Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00896
-�� II . DEVELOPMENT
Tigard, 97
SERVICES 22 503- 639 -4171 3 DATE ISSUED: 11/15/2005
13125 SW Blvd., PARCEL: 25111 BD - 00407
SITE ADDRESS: 14940 SW 96TH AVE ZONING: R - 3.5
SUBDIVISION: DARMEL NO. 3 LOT : 017 JURISDICTION: TIG
Project Description: Kitchen remodel, (4) 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: 3 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:
POEHLER, EDWARD CARL ROBERTS ELECTRIC INC
MYRTLE J 5759 SW48TH AVE
14940 SW 96TH AVE PORTLAND, OR 97221
TIGARD, OR 97223
Phone: Phone: 503 - 244 - 7754
FEES Reg #: SUP 3886S
LIC 9388
Description Date Amount ELE - 34 - 23C
[ELPRMT] ELC Permit 11/15/200' $66.80
[TAX] 8% State Surcharge 11/15/200' $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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: Permittee Signature:
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.
•
F' �tr>ICaI Permit Application 1;oli USE ONLY
City of Tigard l C QVEC� Received . - /j - U) 61 7.--- P Permit No.:� - � � p A,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 1 U' ! N. ,- l' Date/B . Other Permit:
F
Inspection Line: 503.639.4175 ILI t ` I • "iit .F� 20U, GA-- - t' ® . Date Ready/By: See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
1 O � r F 1 ' r W OR I ID - - PLAN REVIEW ` _
r e ' " � Please check all that apply:
® Addition /alter
❑ New construction on/r�plecement PP Y:
El Demolition ❑ Other: ['Service over 225 amps, com'l Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
• ' ,' : " - - CATEGORY ;OF- CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
® 1- and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family El Master builder ❑Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
_ - • .10,B, SITE ',INFORMATION 'AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: -9- ❑Health -care facility ['Other: 7 e y D ' - w - C to Submit 2 sets of plans with any of the above.
City/ State/ZIP: i ._ The above are not applicable to temporary construction service.
0 FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty. 1 Fee. I Total
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.: Limited energy, non - residential 75.00 2
DESCRIPTION OF• WORK Each manufactured or modular
K-±d-R-..-, dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 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: ( ) 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
❑ APPLICANT ❑ CONTACT PERSON - A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: — - - - - - -- - - -- - branch- circuit -
Contact name: B Fee for branch circuits
without service or feeder fee,
Address: each branch circuit ( 46.85 �( 2
Each add'I branch circuit 3 6.65 19 9.( 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax::( )
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
_ ,, - - - ` ` ' - c'' :CONTKACTOR. " - - - ' energy panel, alteration, or
extension. Describe: Page 2 2
Business name: $ a1 Trzi_C, ,A) C
Address: t! Each additional inspection over allowable in any of the above
�7s S- w �Q Per inspection 62.50 _
City/ State/ZIP: Pc L 02 1 72-2- / Investigation per hour (1 hr min) 62.50
Phone: ( 3 a c[ t„( 725 U Fax: (c a,..(.{ -()S(ocj Industrial plant per hour 73.75
:ELECTRICAL= PERMIT - FEES * :: " . ,
CCB Lic.: I 3 ' Electrical Lic.: 34-2_3 C Suprv. Lic.: Sig 4, S Subtotal (.(
Suprv. Electrician signature, required: iiidi i „. ,,,`� Plan review (25% of permit fee) (24 i Sz i el• Date: State surcharge (8% of permit fee) ,1"--,31/ Print name:
w Ou-i4 / � I f / `' 7� Y
TOTAL PERMIT F I /
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
" Number of inspections per permit allowed.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 4404615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard s + `s,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
P RESIDENTIAL•WORI(,ONLy: ' '
Fee for all residential systems combined .. $75.00
Check Type of Wo , Involved:
❑ Audio and Stereo ystems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air C • . ditioning
System *
❑ Vacuum Systems*
❑ Other:
L,t 7 - ERCIAL WORK ONLY:
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
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape fighting*
❑ Protective Sign.. mg •
❑ Other
Total nuumm •r of commercial systems:
*No lice es are required. Licenses are required
q u d L nses a e eq u
for• other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
t .
CITY OF TIGARD E.ec..,.
BUILDING DIVISION PERMIT #;0?Gif2.5 °-60,5 -q
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 A a 4�uypi� I
Inspection Requests (24 Hrs.): (503) 639 -4175 —.1.11
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: / ! 7 t 6 , t ij / CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: ' PHONE #:
Inspection Request Scheduled For: Date: d /a Pour Time:
Code # Inspection Description Confirm # Contact # Message
\ - 7/80
).7.7 \
Corrections /Comments/ Instruction'
7/4 c C
fi
• i,
,,
,PASS n PARTIAL APPROVAL ❑ CANCEL Li NO ACCESS
FAIL I I LL FOR INSPEC ION ❑ ADDITIONAL FEES ASSESSED
Inspector: __I; , /�' Date: J " * 06 Phone #: (503) 718- P7
CITY OF TIGARD
BUILDING DIVISION � PERMIT #: et-C.2 06 C
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 al
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: (' 7 5Ev CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Peng k
Code # Inspection Description Confirm # Contact # Message
120
Corrections /Comments /Instructions: ( /
- Ask, LdfLet) /11-0
c AAAT__@ g30
Z4 PASS n PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: L bt' Phone #: (503) 718 - e