Permit yA.) � O 8 4 e_ �� � l �
ELECTRICAL PERMIT
/Y
C TY TIGARD
PERMIT #: ELC2008 -00239
COMMUNITY DEVELOPMENT DATE ISSUED: 4/29/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133DD
SITE ADDRESS: 11945 SW 126TH PL ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT : 162 JURISDICTION: TIG
PROJECT: RAMSDEN
Project Description: Installing (3) 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: 2 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:
DEBBIE & DANA RAMSDEN STAHLBERG ELECTRIC INC
11945 SW 126TH PL 2435 DRYSDALE CT NE
TIGARD, OR 97223 KEIZER, OR 97303
Phone: 503 - 691 -6075 Contact #: PRI 503 - 393 - 1429
FAX 503 - 393 -5791
FEES
Description Date Amount Reg #: ELE 24 -47IC
[ELPRMT] ELC Permit 4/29/2008 $60.15 LIC 152486
[TAX] 12% State 4/29/2008 $7.22 SUP 4803S
Total $67.37 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
503.246.669Tor 1.B0Q.332.2
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Issued B �� I Permittee Signa 1 � ,q���
i
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: �J7' ` DATE:
f -
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 • FOR OFFICE USE ONLY
w . , _ City of Tigard • C�" ateiBy: " 7 c 4 /'} /
; �� Date /By: l V 1 �!/�—
Permit No.: �- ' rJ . �
n 13125 SW Hall Blvd., Tigard, O 73Z'3 ' g ,, iii ���
Date/By:
Review
Phone: 503.639.4171 Fax: 50 3 98 0� a Date/By. Other Permit:
T I G A R D Inspection Line: 503.639 B 9 `��Q Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard - or.gov PP S Notified/Method: Supplemental Information
TYPE OF WORK rw, � v (} � 0 � PLAN REVIEW
❑ New construction a Addition/altera i in�r 4h
41 Please check all that apply (submit 2 sets of plans w /items checked below):
�'IA`��: ❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: OP' where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
,g...1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: ( 9 Li S 5 0 3 , (2(0 -".• (_ 100HP or more. occupancy.
I ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7 �.� A-Z-D Q V.....E G. 1 C 7 2_2_3 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l ( 34" e4 i,/
, c ❑ Service or feeder 600 amps or more.
' I `�� n " / FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add') 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
p n RE-P/4---Z Limited energy, multi - family
3 t` , �' ,' - Lz / (�. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑- TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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
APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
- ' Business name: S - 2 (, GL - e CJ < Zit) L , B. Fee for branch circuits
Contact name: e__1, L I without service or feeder fee, 46.85 6. 2
LS J�4r-42- first branch circuit
Address: 24 �S b,, e_...--i. Each add'l branch circuit 2 6.65 / 3.30 2
Miscellaneous (service or feeder not included)
City/State /ZIP: / . Z. R 0P�CgO`J 9 7303 Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: (56.-13 ) e S7 - 2..L/ 86 e e( ( I Fax: : (5 03) 39 3 - s 7 1 / Reconnect only 66.85 2
E -mail: S T 1 4 - t v L - Z , 6 - m ( 5 - E L E . < T P S c R., Ct t - s - I - . ' - ' T Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
S �L63 Cp � {- / � ]� �UL Signal circuit(s) or limited -
Business name: /� G� F `L energy panel, alteration, or
Address: Z ' 3S p ?._`-?S .D ALE C___ /✓ extension. Describe: Page 2 2
City/State /ZIP: /fie ,rZ� - 0 RE 6,-(yo 7 3 a 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5o3) 3 2 3 - /' f Z ? I Fax: (503) 3 X73 S 7 9 / Investigation per hour (I hr min) 62.50
CCB Lie.: / g 6 Electrical Lie.: 24-- / , Suprv. Lie.: 4 4803 .- Industrial plant per hour 73.75
sI r :-
`_' t t t a ELECTRICAL PERMIT FEES
Suprv. Eke 1 . si gnature, required: 1 a Subtotal: (0 O , / S
Print name: ('a -" t 4 �s ( i
, s. t 4. �� Date: a 8 Plan review (25% of permit fee):
` State surcharge (12% of permit fee): - 7. 'ZZ
Authorized signature: TOTAL PERMIT FEE: 7 V 3 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00239
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4129/2008
Phone: (503) 639 -4171 41m�ay��'I�I(I
Inspection Requests (24 Hrs.): (503) 639 -4175 . -�__,
INSPECTION WORKSHEET FOR DATE: 5/16/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 11945 SW 126TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 4 LOT #: 162 TYPE OF USE:
PROJECT NAME: RAMSDEN
DESCRIPTION: Installing (3) branch circuits.
OWNER: RAMSDEN, DEBBIE & DANA PHONE #: 503 -G91 -6075
CONTRACTOR: STAHLBERG ELECTRIC INC �� PHONE #: 503 - 393 - 1429
Inspection Request Scheduled For: Date: 5/16/2008 Pour Time:
Cod- -- - -. -- - I - cri •tion -- onfirm # Contact # Message
199 Electrical final 070009-01 503- 851 -2486 \ Y
Corrections /Comments nstructions: N 0N
N
c
11PASS _ PARTIAL APPROVAL _ CANCEL n NO ACCESS
f] FAIL n CALL FOR INSPECTION I ( ADDITIONAL FEES ASSESSED
Inspector: -' 1•+66 Date: sit 01$ Phone #: (503) 718- /-� i
111