Permit N 9 l• CITY CIT OF TIGARD ELECTRICAL PERMIT
_ #: ELC2008 -00300
' COMMUNITY DEVELOPMENT DATE ISSUED: 5/28/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110A B -06200
SITE ADDRESS: 14340 SW 114TH AVE ZONING: R -4.5
SUBDIVISION: HELLER PARTITION /MLP2003 -00007 LOT : 002 JURISDICTION: TIG
PROJECT: ROBERTS
Project Description: Adding (2) branch circuits and modifying (4) branch circuits for remodel.
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: SIGNAUPANEL:
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 FOR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 5 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:
JOHN ROBERTS KELVIN ELECTRICAL SERVICES INC
14340 SW 114TH AVE 5711 SE VISTA CT
TIGARD, OR 97224 MILWAUKIE, OR 97267
Phone: 503 - 504 -1037 Contact #: PRI 503 - 201 -5095
FEES
Description Date Amount Reg #: ELE C54
[ELPRMT] ELC Permit 5/28/2008 $80.10 LIC 163520
[TAX] 12% State Surchar 5/28/2008 $9.61 SUP 3142S
Total $89.71 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 OUNC at 503.246p or 1.800.332.2344.
Issued By- � ��',
' _ Permittee Signat d"
' 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.
Electrical Permit Application �y FO O ONLY ° ' - -
y' City of T igard � oate/B : t� L .-- _
iiIii - e 13125 SW Hall Blvd., Tigard, OR r! '1 Plan Review
Phone: 503.639.4171 Fax: 503.- 960 �O Date/By: Other Permit:
I+ a `
T f G A RD Inspection Line: 503.639 D D Date Ready/By: ® See Page 2 for
P Q Supplemental Information
° °
Internet: www.tigard- or.gov - TYPE OF'W M �`- Notified/Method:
V nO � , 7 . .:. ,.. . PLAN. REVIEW ,
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Addition /alter ce ment
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards.
m CATEGORY Of . _. . ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
'� 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Multi- family El Master builder El Other:
❑Fire pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
' '..—JOB SITE INFORMATION AND LOCATION: _ ` ,. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
Job no.: I re, Job site address: / y 3 C S / 4"-- ' or more. occupancy.
?i ❑ Six Six or or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 77,,..r....0- / f" r , _ ❑ Health -care facilities. ❑ Supply voltage for more than
� ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: & ❑ Service or feeder 600 amps or more.
. FEE =SCHEDULE;. , '•
Cross street/directions to job site: ��a,, ,ee Description l Qty I Fee. I Total ; - I t ' •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: - Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF "WORK . ` ' (with above sq. ft.)
1 /, Limited energy, multi - family 75.00 2
6 r atie� (if tv G� /T S f�1ti8P ! . residential (with above sq. ft.)
l,� // � J Services or feeders installation, alteration, and/or relocation
( � vGu /' S ' re C �/ 200 amps or less 80.30 2
., „.. _M 1R:1.—PROPERTY OWNER ' ._ ` El , 201 amps to 400 amps 106.85 2
Name: - (S 0 J 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: /c3 y S1.) '1/ Y' Over 1,000 amps or volts 454.65 2
City/State /ZIP: 7-(7A-r-., - 9 7 d Temporary services or feeders installation, alteration, and /or
relocation •
Phone: (5 33) ,5 t _ f 2 3 / 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
- pr APPLICANT • ., ' - CCONTACT PERSON • above service or feeder fee, 6.65 2
T z ((^^
each branch circuit
Business name:
�e %' /� �/� /”' G6t. -/ VEs',, [ E'S ‘ 2, - ,, c , B. Fee for branch circuits �
Contact name: without service or feeder fee, / 46.85 T " 2
L-t�` e- �Ye�1e� first branch circuit
Address: 9' /( S 1//6 Each add'l branch circuit 6.65 33
Miscellaneous (service or feeder not included)
City/State /ZIP: /'�, j / � / e, �'_ 9 7 0 2 a? /76,5 Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (j )3 ) 0L0 / _ 6-0 ci Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
. . ' '-- CONTRACTOR"; - A . - Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
�G�, e. C e-,S ,� J/ e �-�T K00;4 energy panel, alteration, or
Address: / extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.:635 Electrical Lie.: C Suprv. Lie.: 3 / S Industrial plant per hour 73.75
/� /� I! l� / r. x ELECTRICAL: PERMIT FEES' ` •
Suprv. Elect a gn ture, required: s� s,� , 2°/t All Subtotal: 30 . (0
Plan review (25% of permit fee):
Print name: iy,o / ,, .,,,4 a Date: 5-�.� .f/6
� y ^^ �� 1 State surcharge (12% of permit fee): 2' 6 /
Authorized signatur ^� , . % TOTAL PERMIT FEE: a 9 , 7 /
/ This permit application expires if a permit is not obtained within 180
Print name: � �� �- Date: 5-7,;).6,-/c,/, days after it has been accepted as complete.
• Number of inspections allowed per permit.
i.\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(I l /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2,- Supplemental Information
LIMITED ENERGY PERMIT FEES:
(' RE'SIDENTIAL,WORK.ONLY: Wiz;° = 17
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
O Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
O Other:
? COMMERCIAL;WORK.ONLY ' `:'
•
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
O Audio and Stereo Systems
O Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
• Fire Alarm Installation
El HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
E l Landscape Irrigation Control*
❑ Medical
n Nurse Calls
n Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required.. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD '
BUILDING DIVISION - PERMIT #: ELC2008-00300
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5i2a
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 A- 11.
INSPECTION WORKSHEET FOR DATE: 6/1012008 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 14340 SIN 114TH AVE CLASS OF WORK:
SUBDIVISION: HELLER PARTITION/ML.P2003 LOT #: 002 TYPE OF USE:
PROJECT NAME: ROBERTS
DESCRIPTION: Adding (2) branch circuits and modifying (4) branch circuits for remodel.
OWNER: ROBERTS, JOHN PHONE #: 503-504-1037
C ONTRACTOR: KELVIN ELECTRICAL SERVICES INC PHONE #: 503-201-5095
Inspection Request Scheduled For: Date: 6/10/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 071122-01 603-201-5095
Corrections/Comments/Instructions:
f PASS PARTIAL APPROVAL CANCEL fl NO ACCESS
FAIL H CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: C.7 Date: ti Ot Phone #: (503) 718- Itfig
CITY OF TIGARD ,
BOLDING DIVISION .. 7,:,. PERMIT #: ELC2008•00300
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/28/2008
Phone: (503) 639-4171 iawilipot
Inspection Requests (24 Hrs.): (503) 639-4175 A. - - 1 1 .
INSPECTION WORKSHEET FOR DATE: 6/20/2008 TIME: 7:02AM PAGE: 21
SITE ADDRESS: 14340 SW 114TH AVE CLASS OF WORK:
SUBDIVISION: HELLER PARTITIONJMLP2003 LOT #: 002 TYPE OF USE:
PROJECT NAME: ROBERTS
DESCRIPTION: Adding (2) branch circuits and modifying (4) branch circuits for remodel.
OWNER: ROBERTS, JOHN PHONE #: 503-504-1037
CONTRACTOR: KELVIN ELECTRICAL SERVICES INC PHONE #: 503-201-5095
Inspection Request Scheduled For: Date: 6120/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
• - 199 Electrical final 0716 2-01 r 201-509 • N
Corrections/Comments/Instructions:
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FAIL r tA . ,,,.,- 1SP TION - b l Cr . ' ' L FEE SSESSED
Inspector: /.' La...
/ Date. Phone #: (503) 7 •11?"
. .