Permit ELECTRICAL PERMIT
CITY OF TIGARD. PERMIT #: ELC2005 -00276
4161 DEVELOPMENT SERVICES DATE ISSUED: 4/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112BC - 03200
SITE ADDRESS: 14685 SW 83RD AVE ZONING: R - 4.5
SUBDIVISION: HAMBACH PARK LOT : 016 JURISDICTION: TIG
Project Description: (7) branch circuits.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 6 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:
RALPH STAEGER KELSO ELECTRIC INC
14685 SW 83RD AVE 545 SE 3RD
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: 503 - 598 - 0362 Phone: 503 - 648 - 6360
FEES Reg #: LIC 116254
4270s
Description Date Amount SUP 34-43
ELE 34 -433c
[ELPRMT] ELC Permit 4/22/2005 $86.75
[TAX] 8% State Surcharge 4/22/2005 $6.94 REQUIRED ITEMS AND REPORTS
Total $93.69
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. � f
Issued By: (j f jx Permittee Signature: A-' G
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.
.1 .
. .
Electrical -Permit Application OFFICE USE ONLY
• A
Cit of Tigard Permit No.: &i / 1
Dates 7
13125 y SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 . 41 _ *Ill it Date/By: Other Permit:
Inspection Line: 503.639.4175 i e I Date Ready/By: Suns: 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: r i (r Supplemental Information
7 ::::::'''.''''''''i I' , 'lryiik ?iji *clitit :',-;,.- : ,'.. '. 7P.;M:IW;,.,.VSit.*yotifw4
..,_■?..: i, r,y. 4.. „F, 7-z.;_tsr' . L-7 - ,.. - . =,':' .... - :„. .. - '. ';;''.,-- . - .1;:'. 7 .',:P. ,- 4 1 ,.;...0 - °V;74T?0 - rieg , K ..,, ...;,..: ..:
0 New construction 0 Addition/alteration/replacement Please check all that apply:
1:1Service over 225 amps, comm'I ['Hazardous location
0 Demolition 0 Other:
. ['Service over 320 amps - rating [IBuildng over 10,000 sq. ft.,
;'•-:',. ,:,- ,,.-, :-. ,,- : -;.:<- i s i tv' - , OF , -- , td g ,. &jib , , -; ; ;..g,.. , ,q*4 . -..!,-,:;i:i-,,.‘„
of 1- and 2-family dwellings 4 or more new residential
4 .1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
El Multi-family D Master builder - 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
--aijk'gfri_i4F6tiMAttot■i: ' '.1 '.',:.-:,":-'-.- DEgress/lighting plan RV park
facility ['Other:
Job no.: Job site address: i y 6 gy c s j,,i gj 41 ElHealth-care
Submit 2 sets of plans with any of the above.
City/State/ZIP: 77 44 ,e, 0 0 , 2 The above are not applicable to temporary construction service.
• „ -,, t • .:7 ...-:. -.,.. ,, tete I §attb ,1,-;ff
Suite/bldg./apt. no.: Project name:
Description I Qty. I Fee. I Total I ..
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.: .
' :;-i.'-4-':.iikgeiiiiitisij Limited energy, non-residential 75.00 2
.& i'oo
4ttiZ :: - i ' ''',:'.‘ '''' ''' .'-' ' '''':' -
_•.,„„- i •• '-. ' • - !.- '.,_, =.:5 - - i ' Each manufactured or modular
dwelling, service and/or feeder 90.90 2
g.43 6'44ver Iff,teh0/1 XL' Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
N - - kiiijitidy OWNER '-.--•::•/":':'' " ; 4-- ,', .. -:, 0 TENANT „--........--,,,, ,.,, , 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: le /4 '- J7;q./C 601 amps to 1,000 amps 240.60 2
Address: ''- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) c-C78 - °-gCe Fax: ( )
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2 _
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
c...0 -APPIACANT' , ,, : ,.' ''' .- ' - -,,-, •-".- E CONTACT' PERSON A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, /
46.85 cv‘ S',5 2
each branch circuit
Address:
Each add'l branch circuit ro 6.65 fq. f'() 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) .
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
031414ACTOB, . ' .!'.. .. ; ....,17.;y: energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Kg-63r, /5 / C.
Each additional inspection over allowable in any of the above
Address: 95 , p. c' 4 4
Cl s 1 ----
Per inspection 62.50
City/State/ZIP: //a, /.. sg,,,,e0 ‘22 ? 7/23 Investigation per hour (1 hr min) 62.50
Phone: („5.0 ) 6 ye _ r. , ,- Fax: C5''3) 6 r ,_ 6e// Industrial plant per hour 73.75
CCB Lic.:n 2,5y Electrical Lic.: . y,” Suprv. c.: y 7s
Li Subtotal ' s .
Suprv. Electrician signature, required: ..;4% Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4 99' • 36//-1
Print name: Date: ,/, V s..-
c.... /4-(re,St.) TOTAL PERMIT FEE f 69
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri-County Building Industry Service Board
0 * Number of inspections per permit allowed.
i: \BuildinePermits \ELC-PerrnitApp.doc 12/03 440-4615TO 0/02/COM/WEB
•
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener* .
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
•
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑HVAC
❑ Instrumentation
Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
' ❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number o£commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PemdtApp.doc 04/03 - -
CITY OFTIGARD _
BUILDING DIVISION PERMIT #:j 4'02 770
13125 SW Hall Blvd:, Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 ii�an�ml � �i���a,
Inspection Requests (24 Hrs.): (503) 639 -4175 —"Jig- '__..
INSPECTION WORKSHEET FOR DATE: 4 / 3 / 0i l TIME: PAGE:
SITE ADDRESS: ( 4157 /14-) 5319 41/ CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: 7 Gk
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description � Confirm # Contact # Message
1.11 4� i-1 LI 8003 -p I
Corrections /Comments /Instructions: v
4 Y
AU
•
oy-
/ .
PASS ❑ PART. -- L APPROVP [I] CANCEL 11] NO ACCESS
❑ FAIL ❑ . < "L Fr ,TION ❑ ADDITIONAL EES A ESSED 0
r! 7 7' Ad "'
Inspector: Date: Phone #: (503) 71 )4
p -
, 'p
CITY OF TIGARD • •
BUILDING DIVISION PERMIT #: L;
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 / w ?:L gp�
`�
Inspection Requests (24 Hrs.): (503) 639 -4175 ' 1
INSPECTION WORKSHEET FOR DATE j` di - '0 TIME: %. A PAGE:
SITE ADDRESS: -65 SLII <rr✓ e �C CLASS OF WORK: •
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: /
DESCRIPTION: 5.fII (�j Re ep 'MC1e'
OWNER: f eij P I ' ' c t - 5 4 - Q e l e - PHONE #: 5b3 - 0 3 0 - - . -.
CONTRACTOR: � r � �� PHONE #: 5 50 3-/ t$- 45-5,a,
Inspection Request Scheduled For: Date: 5 -,P -DS . Pour Time:
Code # Inspection Description Confirm # . Contact # Message
. i W7 .
Corrections /Comments /Instructions:
itti_K et--- Ell:=7-MW: g0,
dbv►1 eouOiner ()Jov l a I ke. ail nor to, ( 1 i5 -1-1 erg d e ie -
he a,&v -fi me n s her Bled- r iia.I krrtlk -) rel ► e&I - ice
-}-k& toi lI he hedu /ed -cDr d-- r ida1 Mvrhivt ; S - -oS.
.; „/( 1, /1 J / i 2 e 3
' Relk.e--- 510
' P14
'PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ ' LL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
i -� -6)
Inspector: P Date. Phone #: (503) 718-