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Permit CITY CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2007 -00707 COMMUNITY DEVELOPMENT DATE ISSUED: 10/12/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 25111 CD -03100 SITE ADDRESS: 09645 SW BRENTWOOD PL ZONING: R -7 SUBDIVISION: SUMMERFIELD NO.9 LOT : 520 JURISDICTION: TIG PROJECT: JENSEN Project Description: (3) branch circuits for kitchen 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 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: ROLLAND & KATHLEEN JENSEN PERFORMANCE ELECTRIC 9645 SW BRENTWOOD PL 14674 SE SUNNYSIDE RD #170 TIGARD, OR 97224 CLACKAMAS, OR 97015 Phone: 503 -620 -1152 Contact #: FAX 503 - 656 -0693 PRI 503 - 656 -0496 FEES Description Date Amount Reg #: ELE 3 -582C [ELPRMT] ELC Permit 10/12/200' $60.15 LIC 161535 [TAX] 8% State Surcharge 10/12/200' $4.81 SUP 4499S Total $64.96 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 952-001-00 0 through OAR 952 -001 -0 ! i. ou may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344. Issu =y: �� J f� , Permittee Signature: I J2L X dal 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. illi 12:20p Performance Electric LLC 503 - 656 -0693 p.1 P' FOR OFFICL. USE ONLY - - - Er ' 1- ;i>Val Permit A < < C ,y of Tigard 0 C T 1 2 Z007 /e? //z t 51-46 Pcnia N °.:(2-& —716 13125 SW Nall Blvd., Tigard, OR 97223 plan Review ® Phone: 503.639.4171 Fa omen t air. Five 503.5911 ( F [((3ARD :` " ' , c1Y j , j. ` � -l -i DatBDatcReadYlSY- Julie 1 0 See Page 2 for Inspection Line: 503.639.4175 DUI�DIN(aDIUISI = - r�ri 776-1 snppl e Information Internet www.cr.u�rdar.us PLAN REVIEW OF WORK Please check all that apply ❑ New construction Additibn/alteration/replacemerrt ❑Savicc over 225 amps, comet ❑Hazardous location ❑ Demolition ❑ Other: ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. it, of 1- and 2- family dwellings 4 or more new residential CATEGORY OF CONSTRUCTION ❑Syslerri over 600 volts nominal units in one stroclurc - and 2- family dwelling ©CommerciaUindustrial ❑Accessory building ❑Building over three stories ❑Feeders, 400 amps or more ❑ Multi-family ❑ Master builder ❑ Other. ❑Occupant load over 99 persons ❑Manufactured structures or V park JOB SITE INFORMATION OCATION ❑Eight R 8Plan ❑Vp _ ❑Nesidr -care facility Job no r C1 1 Job site address: S - �i Submit sets of plans with any of the above city/State/ZIP: 77 r / �); 9 7 Th above are not applicable to temporary construction service. FEE* SCHEDULE � g 1 (211- Pte. Total .. Suite/bldgJapt no.: Project nacre: , 9 fj 'jE� f r e - l G Cross street/directions or multi- family dwelling nit New residential xions to job site: Includes attached garage. 1,000 sq. ft. or less 145.15 4 Ea. add'] 500 sq. ft. or portion 33.40 5ubdivisian: Lot no.: a. Limited energy, residential 75.00 Tax map/parcel no.: Limited energy, non-residential 75.00 DESCRIPTION OF WORK Each manufactured or modular (twellin, service and/or feeder 90.90 ' Ii ' a ,.y? &i L Services or feeders installation, alteration, and/or relocation �, tj` 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 ❑ PROPERTY OWNER ❑ TENANT 401 am ps to 600 amps 160.60 2 • 601 amps to 1,000 amps 240.60 r Address: � , J) / t P Over 1,000 amps or volts ���U • � �' "' � 7 , ' ` Reconnect only IN 66.85 Adam - Ell V .. Temporary services or feeders installation, alteration, and/or City/State/ZIP: erzrP: A t •. • • . .4 - _ � r relocation Phone: (50 ?) 7 () f/ ,; Fax: (5 ) 912 - /' - 200 amps or less 66.85 — 10030 2 Owner installation: This installation is being made on itpesy that 10 at I own which is not 201 amps to 400 amps 133.75 2 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 snips Date: Branch circuits - new, alteration, or extension, per panel Owner signature: A. Fee for branch circuits with • ❑ APPLICANT k ❑CONTACT PERSON service or feeder fee, each 6.65 2 branch circuit Business name: 13. Fee for branch circuits Contact name: without service or feeder fee, 1 4635 4. 2 first branch circuit 2 Address: - Each add'] branch circuit 4.. ,,,_ 6.65 _ '3, 3 Miscellaneous (service or feeder not included) 2 City/Stale/ZIP: Pump or irrigation circle 53.40 Phone: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2 Signal circuits) or limited - E energy panel, alteration, or 2 CONTRACTOR ectension. Describe: Page 2 . Business name: 1 � Each additional inspection over allowable in any of the above C $ /4"4/7C ' ec ion 62 50 Phone: ( ) Address �� }r /ial��t 62.s i ll /� Investigation Per hour (1 hr min) City /State/ZIP: /f i j,...-:;, j,...-:;, �,� p���r' 9�� [rcdustrial plant pechour 73.75 * - - (' / /� i�ax W) ; —669 ELECTRICAL PERMIT 111 FEES (� C� %�/ '*" C!� Subtotal � 9�° if Electrical Li 81 - Su • . • . Lie.: 9 Cat 3.ic.:1 ��� I // not a .. plan review (25% of permit fee) Swim. Electric --•- signature, required: .,s. - -r State surcharge (8% of permit fee) w k . r-� Date: �Q /- r TOTAL PERMIT FEE r Print name: /` I r.. - i. in 1 : �� ,a � , ,/% The permit application erpites if a permit is : :1 Authorized signature: jtJ 1t � I �f s , • Fee methodology after it 1 t y T Barring Indostiy Savior Bound •� Date: CJ —' beta accepted as (anode P rint name: ,r �, ,�._�... _�- ..�- --�..— — ___..: _ • CITY OF TIGARD J' 4 • ..... ,z BUILDING DIVISION Atb ,),A; 4 5,,,/, PERMIT #: ELC2007-00707 13125 SW Hall Blvd., Tigard, OR 97223 ,, r „„..4.p_ A id i L. oxii DATE ISSUED: 10/1212017 Phone: (503) 6394171 ......A5P Inspection Requests (24 Hrs.): (503) 639-417 '' Y...,.-441'. (U. INSPECTION WORKSHEET FOR DATE: •0/17/2007 TIME: 7:02AM PAGE: 40 SITE ADDRESS: 09645 SW BRENTWOOD PL CLASS OF WORK: SUBDIVISION: SUMMERFIELD NO.9 LOT #: 520 TYPE OF USE: PROJECT NAME: JENSEN DESCRIPTION: (3) branch circuits for kitchen remodel. OWNER: JENSEN, ROLLAND & KATHLEEN PHONE #: 603-620-1162 CONTRACTOR: PERFORMANCE ELECTRIC PHONE #: 503656..0496 Inspection Request Scheduled For: Date: •0/17/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 057744-01 503-307-6659 Y Corrections /Comments / Instructions: A".. i v art ro ifff 1 i fer.A,00 4 - 01, . — tat - _;.-.—..1 ir-I -_--"- 7......a.4 . .',..._ i __ /. ' 1\ ' ‘ i - A - ' ,‘,..: • ,Ara -// 0 V--1-i (4-/‹ "Ad- '' -/ / iv, 61-ediL ..* a ' L, 111 //'' ' iflz . , Al , , IVNIMOIRMIEL 1 .. • 1. itiA / MilW IA , • irmay ar .., mm 4 , I 4.• ,.. , .... ..... `-\-' I v• I v" W v • i 6::, c ) .... . _ _, .. , 14 z-- '<- 41 i 6 I 2 tkni152-- ASS I I PARTIAL APPROVAL I CANCEL NO ACCESS ta A I L *41? ii* ALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED , q 1 11,7 ____ Inspector: Date: 0/11 i 0 #: (503) 71:3- , t* . . .