Permit '' , A CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00481
law , ., ,, ci� DEVELOPMENT SERVICES DATE ISSUED: 7/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 110DD -02100
SITE ADDRESS: 10515 SW CENTURY OAK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD LOT : 028 JURISDICTION: TIG
Project Description: 2 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: 1 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:
JERRY DURGAN CANBY ELECTRIC INC
10515 SW CENTURY OAK DR 790 S IVY
TIGARD, OR 97224 CANBY, OR 97013
Phone: 503 - 620 -1802 Phone: 503 - 266 -7878
FEES Reg #: LIC 26071
SUP 2123S
Description Date Amount ELE 3 - 112C
[ELPRMT] ELC Permit 7/6/2005 $53.50
[TAX] 8% State Surcharge 7/6/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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 - : 332 - 2 , 4.
Issued By: �Oj� Permittee Signature:
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.
e
FRAM : CANBY ELECTRIC INC PHONE NO. : 5032665543 Jul. 05 2005 04: 17PM P2
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Electric \1 .:
trical Perm .41, - if 4 . ,.
. . . rpripottE:ti,seopax ., ..• '
-....., -
City of Tigarci t
4 •
Ph: 50.6394; O3 osz_,, pgrmitN0F. _ -AD
13123 SW 4-1all Slvd . OR 9.11.2 \.\\... () 1 Flea Ileviiw . ....
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atly,71 p2x: s 51'1 it.16t„y
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inspection Li: 503.639.45
Ini ne1; ../ 01. - \ swer.v....,.., ".....,e Dae eae , r tr '' - Tr c 2 Mr
. supp1emeocal Informotloo 1
leternet: www.ci.tigard or.us CV' I icA\11 NotiaadMettioe;
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- 77.7,73.1747F, , 1. .qi,91:...:1!*, ; ;pie ,- : ; .4 , ..;,:8,:igA ti a.44-1,,i-4 : Wt.:''''',; . '21 1 -':ir:c . ' $ .,•'11RAV;L: .'...,%.' .:,. - '1444.,44%. ;1 7'1,,•-•.4‘.
...':-..77:.-:iv_____, ./...,,i-_____a..,'"Latf-AP-•..i.::,..A-24,1He "ItreL.:Iwriiikepr,,..1..■ v. 4, :.' AV.IW.',IN L.' •'.'.‘.. V..: , .,, .11+ni..'.. ',......,..„ .....r.:..... • • • I
Please check ail that apply:
, E NeW eoct51r11c1I0:1 Addinon/altetation/rcplacament
(:)Service over 225 amps, comrn'l Ol-lenrdous location
0 0=cl-it on r Other: 081 over 2CI arnps - rating El/Sulking over )0,000 sq, ft.,
' • ' ' ' ,c1 til't 1 'o of I
r ig,
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7., . ti ..:. ..1. '1 , ti - t• tut 'AT e l" a * NI st .t • * A it iroo AI ,
:11•4141- Ai' .y, . I ' esolt • 4. 1 7 ..7,:it.• ore ' ..6 ..■ • : - '''..ola,ia-' :: , • ::' a . ' , A . V.' 'i 'Mai • U. ‘li - and 24:nnily d wellings 4 or more new msident1s
.,
_ over s Units i
v.1 1. and 2-family dwell:rig 0 Conu.nercial/indusnial 0 Accessory building 17ISystem 600 volt nominal n one sructtrm
013uilding over three stories C.:Weeders, 400 amps or meta
• Multi-f4Tuily 0 Master builder in Other! ElOcoupsht load over 99 persons DMfinufaQNre,d structures or
' ':1; ' I giMalle q -.4'4 ' Rs ..11MWetiff triIR‘4" - 11.4t 0 Egro B iltin g plan RV park -.
. .
, lob rto.:13vg - Job site acid.ress: f1) SO 4 .-. 40 , faRealth-eare facility . .
1
Ciatc/ZTFL: -, , -. .
a_ I Submit 3,_ sets of plans with any th ° ith l ov tr e.
ty/St . • . . ; .
the above are not applicable to temporary conSrttletion Ileryice,. .,
• .
/ • ktianglifflinianaiMiriiIi,; •,•.'''';'
• . • ..
• Site/bldg ./apt_ no Project name:
—., PeseTiodee Qtr' glreiti 1 .°Iii ..‘ • •• • ..':':
. .
.. . 1. CtosS Street/directions to job site: 10 LI New residential stegle. or mu1tl-fainily dwelling unit, . .• .
. .
-- - . Includes attached , ara:e. .
...
_ . ..
: . . 1.000 sq. ft. or less MIMI ...' •
. • ,.. ' Subdivision; Lot no.: Ea. add'l SOO sq, ft, or portiOn MI 3 3. IIIIIINIIIEIII:
.., Limited after, :y , residential all 75,00. • . - : - 2.
., . : • Tax mep/parn el no.: • .
' .. Limited energy, non-residen dal MI 75.00
16,7 : .45;:`14:TI' 7 .Fizivi leyvsito p h f d
. ..., . 4: iL7. • • _ .: ,...... LT:, 21,.....z.,AL,..rat..i.tfi. o.'s•ALL 1.r.a.o..- :*;.1:72,thic. oi ., 1 1, %., . .a mane achare or modular .
• lin • sery endor
ice / f • 90.90
i .4 ..1 r--4.,.ix _ .01,11/11M dwel
01111= • ServSeas or readers itartfsilatlon, alteration, and/or relocation. . •
• . . : 200 amps or less 80.30 . "...•,••:. . • •
V amp • • .2; 1
, .
. .
. . . .
. 106Z .
. • . a e - ' 2 KF'', rir.:-VV,411. ' ,-""XP,V.MOL5Maillac , 201 amp athp
s to 400
.: 7. • ' , ote.■".feze7rieJ.T.1 - •te iNals.U,6 • - .. A * 4i2l . ■. / : .
. 401 s to 600 amp I 60.60 •: •••.• L . : .. '1
, • Name: 1 ib
. • ,, .... . • .,...... _... ..,...... 601 amps to 1 amps ,000 240,60 L : '.. •
Address; 0 . .-,
' • 2•:.
. . L Or 1,000 ahlps or volut 454.65 • • 1 5 .. ' ' ;I•
. i 1 :
• .
- — . - Reconnect only . • 66.85 •• • .. ....
. ,
- • • tity/Siate./ZIP: - . .. • Temporary services ot feeders installation, 411$ration) sittilor.'
. .
•
------- . relocation
.. .
hone: (0 ,...2!2 ; 0 ._ Fax: ( ) 200 arnps or leis 7 d„.65.... .,:.,
..,.. .." Owner installation; This mstallanon is being made on property that I Own. which.,it not 201 =pato 400 !Ma 10030 .: . ' : • .2
in
• . , ...L ended for sale, lease, rent, or exchange, according to ORS 447;449;670, an 401 amps m 600 d 701.
amps 133.75 .. ::: .... ... : 1:.
... .• • • :Ow* stgnattire.: .: Date; .: • Branch circuit s -t le. ,.. _! 4...., v pitanon, or extension, er pima/ : • :..'.. I '
:7•Tr.;7',..9'.; , r .ik., Fee kirranch circuits wtrti . . . fl
.
: , • 1;g2;LW.,:T.1 ,I....iittrarlIE..d.iit±,,it:ti.ltdL....1.11::t1s.t...azieflilLifr.int:s6.4.ezi".....__41AS.,.:d1...!.0:-A, 1117.ALI:121ai:8:.).11i. seniite or feeder fee, eaoh 6.63 • - • - • • ,: 2 •
• . , .
Business name: branch circuit ...:-
. ... — E. /lac for branch circuits • ' • •• •
• • • • - ... •., .•• . .•.
' • • Contact tome: ' ' withene service or feeder fee, i
- ,...._ . 46,85 .,4/6,. ..-. .. .2, •
each breach circuit
. . . '. • Arldress: - .,
' Bach WW1 branch circuit 6.61 . • ...:::•• . 1 :1• •
..•
• CitY/Srateali): • . Miscellaneous (service or feeder not Included : :. .....:. . ' .: .•:::-• :
. . . . . • :Pim- or icri: 'on circle 1111 ,40 . ::" .'", •
• • . ' • Phone: ( ) Fax: ; ( • ) • .
Sign or outline lighting
- ' ..• , E,: Signal circult(s) or limited- ...
.
• 1 • : • • .
S. ":il.j. ..1 iff4;11:14:WaL1574*.MkitTerirgEM.V.i.5 . Milt • RILIE energy ri"eL 81 " . •
.
'`
. .
. .
• extension, Describe: Page 2 • • .
. .
— .
• •:•: - A4dT c"' 7_121_(2_ - 1-. Si . . :Bun additional inspection over allowable In any of the alba e
Per nspection
: •
" ____---.I_—,
i
.. .. City/State/ZIP: Cr.,).1...,■_ 0 "2- .
C t s 0* l *3 Investigation per hour (1 lir min) 62;50 - . • - .. :...
:. ". ::.• Phcii: (Te ) "IL it, -. - 1 -1 (e Fax: ( - ( . z) --2 .‘ _ s-s 44 .--- .. Iridustrial • lant per hour .
. ___ . ;' :',EiMitaTENSMWesi.MEMUEM
., • • : GCB Lic.: 2 1,,, on Electrical 1....io.L. - 3 .- kk - 2. C.... I S Pe--: 2.
• L----------.... ....,0.i
•
• . . • Suprv. Elecnician signaaire, required; (.... or • 1 k Nati review (25% of perrnit Pee)
. . : Prinr narne: • L ''-' 0 _
Datt: • - State surcharge (a% OPpermit fee). • • 4/,. 2g, .
... , .L.r....S.-_____ • "..1 o
• • . TOTAL PERK1T ittt... •
Authorized signorine: ‘ 1 _ . 41/' '
. .„.. . ____ _.. Thi s permit apiAlcatin x
o epires If a permitter net atateloed
. . . , •
.:
.,..
•
• ' .. print name7-- - L ' - Z . ), _ • 0,4 Date; 41;51 after It an: bout kettpcad AS empty.** • • • L • , •L L.: "
• Fee troeMeetology sat by TrI.Coartry Baildhig Loeustry Seryicr Scare'
• '' Number of inspections pet permit allowed,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005- 00481
' 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639 -4171 / A�mr ' spimpFllj(j
Inspection Requests (24 Hrs.): (503) 639 -4175 • _
1 INSPECTION WORKSHEET FOR DATE: TIME: PAGE: 93 1
SITE ADDRESS: 10515 SW CENTURY OAK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD LOT #: 028 TYPE OF USE:
PROJECT NAME: DURGAN
DESCRIPTION: 2 branch circuits.
OWNER: DURGAN, JERRY PHONE #: 503-620-1802
CONTRACTOR: CANBY ELECTRIC INC PHONE #: 503- 256 -7878
Inspection Request Scheduled For: Date: 7/14/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
145 A/C or heating unit circuit 011339 -01 503 - 266.7878 N
Corrections /Comments/ Instructions:
i�1 PASS r d R L APPROVAL ❑ CANCEL ❑ NO ACCESS
I I FAIL L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: III IIIII■ Date: Phone #: (503) 718 -
V