Permit 4 t‘ T ELECTRICAL PERMIT
C' 1 `` TIGARD PERMIT #: ELC2005-00898
DEVELOPMENT SERVICES DATE ISSUED: 11/15/2005
p1 � 13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171
PARCEL: 2S103BD -02400
SITE ADDRESS: 11800 SW CARMEN ST ZONING: R -4.5
SUBDIVISION: CARMEN PARK LOT : 007 JURISDICTION: TIG
Project Description: Panel change.
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:
JEFF SCHARN T & T'ELECTRIC
11800 SW CARMEN ST 4120 SE INTERNATIONAL WAY
TIGARD, OR 97223 SUITE A -105
MILWAUKIE, OR 97222
Phone: 503 - 330 -2968 Phone: 503 - 652 -7610
FEES Reg #: LIC 150973
Description Date Amount ELE 26-1105C
SUP 2184S
[ELPRMT] ELC Permit 11/15/200' $80.30
[TAX] 8% State Surcharge I (/15/200' $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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 By: // CiQll;,' Permittee Signature: S9 -2, (7
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.
02/17/2014 11:17 FAX la 001/002
' � • G �", ENE D •
Electrical Perm A flc Pion IOItattic•r.IISE
City of Tigard 91 ®� , )
y o o
�S pa / 1 � U �� 1 _ Permit No. : Lill )01
131255W Hall Blvd., Tigard, OR 97223 �� p ,1960 CIGAR °`-'' ' Other Permit
Phone: 503 - 639.417 t Fax: 503.598
v 1 - N O tr L , �I.if . I Plea Review
D
Inspection Line: 503,639.4175 B DING DI MS •1 i 11, , Date Readylgy: Iu )J� I !� see Page E for
Internet; www,ci.tigard.0r , us UIL Notified/Method: I V Supplemental information
i* 1 , i4:T. a n. p t . Ta , . .. __ ... ,
❑ New construction :11 Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ ether; Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq, ft.
al- and 2- family dwellings 4 or more new residential
W. 1 - and 2- family dwelling ❑ CommerciaVindusttial ❑ Accessory building ❑Syatern over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other: ['Building over three stories ❑Feede s, 400 amps or more
•- . ,., ,.,, . _.:. :..... . red structures �',:, ; .Sur ^,�:i,y3r.;::�`a i' "; ....:. i ... �.:.
I; , , • t- persons re9 or
h1 l ..y :; ;":': , i : : ; .'.'.:.r::.I' I .:41.;,.::',"...1!.::'....f.,:;;.. :: SGutr, , "'•;:,L ' : `, '.!,k! ';:lit ` "''
ccupanl load over anu ac u
.,rfi,�.r n, 9 , .,,.,,�. ,,, ❑ Egress/lighNng plan RV park
Job no.:()05 +3Q I 1 Job site address: 1 a D. A. 11 i , ❑Hicalth -care facility ❑Other: _ -
Submit i sets of plans with any of the above.
The above are not applicable to temporary construction service.
EMEMEEME Project name:
oesemptioe Qty- he. ToNI "
Cross street/directions to job site; New residential mingle -or multi - family dwelling unit,
Includes attached garage.
1,000 sq. ft, or less - 145.15 4
Subdivision: Lot no.: Ea- add'] 500 sq, ft. Or portion 33,40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
:
2
,< Fk ,. h ., . . .:,; trimitcd energy. non- residental 75.00 •
- ' _ • Each manufactured or modular
dwelling, service and /or feeder 90.90 2
] �� - Services or feeders Installation, alteration, and /or relocation
200 amps or less I 80.30 ,
�1 "�r ,f fi t, }, c 201 amps to 400 amps 106.85 - 2
E }} 2
iwi 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
Reconnect only r 66.85 2
City /State/ZIP: Temporary services or feeders Installation, alteration, and/or
Phone: SO , - � ' Fax: ( ) relocation
• 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 600 amps 133.75 2
Owner signature: Date: _ Branch circuits - new, alteration, or extension, per panel
,6.,,, •,
,
. , ,i : .r•' . ,,,.,•.••,.; ee for branch ci rcuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder the,
Address:
each branch circuit 46.85 2
Each add'I branch circuit 6.65 , 2
City /State /ZIP: Miscellaneous (service or feeder not Included)
Phone: Pump or irrigation circle 53.40 2
( ) Fax ( ) Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited -
E €: i?g•' . 1'......'•.;. •
. ... ,:e" . :i ••. , energy panel. alteration, or
Business name: T & T Electrical, LLC extension. Describe: Page 2 2
Address; 4120 SE International Way, Suite A105 Each additional Inspection over allowable In any of the above
Per,inspection 62.50
City /State /ZIP: Mtlwaukle, OR. 97222 Investigation per hour (1 hr min) 62.50
Phone: (503) 652 -7610 Fax: (503) 652 - 7612 Industrial plant -cr hour 73 - 75
Y xg A
E
Electrical • c.: j, ( 5 Gt • Suprv. Lic.: 47315 l . ? t.. :`r ...' " Subto[s ' f m sir 4 r5r
Suprv. Electrician signature, required: , - �� ? Plan review (25% of permit fee) , lJl
/.1 /. 4 t .-to .
Print name: - D • N{ F1 '1RfC L1 NE�Yf}1_ pate: - I I s a 5 State surcharge (8% of permit fee) i
TOTAL PERMrF FEE ��
Authorized signature: frtto a ermlt application expires tea
at p days Atter It has been accepted as com d wlthrn ISO
Print name: rQ. V i ff y Date: • Pee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed.
, 08011001g1PermitsTIC- PertrI,A0p,doo 12/03 440 461$T(I0/02/COM/wEH
04/03/2014 16:08 FAX U001/001
12/30/2005 09:46 FAX 6035981860 CITY OF TIGARD 1001
s s • •
Building Division
A Request for Permit Action or Refund
City o Di and _ v ; II,
TO: CITY OF TIGARD ` 0 2005
DK Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD
Phone: 503.718.2430 Fax: 503.598.1960 BUILDING DIVISION
FROM: ❑ Owner ❑ Applicant g. Contractor 0 City Staff
(nimnic ono)
Name:
IAdlvidual) / ,XY':7' Y','2'a.. I
J 77j1// ✓�
VOID Mailing Address: Yi0�0 5E =n J�rrna���srrpI A X; ,. - /1 "V ,c
City /State /7 lye,. /W
City/State/Zip: w / 7c?mR
, OR , 93
Phone No.: 56 3 •-., s,- d
PLEASE TAKE ACTION FOR THE ITE1VI(S) CHECKED (✓):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES.
REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: 4 5 - a0 e
Site Address or Parcel #: f goo SG✓ t ri„u„ ‘
Project Name: _ Neff S 'e Gtr, F05 3‘96
Subdivision Name: Lot #:
EXPLANATION: f{o tW4. e" /10I i.. 71 , z , ,r
•
Signature: 7,----, Date: /,7 - •7 - OS —
Print Name: / r °� /rkr
Ftofund Pedlar
1. Tlie Building Official may authorize the refund of
a) any fee which was erroneously paid or collected
b) not more than BO pact of the permit Yee lbr issued permits prior to any inspection requests.
c) not more thaw 80 percent of plan review fee when an application is canceled before any plan review c>tbrt has been expended.
2. Retiands Will be returned to the original Payer in the same method In which Payment ►wa received
Ate to Sys Admen: Dated 30 0 / 5 B � Rte to Bldg Admire: Date f 4.5 Hy
Re&lnd Processed: Date 44 / o s By Invoice Processed: Date Hy
Permit Canceled: Date // /05 By , Parcel Tag Added; Date By
Receipt #.O.SS$ Dt to /d/../05 Method C G_ Amount $ er4, 7Z.
ilding \Forrn55RceurmitAction- uldg.doc Rev 10(17/05