 , r . ? �"' ,f `" %l�' ; I�'�: °
� , i?.� j�- t e '' ' ❑System over 600 volts nom uni in one structure
and - aa`a ' tt { w l } - tits , A ccessory building ❑Feeders, 400 amps or more
® 1- and 2 family dwelling ❑ Commercial/Mdustrial ❑ []Building over three stories
❑ Master builder ❑Other: ❑Occupant load over 99 persons ❑Manufactured structures or
CI Multi TMi , ., s ix 1 .1 r L V
RV park
'y . > '1 +r;: 14 q s ,4 ,� *X ' i ` a;, � ,1 a t ; 1 .,` i.. ', DEgressllighting plan
�1 + hlci A} i a 1��4�1L�ivlw l e �,i wss s n, QOther:
L vu r n 4 g.e_: AI Wit �. /f ,, ❑Health -care facility
Job no.: 6 q'70 Job site address: 11 OS $ w ?rig- ll�f1`� - _ Submit 2 sets of plans with any of the above.
The above are not applicable to temporary construction service.
City /State /ZIP: Yi r J i Total - r galt.N ' MTIT - D D,e . i ..
Project name: t a, d e i 5 e.
Suite/bldg./apt. no.: � Pro J Description Qty. Fe
New residential single - or muki- fatally dwelling unit.
Cross street/directions to job site: Includes attached garage.
1,000 sq. ft. or less 145.15 4
Ea. add'1 500 sq. ft. or portion 33.40 1
Subdivision: Lot no.: Limited energy, residential 75.00 2
Li energy, non-residential 75.00 2
Tax map /parcel no r, z , f r , a;i l 1 : 70'44' 2
q fi ° +`y ' "•i „t6 i .^ 1 ? �v iuz�rr -.+ t3 ° ,,° t+ 1. i + �t #; li ", k Each manufactured
and/or r feede
� :�, a . vi ll .�, ;t vrtr " �•, dwelling, service and /or feeder _ 90.90
P4 L C 4 9 ' -t - Services or feeders installation, alteration, and/or relocation
200 amps or less j 80.30 to 2
_ x ,,,�.,� � �• ,. t i ;t 201 amps to 400 amps 106.85 2
r x 5ry} m -�e r�'dia�'',l � ��r� ".its 4 1 i =,rr 401 as to 600 amps 160.60 2
_
Pf i ra 1 � tis. a ....rCi t®ai>a"I. ae a di, i
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts
Name: _
454.65 2
2
Address: Reconnect only _ 66.85
Temporary services or feeders installation, alteration, and/or
City/State /ZIP: relocation
Fax: ( )
Phone: ( ) 200 amps or less 66.85 1
10030 �
ro that T own which is not 201 amps to 400 amps
Own installation: This installation is being made on p pertY 401 amps to 600 amps 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch s to circuits 00 a new, alteration, or extension, per panel
Date
Owner signature: a :_ A. Fee for branch circuits with -
rFM c 1 m E! $1.i t ,t til . ar i,fi : n }t PZI Firgq;ng t� 2. < � '' ,� i 2
iiri, i 4 i t i , i -d o , i 111.E ,t 4 ) En , ,, rf d t _. st: .� s� service or feeder fee, each 6
lf : -.a ' eifra' s.t, Atak a. , 1g .)3u' F �, � .. branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Contact name: each branch circuit _
Each add'l branch circuit
6.65 2
Address:
Miscellaneous (service or feeder not included) 1 2
City/State/ZIP: Pump or irrigation circle 53.40
Phone: ( ) l Fes' ' ( ) r Sign or outline lighting
53.40 2
Signal circuit(s) or limited -
E r t r i^ac T a ra ,71P ra i q :¢3 , ��fll , R G� 76€ q , i� , energy panel, alteration, or 2
i t 'N; 3' S .. Il . 44' t t „••• - 4°; T4-. b S• ,:Yv . -S[ 5„ & ,, l ` ,d , Page 2
t + 1 `'a''�f� �k���'� l� �:�n:,l�:..� extension. Deacon.. �,,�' + +� .ii.txra l 51�.r
Business name: LAI / j a " c 4lr� ''4
Each additional inspection over allowable in any of the above
/ 0 f
. Address: Ts.›, 23 5.- Per inspection 62.50 62.50
Investigation per hour (1 hr min) C ity /State/ZIP: . 4,./ ,> F 73.75
Industrial plant per hour n .�` . : ei
2y -1 Z/ Fax: (C (2 s., i' ' ,. ;y s' i l�>l � 1, <; `,fit �• `'.} P. _,..
: l aril + .,
Phone: (•:�` $) 1� Z.?
,
j -erg Su °91.) " -; Subtotal j�O
CCB Lic.: p � 1"� „r* � 1 Electrical Lic.: I Suprv. Lic.: 1
Plan review (25% of permit fee)
Suprv. E lectrician si gnature, required: Y L
State surcharge (8% of permit fee)
f � y �^ D ater° f,,..�+�- ... . • 1 8 6 Z
Print name: f d c - ,,,st . I TOTAL PERMIT FEE
T h[s permit application expires if a permit is not Attained within 180
Authorized signature: This after It has been accepted as complete
I Date: • Fee methodology set by Tri- County Building Industry Service Board
Print name: •* Number of inspections per permit allowed.
44(14615r(I0Ie2/COM/WEB
tinuildingTemits \BLC- PconitApp.doc 12/03
CITY OF TIGARD
1 BUILDING DIVISION PERMIT #: E.? C 005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/4f200.5
Phone: (503) 639-4171 u� @ H I
Inspection Requests (24 Hrs.): (503) 639 -4175 _� A II
INSPECTION WORKSHEET FOR DATE: f iii b12O0 5 TIME: 7:17AM PAGE: 92
SITE ADDRESS: 110D5 Win AVE CLASS OF WORK:
SUBDIVISION: FRIENDLY ACRES LOT #: 025 TYPE OF USE:
PROJECT NAME: LANDERS
DESCRIPTION: Palna'.l repiacat ent. ',
11
" ":� OWNER: LANDERS, MERIJE:Ah1, PHONE #: 503 -51? -1740
CONTRACTOR: WI ETTE 4-1 E RIC INC ' / z, ff , t, / PHONE #: 503-6241631
Inspection Request Scheduled For: Date: '011812005 Pour Time:
Code # Inspection Description Confirm''# Contact # Message
116 _ ,�_ ::r. :ervic: 0217 �1 Y t
Cor - : - - . - - - - nstructions: : 7624-3631
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•
r1;1 PASS 1 1 PARTIAL APPROVAL CANCEL I NO ACCESS
_PrAs CALL FOR INSPECTION 1 I ADDITIONAL FEES ASSESSED 1
J �/ / k, Inspector: 1 "" �y Lam�;' c. Date:/ / Phone #: (503) 718 -
/ /
i
CITY OF TIGARD
BUILDING DIVISION"' - PERMIT' #: ' ' L" 2005 -00869
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1114/2006
Phone: (503) 639 -4171 5i# Ii
Inspection Requests (24 Hrs.): (503) 639 -4175 .,•
INSPECTION WORKSHEET FOR DATE: 11/7/2005 TIME: 7:05AM PAGE: 3
#4 l J P r%il" Lc
SITE ADDRESS: 11005 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: FRIENDLY ACRES LOT #: 025 TYPE OF USE:
PROJECT NAME: LANDERS
DESCRIPTION: 'Panel replacement.
OWNER: LANDERS, IMiERIJEAN, PHONE #: 503-619-1740
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/7/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final i +1 03-619-1740 Y
,-Lt- / / P' /o1
rect� e s /Instructions elm oAJ4/t X_
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•
❑ PASS al 'ARTIAL APPROVAL n CANCEL n NO ACCESS
■ FAIL 21 LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspect. : Date: // . t) . Phone #: (503) 718 -
1