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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2006 -00165 4 _�I W i DEVELOPMENT SERVICES DATE ISSUED: 4/3/2006 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 1S134CA -00720 SITE ADDRESS: 11460 SW 115TH AVE ZONING: R -4.5 SUBDIVISION: BURLWOOD NO.4 LOT : 018 JURISDICTION: TIG Project Description: (2) branch circuits for furnace and heat pump. Job No. 17074 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: 1 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: SAM & MOLL ARNOLD ENGELMAN ELECTRIC INC 11460 SW 115TH AVE POBOX451 TIGARD, OR 97223 HUBBARD, OR 97032 Phone: 503 - 521 -0689 Contact #: FAX 503 - 981 -4026 PRI 503 - 981 -8041 FEES Description Date Amount Reg #: ELE 24 - 46C LIC 94581 SUP 4739S Total 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 suspende• • •• • - than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules - set forth in • • • • 80 8010 through OAR 952 - 001 -0100. You may obtain copies of the ules or direct questions te.OUNC at 503 46 -6699 or 1 -800 -. -2 • • . _ Is- ed By: 0 - l / Permittee Signat r(/ OWNER INSTALLATION INSTALLATION ONLY The installation is being made gza._property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: < �� � — =riiJ"M 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. Mar 30 06 12:12p ENGELMAN ELECTRIC 5039814026 p.2 Elecitical Permit Application .. /F FOR OFFICE USE ONLY City of Tigard Received , e ) /- �'�� �� /- // ' Date /Bv: 4 ,, Of, P;t P ermi t No.: Ey... -lt04 p 66 (((/6— 13125 SW Hall Blvd., Tigard, OR 97223 MAR t% �. LU 77rr�� Plan Review Phone: 503.639.4171 Fay. 5035 . 98.1960 I _ ( , DaDate/By: Other Permit: Inspection Linc: 503.639.4175 e' I Date Ready /By: tu' See Page 2 for IInternet: www.ci.tigard.or.us - - , aARD Notitied/Method: /C4 ® . Supplemental Informat TYPE- 4F'- WORK (VISiON PLAN REVIEW ❑ New construction " Addition /alteration/replacement Please check all that apply: ❑ Demolition Other: ❑Service over 225 amps, comm'I ❑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 K I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi-family ❑ Master builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ©Egress/lighting RV park Job no.: Job site address: (�j I 1� ❑Health -care facility ❑Other: )0 �� ' ' "" �� I 1 Submit 2 sets of plans with any of the above. City /State /ZIP: () 7 �} 2 The above are not applicable to temporary construction scrvicc. Suite /bldg./apt. no.: Project name: IA �" / �! FEE* SCHEDULE e !I l („��1� 00..i.--; [ n Description j Qty. I Fee I Total_ I '' ' Cross street /directions to job site: s �) or4-1n I C, te 14. -- 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 / /, p A dwelling, service and/or feeder 90.90 2 I C (J L I - r () c ,.,�, 10 K j cuf y �/�o�-�✓ f1 Services or feeders installation, alteration, and/or relocation ( l r 4 hen qU /1 i 200 amps or less 80.30 2 ❑ PROPERTY OWNER J ❑ TENANT 201 amps to 400 amps 106.85 2 �! 401 amps to 600 amps 160.60 2 Name: Xit A'rr)r)jo 601 amps to 1,000 amps 240.60 a 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 Phone: (ZS S,, I , (�/ 1 ,, 25 1 I Fax: ( ) 200 amps (ZS) relocation 1[ or less 66.85 1 Owner installation: This installation is being made on property that 1 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 1 ❑ CONTACT PERSON A. Fcc 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, Address: first branch circuit , 46.85 (� �, �� 2 Each add'I branch circuit i 6.65 Lo (0� 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2 Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: - I man Ei 'eit (_, Address: h J _jam` J Each additional inspection over allowable in any of the abd id -r 1 Per inspection 62.50 t City /Stale /ZIP: ll boar a G '703 a Investigation per hour (1 hr min) 62.50 Phone: (,-1), l j / _ �j'�\ I /") Fax: ( Q 1 �3 �j/ — �/ _ Industrial plant per hour 73.75 t t 0 / ` 1 �( �I/l ELECTRICAL PERMIT FEES* CCB Li c.: 9` /� � � I . 4 rival Lic.:pg.. rv. Lic.: (,�.7 8Cl . Subtotal Suprv. Electrician signatu , p / equired: - , /41/0 Plan review (25% of fee) Print name: on riht n j e f 1 Date: 2/1 ,0/„ State surcharge (8% of permit fee) y /V 1 t JV t j/ TOTAL PERMIT FEE S7 ' Authorized sigtlatur8: 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.', Duitdina '\Pcnnitr.ELC- PcrnsitApp.dac 12iO3 440 -45 I5T(Itll02COMfWEI3 CITY OF TIGARD BUILDING DIVISION ' PERMIT #: 00!65 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 is �r- "�10NPBI��`�i�,l\ Inspection Requests (24 Hrs.): (503) 639 -4175 —.4..... INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: l / ( 6,o l r6 f4 P CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE t S Ag5/ — el )( 1 4 ( CONTRACTOR: (. ' PHONE #: Inspection Request Scheduled For: Date: `7 1 0 - 0 CO Pour Time: Code # Inspection Description Confirm # Contact # Message 01 k.,cif-te t "TiA.c.() Correctio - s /Instructions: S S ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: — / 0 ` 6 tm Phone #: (503) 718 - CITY OF TIGARD 1 tic� �� BUILDING DIVISION '" PERMIT #: qCa'906 DU! "- 13125 SW Hall Blvd., Tigard, OR 97223 - DATE ISSUED: Phone: (503) 639 -4171 4 ft r SO pl°x I � Inspection Requests (24 Hrs.): (503) 639 -4175 'L INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: 1 1 L/ &O 1 / J v ` CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE &5� 4 3Y i ( 04 / CONTRACTOR: L- v " i S PHONE #: Inspection Request Scheduled For: Date: 2 1 - 7 -0' Pour Time: Code # Inspection Description Confirm # Contact # Message )9? V1_42‘{ Corrections /Comments /Instructions: 1 1 / t /* . /._ _. I ,(I ' 4 L _II' 0" A !' 44 4l. i t_ 4 V 114.) + 04411./V PJ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS g FAIL ❑ LL FOR INSPECTION ❑ ADDIT ONAL FEES ASSESSED C' e Inspector: Date: Phone #: (503) 718 t (I°