Permit 71 CITY OF TLGAR® ELECTRICAL PERMIT
PERMIT #: ELC2007 -00371
COMMUNITY DEVELOPMENT DATE ISSUED: 6/1/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S111DB-02000
SITE ADDRESS: 15555 SW ALDERBROOK CIR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.8 LOT : 479 JURISDICTION: TIG
PROJECT: MATHISEN
Project Description: Change panel, install ground rods.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
MATHISEN, CHARLES A + BETTY I WINNER ELECTRIC INC
15555 SW ALDERBROOK CIRCLE 5950 SW PROSPERITY PK
TIGARD, OR 97224 TUALATIN, OR 97062
Phone: Contact #: PRI 503 - 638 -5028
FAX 503 - 638 -4242
FEES
Description Date Amount Reg #: ELE 34 - 150C
[ELPRMT] ELC Permit 6/1/2007 $80.30 LIC 14794
[TAX] 8% State Surcharge 6/1/2007 $6.42 SUP 2825S
Total $86.72 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 503.246.6699 or 1.800.332.2344.
Issued : . / . i Permittee Signature: /1- I i co lion
( 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.
u.sizufkuu4 09:38 FAX 50 3 5 : i •
1-'z- ;Me VED
CITY OF TIGARD 2 0 0 1
Electrical Permit Application FOR OFFICE USE °NIA' • ri
City of Tigard rr ''' ' L 1 100 ' Received
DucIS : • I lb 1... Permit Nu.: EL ,... oil ow t
13125 SW Hall Blvd., Tigard, OR 97223 C I i V I OF ki 1 .,,,,„ , .,,, ..A Plan Review -
Phone: 503.639A171 Fax 503_598.19 i'.'-rOXIIA- Date/B ! Other Permit:
Inspection Line: 503.639.4175 6%9U /G 1 1.01
..,G Div--- , 7...m.. Date Redy/By:
Internet: www.ci.tigard.or.us - - - - , n Notinewmetheat Mill rup r 0 rm el 0 n
!!! ' ''. : ii/'; ' :I' '' i:i . i:' !,■...H.:111141I!:!'''',.nViiilltkititsii:**V.::!I.I ''': ' „'i.''i ill' I ' ' :- ' '' '''' .. I I ' ' ' ' ' ' ' '::'.1 ::'' 7. - ' '''' • '''' : : I PLAIli : AkVit* I fli Ili H ... . '.' : ' • . • ' . '
lij New construction 8 Addition/alteration/replacement Please check all that apply:
l rim - l ` On
,_,..azar-ous ,Ooat.
D Demolition U Other: DService over 225 amps, comm
I:Service over 320 amps - rating UBuildng over 10000 sq, ft.,
, : : . :1I1111 ;l i fpgm .1 ! :!:: H :ii...0 !!; 171i! l.': 1: :: 0000 0.iTli:Olv,i:IgOiNt§t 1 4 . #T.e.* , ..:.::'''.iiiii , ::;::! , i': . :.::! . .1:iNiQ of 1- and 2-family dwellings 4 or more new residential
1- and 2-family dwelling 0 Commercial/industrial 12 Accessory building
Multi D Master builder 0 Other: DSystem over 600 volts nominal units in onc structure
['Building over three stories I:Feeders, 400 amps or more
Occupant load over 99 persons EManufacturcd structures or
• ''..." '.... ' ''" rtfIbi ' .thOdi6ii** 7• 111 . 0: 1 1176 , !ItiJik e vioir . : , ....P.r.r:LII.,:r.:' . :.,.
ill!.11•1;11'1 .,..,• . • ;..., ....... . . ..' ...w.1 •. • . •• :!•::•!-:'.',*!!'. - DEgress/lighting Plan RV park
00ther:
Job no.: 1 Job site address: / 5 55
-5 w A jj b ecoic 0 4 care lth- facility
' ubmit 2 sets of plans with any of the above.
City/Statc/ZIP: 771-barti) The above are not applicable to temporary construction service,
- ill.i i.il:1;:i ili,y . • :. pilynEt .: .. ; •...i.,.. ,.
Suite/bldg./apt. no.: Project name: 7
Description I Qry. i Fre. T . Total I .•
Cross street/directions to job site: O fy , ue.4#14 R N ew r tt esideutia h l .d g
single- or multi-family dwelling unit.
I ncludes
1,000 sq. ft. or less 145.15 4
Subdivision:
Lot no.: Ea. add'1 500 sq. ft. or portion 33.40 1
- Limited energy, residential 75.00 2
Tax map/parcel no.: .
, Limited energy, non-residential 75.00 2
!fl:.!•i:.';':.:iii:ji!ifl!!!.r[ill,!•14,1#,T0,;;!.00,,:*.Plikli!!!11:1;1!.;.!...:"!!: . 1„.:IP.IIC I ' ':'' .. Each manufactured or modular
dwellin:, service and/or feeder 90.90 2
e it A ni--r_ PApre_C
Services or feeders installation. alteration, and/or relocation
- _
ral . 90
a k C,-2. ' c B „ 1 c f G its •kk 200 amps or less 80.30 ,3,) 2
2i;; ,..; ,., .., • iir".•:r <-,,■,.,. ,..,, . • i .. ,• •• , .1 • •', i';!' Nw.ri , ;:.. ..: ••,. • .. ,.i•;..,,,,;•; 201 amps to 400 amps 106.85 2
1•::!•!f 18 : 1 :'Pig,9Fg.r.q . . 1 t , ,! 4 !!..' • g4 ii::!,,i..i.,! .,,,■IrlilgliTIH:.1.111!0.,/..C7117-NtNT, . , • . : ii1 1:1 4c - F; - , - , ps T. , Go o amps EMI 160.60 2
--
Name:
• • 601 amps to 1,000 amps IIIIII 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 66.95 1 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 ex per panel
tjrAii; , ■:. A. Fee . for branch circuits with
service or tccder tee, each
6.65 2
Business name: "ezt-INWIWZgwt-A__. branch circuit
B. Fee for branch circuits
Contact name: ,
without service or feeder fee,
46.85 2
each branch circuit
Address:
_ Each addl branch circuit 6.65 2
City/State/ZIP:
Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53,40 2
?hone: ( ) Fax: : ( )
_ Sign or outline lighting I 3,40 I 2
1 E-mail:
Signal circuit(s) or limited-
i lill'!:::ii:.1',:!•: :: ill.! i!" : .:•: '... :.: :.i !ObN ;;:l.1,:.,:li .:• • .. '...: H:a :;;:!'::.:.;::: . '. .1:,'. 'tn panel ; alteration or
Page 2 -
Business name: ttliAA e L
Each additional inspection over allowable in any of the above
Per inspection 62.50 I
h-
City/State/ZIP: T 41 4- .0,4- - .- Investigation per hour (1 hr min) 62.50 • i
Phone: (5113 ) 3g s ze Fax: (533 ) 638 4) . Indust plant per hour 73.75
' I
•
i'.; '
CCB Lie.: R./.793 Electrical Lic.:s/66.4c Suprv. Lie.: d8 6 „.
Subtotal I 20, 3O
(.3 b
Suprv. Electrician salacule, raquired: aNA- Oth Plan review (25% of permit fee)
State surcharge (8% of permit fee) 6-4/).
Print name: d ti‘ A D ate: 5_ 3/ 7
TOTAL PERMIT FEE y c 7
Authorized signature: pA ib
Thiel permit application expires if a permit is not (a) toined within 180
days after it has been accepted as complete
Print name: Ize..,pt VA 1/4/1 Date: 5 6 .7 • Fee methodology set by Tri.County Building Industry Service Board
'‚ Number or ingnentinnc nor nArrelil t.11.....11
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00371
13125 SW Hall Blvd., Tigard, OR 97223 ISSUED: 6/1/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 J .. `__..
INSPECTION WORKSHEET FOR DATE: 6/21/2007 TIME: 7:03AM PAGE: 100
SITE ADDRESS: 15555 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.6 LOT #: 479 TYPE OF USE:
PROJECT NAME: MATHISEN
DESCRIPTION: Change panel, install ground rods.
OWNER: MATHISEN, CHARLES A + BETTY I, PHONE #:
CONTRACTOR: WNNER ELECTRIC INC PHONE #: 503 -638 -502B
Inspection Request Scheduled For: Date: 6/21/2007 Pour Time:
Code # Inspection Description V Confirm # Contact # Message
199 Electrical final 050599-01 503- 636 -55026 N
Corrections/Comments/Instructions:
(1 .
V PASS U PARTIAL APPROVAL n CANCEL NO ACCESS
FAIL I I CALL ,.R INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: F 1 Date: t 1 (cy
Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00371
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/1/2007
Phone: (503) 639 -4171 10091" � +� P'6
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'! FILL
INSPECTION WORKSHEET FOR DATE: 6/5/2007 TIME: 7:01AM PAGE: 91
SITE ADDRESS: 15555 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: :479 TYPE OF USE:
PROJECT NAME: MATHISEN
DESCRIPTION: Change panel, install ground rods.
OWNER: MATHISEN, CHARLES A + BETTY I, PHONE #:
CONTRACTOR: WINNER ELECTRIC INC PHONE #: 503- 638 -5028
-
Inspection Request Scheduled For: Date: 6/5/2007 - Pour Time:
Code # Inspection Description Confirm # ' Contact it Message
109 Electrical final 049462 -01 503 -638 -5028 N
Corrections /Comments /Instructions:
•
1 a-AZ/7 Zei
ejr9 66{4 J U ► '
/1
'eA'16 L f t ` j 7L-- i lire(
•
❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
0. FAIL FALL F, I PECTION n ADDITIONAL FEES ASSESSED / h
Inspector: Date: (p 0 Phone #: (503) 718 -0�-