Permit CA Y OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00947
DEVELOPMENT SERVICES DATE ISSUED: 12/9/2005
‘k I I • ° �I' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S111 BA -04700
SITE ADDRESS: 14025 SW 97TH AVE ZONING: R -4.5
SUBDIVISION: OMEGA LOT : 003 JURISDICTION: TIG
Project Description: Reconnect only.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
THOMAS JOHNSON OWNER
16805 SW UPPER BOONES FERRY RD
DURHAM, OR 97224
Phone: 503 - 639 -9261 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 12/9/2005 $66.85
[TAX] 8% State Surcharge 12/9/2005 $5.35
Total $72.20 REQUIRED ITEMS AND REPORTS
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: j {'�� Permittee Signature: 5e,c,
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.
01 00 12:19p Q p.l
eCtriC 11 pe r rni# Applicatio E C E 0 ry D I c :+: c ∎1 1 It i I ...I C ) 11
City of Tigard nos '' j Pooh Km; -, / I i2 1
•
13125 SW Halt Blvd.. Tigard, OR 97223 DEC 0 . l 1 l Plan Rcviv r
Phone: 503.639.4171 Part: 503 Dada . Other peonit
Inspection Line 503.639.4175 . iI- ...L Ewe Raaay/8y: UM la Set Pagel kr
Internet: www- eitigrrd.or.us C ITY OF TIGARD N
9ppitassata) lalornrsiaa
-:: _ . . .'• 47l7i'P .OF 11:NG:D/VISTON.:....: - .. I: -. . Profit' tsfr::.. ' : +: -
'..
❑ New Construction 0 Addition/alteratian/replacemem — Place chedr all that apply:
0 Demolition thcr. ce over 225 amps, conmr' Hazards location
G . " Savi over 320 amps - rating 011ialleh g over 10000 L,
OServt r9-
'? TE[;a01 11( OR .; `` :' . -..... . _ _ of 1 - and 2- family dwellings 4 or more new residential
- and 2 family dwelling 0 Commercial/industrial ❑ Accessory built IDSystcrn over 600 volts nominal units in one structure
❑ Multi- faal;ly ❑ Master builder ❑naiWingover dime stories DFeedas,400 amps ormore
"`. }:74>! &:$F1PIt :i Mast r b DOcomPant load ovcr 99 persons OManafneaaed revcturas or
r: .,i , : ':•'! 'ION: 14.10CATION- - -. ::' '•..:.. ; :.;'. '. •. ; RV
�Egcss<Iigtrtirtg plan park
Job no.: I Job site address: t4 ZS SLti . q 115 . OHeelth.rare Malty 1:10thet
-
Submit ,a, cuts of plans with any of the above.
City /Stare/Z1P: n r D1 • q17-7--14 The above are not applicable to temporary 000struetion service.
Suiaelbldghlpt. no.: I Project name: ! ' : .�
1Z1 v t
e et/direGtiotns to job site: tan '1,�r T7() A New residential single- or md*i -f iatdy dwelling J
Cross street/directions
.mil- /trrt,.� 1 , " `.� L1� 1 D � 1�. as leaere'tL
ak ZN1 D 4111: 7�i 01� L ' 1 0 so. attached less gs�c.
1.000 sq. S or lea 143 -15 4
Subdivision: L et n o . : Ea. add'I 500sq. it or portion 33.40 1
- Limited comfy, residential 75.00 2
Tax map /parcel no.: Limited ,
� s • :. cusp, autiesldmLal 75.00 2
.. D Al1T 111bi1TC .. Sbcb manufactured or modular
_ dwelling, service endfor feeder 90.90 2
Serrkt, or feeders instwsatioa, alteratro n, and/or relocatio
200 amps or less I 8030 2
f `rs ? _• •: •.,.: 1 : :: : a � ; _ • • . .201 amps to 400 amps 106.85 2
~ 401 amps to 600 amps 160.60 2
Name: `� � JO{ N SC N 601 amps to 1,0P0 amps 240.60 2
Address: 1,g05 �, . 'I , , , �• t 1 41470g-130o e • - Over 1.000 amps or volts 454.65 2
City Recoa„ect only 1 /�� " _ '''' 66.85 2
Ci 1State/ZIP: `��'Q '11� J �� • �� 174 T empararyaervicesorfeedea s ®,and/or relocadoe
Phone 5 D 7 ---12b1 I NM (t7 1)3 t - 6 zoo amps or less _ 66.85 1 -
Owner installation: This installation is bei g made on property that I own which is not 201 amps w 400 saps 100.30 2
intended for sale, Ieasts t, or exchange : • •.• .' g to ORS 447, 449, 670. and 701.
401 rumps to 600 amps 133.75 2
Owner signature _,.. . /_/ Data: 1.2 - 9 - pc Breach ratuits - new, alteration, or extension, per panel
'- '-. :: ':C3:• •4 it dal1V:: -• - A . Foe for brmdt citcvio with -
(] a901uTAC1F i'�i9t1[V': . service or Ices der tae, each •
Business name: branch cboait 6.65 , 2
' B. Fee for branch circuits
Contact tame without service a fader foe, 46.85 2
.Address: branch circuit •
Each add': branch circuit 6.65 _ 2
City/StaseJZIP: - -- - - - - M'sseltaneoaa (service or feeder not include* - - . -
Phone: ( ) I Fax:: ( ) Pump or irrigation circle , 5140 2
Sign or ocd'ote Betting 53.40 2
E-mail: Sig>ai eircuil(s) or limited- .
•'t," . .. ',; 51 -•'.,:- :<::. , `CO2frKACrOR: .. ' .. : ":" . .'' -r energy paid, alteration, or
extension. Describe; Page 2 . 2
Business name: .
•
Address: Each .ddIdaaaI aiper6na over alloaabk i. .iiy of the above •
Per inspectioss 62.50
City /State/ZIP: investigation per hour (1 beaois) ! 62.30
Phone: ( ) I F ax: ( ) Industrial plant per how 73.75
•
cCn Lies: I Electrical Lie-: I Suprv, Lie.: Subtotal vi,,$ 5 •
Suprv. Electrician signature, :Inquired: Plan review (25%orperrair tee) 5 ,3�
Pr Date; State surchar (8%ofp fcc)
Si TOTAL PERMIT PEE 1 Sop
Authaired 'IL's permit appiitatioe expires it ■ permit la oat .:steed aitt,h 188
dada .nv it ens beep a ccpted we complete
Print rtaRle:
I Date: • Far merbodototy to by Ti .Cn.aay Bislang Wintry Service Board -
•• Nuaber or im:Kaioas per patron ileums .
1: nA.aeneF..a.ievn.cae,airayn.4cc tze, 450 MISTUelineLOMIW® •
CITY OF TIGARD ,�
BUILDING DIVISION PERMIT #: ELC2005-00947
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/9/2005
Phone: (503) 639 -4171 :colt
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/12/2005 TIME: 7 :02AM PAGE: 42
SITE ADDRESS: 14025 SW 97TH AVE CLASS OF WORK:
SUBDIVISION: OMEGA LOT #: 003 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: Reconnect. only.
OWNER: JOHNSON, THOMAS P NE #: 503-639-9261
CONTRACTOR: OWNER PHO
clis
Inspection Request Scheduled For: Date: 12/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 023283-01 503 -639 -9261 N
Corrections /Comments /Instructions:
N t.Y6. ‘A)ozsiffe'.`.-
N O IN. cA -�
PASS I ( PARTIAL APPROVAL ❑ CANCEL �1 0 ACCESS
t'ar FAIL ► 4 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r Date: Ili V (36-- Phone #: (503) 718- 1-44L
•
CITY OF TIGARD
•
BUILDING DIVISION PERMIT #: F1.C2005 -00947
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12,9/20(3 ='r
Phone: (503) 639 -4171 aNypivll�i�l,
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 12/27/2005 TIME: 7;03AM PAGE: 36
t> M4( zj
SITE ADDRESS: 14025 SW 97TH AVE CLASS OF WORK:
SUBDIVISION: OMEGA LOT #: 003 TYPE OF USE:
PROJECT NAME: JOHNSON
DESCRIPTION: Reconnect only.
OWNER: JOHNSON, THOMAS PHONE #: 503- .639.9261
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12127/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 El ectrical service 024025.01 503. 633.9261 Y
. "n/ /Z,
Corrections /Comments /Instructions: q
I \1•NIA161 V tST74 -\ 0 ilk
• saw N - r -f . 4 nr - 1E"
e5 Al
- SS • ' • TIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
l FAIL • ' AL c - INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: / — ■_ /Z hone #: (503) 718-