Permit ,r CITY OF TIGARD ELECTRICAL PERMIT
P E RMIT #: ELC2005 -00304
� . DEVELOPMENT SERVIC DATE ISSUED: 5/5/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CC 02200
SITE ADDRESS: 08035 SW CHURCHILL CT ZONING: R -12
SUBDIVISION: BOND PARK NO. 3 LOT : 050 JURISDICTION: TIG
Project Description: 1 branch circuit for new a /c. Job No. 07 - 3666
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:
KRUM, CATHY EVERGREEN ELECTRICAL CONTRACTOR
8035 SW CHU RCHILL CT PO BOX 1212
TIGARD, OR 97224 SANDY, OR 97055
Phone: Phone: 503- 668 -4608
FEES Reg #: LIC 136311
ELE 3 - 472C
Description Date Amount SUP 45815
[ELPRMT] ELC Permit 5/5/2005 $46.85
[TAX] 8% State Surcharge 5/5/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60 .
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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 -6 9 or 1 -:.,- 3 • • 4,-- /
Issued y: L____ #' LA P ermittee Signat ! 6„ J til_ ' '
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:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: allillk ' - -' - 4/' '` 48 ° 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.
Electrical Permit Application FOR OFFICE USE ONLY
,City Qf Tigard Date 5r TAN Permit No.: �', ;jp6 j � 'ay
13125`' S W Hall Blvd., Tigard, OR 97223
R , I V Plan Review
Phone: 503.639.4171 Fax: 503.5 ,p,,A � � j� Date/By: . ; ;r - - ; Other Permit:
Inspection Line: 503.639.4175 t „_, _ Date Ready/By: tu• -. H See Page 2 for
Internet: www.ci.tigard.or.us MAY 0 24 s .Notified/Method: Ds Supplemental Information
- e g r g .. f 1 F :�. ,--y,f, a P m-Y4 - '4T";ti't x, a .,:,, } , V ...
s4',:-I 4T i '�" .. aaa _ ' '.,'4 �� 0 �'� y, ,c k . - 3'a- - r . " w. `Ki *a "3• }` - s . , �� ., .P , 1. - :
�s;'/}.
❑ New constructio ►li • ddei s R• 4 1 0 : , - ? � ; , 7t1 *. ; Please check all that apply:
❑ Demolition Other: ['Service over 225 amps, comm'I ['Hazardous location
❑
, _..7 ;z Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
� a d t d ; ' "` "` ' t , : of 1- and 2- family dwellings 4 or more new residential
M 1 - and 2 family dwelling II Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories OFeeders, 400 amps or more
❑ Multi 0 Master builder 0 Other:
- :"t ['Occupant load over 99 persons ❑Manufactured structures or
i;. - - t r i ,- , . a ` a k �, , P it :c �a '-: . . ❑ Egress/lighting plan RV park
Job no _ O , Job site address: , I ( ` C ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: t� ~��.:� .�n�y� - .. .. •
Description Qty. I Fee. I Total ..
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
i 1,000 sq. ft. or less 145.15 4
Subdivision: . Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no Limited energy, residential 75.00 2
wEr 114 Limited energy, non - residential 75.00 2
. sue, ' 1 ', Q ty a : 1 " : . �_ A Each manufactured or modular
r 11- i • 11 Ili. dwelling, service and /or feeder _ 90.90 2
� - 1 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
4. , a ' , , �� 3 -;• ?" 4 ` "" amps amps 106.85 2
� � -��� � k �� ; a s to a
: -, -; ' P . .a a. �li . 1 ' . , ' ' -' '', . , * ' 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps - 240.60 2
Address: I \ Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: i Temporary services or feeders installation, alteration, and/or relocation
Phone: ( ) - "71 Fax: ( ) 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
. -tAi l P 'a a o' ,. ;. w , ava 8 " a w oi p ',w,f .; A. Fee for branch circuits with
Business name: branch circuit
eder fee, each 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit ( 46.85
Address: • Each -add'I branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( )
' Sign or outline lighting 53.40 2
E -mail: i Signal circuit(s) or limited -
' energy anel, alteration, or
extension. Describe: Page 2 2
Business name: _ , i ' .
Address: • b'®)( a Each additional inspection over allowable in any of the above
- . ' - Per inspection 62.50
City/ State/ZIP: 4 ci bSS Investigation per hour (1 hr min) 62.50
Phone: (a'i� t$- - O Fa x: r�- ` Industrial plant per hour 73.75 •
CCB Lic. 4 ..:. :.
j am,) i CEMEMIll...411 uprv. Lic.• 1 4jgt S Subtotal L.,4 ( Z3 '. Electrician signature, required: �.� Plan review (25% of permit fee) �.
! n State surcharge (8% of permit fee)
Print name: << J
l rl y "` -(J
o , Date: ��
TOTAL PERMIT FEE
Authorized si atur� ,�f5�1
�,��I This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: .I 1 ':4.i l► i Date: , mm I 1 * Fee methodology set by Tri- County Building Industry Service Board
go. _
/ ** Number of inspections per permit allowed.
i:\ Buitding \Pennits\ELC- PermitApp.doc 12/. 440 4615r(10 /02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200G-00304
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/5/2005
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 100
SITE ADDRESS: 08035 SW CHURCHILL CT CLASS OF WORK:
SUBDIVISION: BOND PARK NO. 3 LOT #: 050 TYPE OF USE:
PROJECT NAME: KRUM
DESCRIPTION: 1 branch circuit for new a/c. Job No. 07-3666
OWNER: PHONE #:
CONTRACTOR: EVERGREEN ELECTRICAL CONTRACTOR PHONE #: 503-668-4608
Inspection Request Scheduled For: Date: . 6/23/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 009880-01 503-650-9602
Corrections /Comments/ Instructions:
r ASS E] PARTIAL APPROVAL 0 CANCEL NO ACCESS
FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Date: C Phone #: (503) 718-