Permit 5 ,. CITY OF TIGARD • ELECTRICAL PERMIT
PERMIT #: ELC2006 -00007
a�i� DEVELOPMENT SERVICES DATE ISSUED: 1/6/2006
�-`-` 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2 S 104 D D - 09400
SITE ADDRESS: 13515 SW 129TH AVE ZONING: R - 4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 3 LOT : 052 JURISDICTION: TIG
Project Description: (1) branch circuit for a/c unit. (Replaces expired permit ELC2004 00562)
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: 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:
LINDA YORESEN EVERGREEN ELECTRICAL CONTRACTOR
13515 SW 129TH PO BOX 1212
TIGARD, OR 97223 SANDY, OR 97055
Phone: 503 - 579 -5053 Contact #: PRI 503 - 668 -4608
FAX 503 - 668 -0308
FEES
Description Date Amount Reg #: LIC 136311
[ELPRMT] ELC Permit 1/6/2006 $46.85 ELE 3-472C
[TAX] 8% State Surcharge 1/6/2006 $3.75 SUP 4581S
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 a re orth in • • R 95 -001 -0010 through OAR 952 - 001 -0100. You may obtain copies of thes es or direct questions to &UNC at
503 -246 699 or 1 -800 - - 4.
Issue By: Permittee Signatur_ .
--
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: 401111 " ' . A%% / /0" DATE: / If '
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.
Jan 05 06 02:05p Evergreen Electric 503-668-0308 p.1
Etectrigealsokrin ' llVED • - - , ,. , , _.,
it.
' City of Tigard A Received
P-iiNc-
13125 SW Hall Blvd., Tigard, OR 97223 i .. ) 3 Pion Review
Phone: 503_639.4171 Fax: 503.598.1960' " ' '' '-' 2006 - ..- - Dnepr Otbo- Permit:
Inspection Line: CIT
503.639.4175 .. , ‘ ,....14,4,' •1 1 -
• •• I ill See Page 2 ilwr
Intranet www.citiganicrus Y OF TIGARD- --- "RtadY114: : ( Uor. I Supplemental Infermatien
R1111
- ..-± '- . - -..',. ':'..:.• ''''' :: '' :I.:: ''.' ....r..'• ., 1 .:•.-., .•:::***Olit'7.~'„Yft:. . . ..'..-.-..-".' '...,: .-... , ,'....?-''',.:-.., : T .,......• .: ......-:,.;,:'; ,*' :... - !::.......... OtiiiitilEVIllat ...:::.:. • • 1 ..::: ..' , - ..•-
. . . . . .. . . . . , .
CI New construction ll Addition/alteration/replacement 1Please check all that apply:
Oth
El
OService over 225 amps, canto' i 011azardous lot:maim
Demolition DI er
['Service over 320 amps -rating 0Builthig over 10,000 sq. ft,
4 or more new residential
pt 1- and 2-fainiiy dwelling 0 Commercial/industrial 0 Accessory building ElSystem over 600 volts nominal Gaits in one structure
ClBerilding over three stories 0 Feeders, 400 amps of more
Multi family El Master builder 0 Otber: '
‘ . Cloecuppirt load ova no p aso n s 0114anufuenned sawyers Or
* *****:04 41 * :: .'-.:.:.:..'-.' .::::: -. ClEgremilighting plan RV park
l facility :Ohm
lob no.: I Job site address: 13_5;5 5 ' 01-eidth-care
i ‘ D...9 Di- A-
Submit 2 sets of plans with any of 'he above-
City/State/ZIP: 7 &.1-.8.. 0 `-'1-1 The above &coot applicable to tanporary construction service.
:-.:. :.::.: '..: ....-- • .. --....' ::::'..".. illitailirSINU'; '. ..- -.•:: ...' -.: '...-.. '''... -
Suite/bldg./apt no.: 1 Project name:
powwow 1 00 1 Fet- f Te t e i r..
Cross street/directions to job site: New residential single- or mild-family dwelling malt.
laciades attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 1 Lot no.: Ea. add'I 500 sq. IL or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
non-nsidential 75.00 2
' '''.-1 ''', '''...'..:',...:':: - • • * ' manufactured or modular
dwelling service and/or feeder 90.90 2
:SRC air r- ' V .111 GI-C. )41)
•
- kb - 0.0 Services ar feeders installation, alteration, amine relocation
4/( ark IA- 200 amps or less 80.30 2
106.85 2
160.60 2
Name: k3ki '
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 nstaihstion, alteration, and/or
relocation ,
Phone: ( ) i Fax: ( ) -
200 amps or less 66.85 I i
Owner installation: This installation is being made on property that I own which is not 201 am k, op 100.30 . 2
intended for sale, lease, lent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 ' 2
Owner signature: Date: Branch draft- new, alteration, or extension, per panel
'''' '', ;,...'.:' .• ....:::.....,....-: crotiropot-::-:.!:.: A. Fee for bona circuits with
SCIVI4X or feeder fee, each
6.65 ' 2
Business name: branch circuit
B. Fee for branch arcuits
Contact name:
without service or feeder fee,
1 46.85 L bE, 2
each branch circuit
Address:
' Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneoes (service or feeder not Warded)
Pump or irrigation circle 53.40 2
. Phone: ( ) I Fax: ax... )
Sign or outline lighting 53.40 ' 2
E-mail:
Signal crenit(s)or limited-
- .....' 1 ''' ..:- • l '": .-..-• ' ... • ' ''. , - ..: 7: :i ,- :::: - .1r.)00040Apitot '. -:i :::'-:.';',.-, .:_:, ..-:; .,:[::-.. :...:-..: ::.. - -.... --, .7. erwl8Y Panel, Alteration, or
extension. Describe: Page 2 2
Business name: Ei Fi ci-
Address: --- P0 _, \ ,D..1 D, Emir additional inspeetiou over allowable in any of the above
Per inspection 1 62.50
City/State/ZIP: --- - cAnat C I — 1 D5>5 Investigation per hoar (i term* 62.50
icibrale:: ) /. 8 -L-4S Fax:EC.6 (.49(..A' s- C)- , in, . distrial, - .. . •.. , Per ha& ' 73.75 .
. .. . - . ....- :::. , '''• . --Mei '..' '..• -. ‘..-: - .• ::'''''
CCB Lic.: I Electrical Lic.. -- p :frv: 1 S .
Subtotal L AP 15
Suprv. Electrician signature requar _7:14 Man review (25% of pernti( fee)
Print name: ( b c.. T r
_
1 Date: 1.._ 5" --0,5- State surcharge (8% of vomit feel 3 .'75
TOTAL PERMIlf IFEE * 5i .�D
Authorized si .... , : N 1 _.—
, --- nib permit appikatko expires if a permit I root obtairod widths Me
. days raer it Ms bees secenebi es ever**
Print name: liv i ii A a s ,,,. .. Date: 1_ .-05 L N Foe o tsedue l lojogy set by %tag industry service Board
jARsildisskrossits\OLC-PensitApp.oee . . 440-4615TOMLOCOMWEB
. ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: FL.C2006-00007
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/612006
Phone: (503) 639-4171 40 401 i
Inspection Requests (24 Hrs.): (503) 639-4175 ,...,-4 1L
INSPECTION WORKSHEET FOR DATE: 1120/2005 TIME: 7:00AM PAGE: 213
SITE ADDRESS: 13616 SW 129TH AVE CLASS OF WORK:
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 3 LOT #: 062 TYPE OF USE:
PROJECT NAME: YORESEN
DESCRIPTION: (1) branch circuit, for ale unit. (Replaces expired peal* ELC2004-00662)
OWNER: YORESEN, LINDA PHONE #: 603-3579.5053
CONTRACTOR: EVERGREEN ELECTRICAL CONTRACTOR PHONE #: 503-660-4600
Inspection Request Scheduled For: Date: 1/20/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199\1 Electrical final 026375-01 503-668-4500 y
Corrections/Comments/Instructions:
C ( .
,
• .
)PASS 111 PARTIAL APPROVAL D CANCEL 0 NO ACCESS
FAIL D CALL FOR INSPECTION / 0 ADDITIONAL FEES ASSESSED
i
Inspettor: A .,,, ._ .. Date:_62d ' g Phone #: (503) 718- -2 5
L