Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00661
COMMUNITY DEVELOPMENT DATE ISSUED: 9/24/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S113BA - 00100
SITE ADDRESS: 07420 SW DURHAM RD ZONING: I -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: JOHNSON FAMILY TRUST
Project Description: Install temporary power pole with (2) duplex recepticals.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 2 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:
JOHNSON FAMILY TRUST, THE WINNER ELECTRIC INC
BY CARL H JOHNSON TR 5950 SW PROSPERITY PK
8965 SW BURNHAM ST TUALATIN, OR 97062
TIGARD, OR 97223
Phone: Contact #: PRI 503 - 638 -5028
FAX 503 - 638 -4242
FEES
Description Date Amount Reg #: ELE 34 -150C
[ELPRMT] ELC Permit 9/24/2007 $80.15 LIC 14794
[TAX] 8% State Surcharge 9/24/2007 $6.41 SUP 2825S
Total $86.56 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 -001 • • ou•h OAR 952-001-01 •• You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
/ /
Iss - By: � / / Permittee Signature: (�� - Ham
• 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.
ul/ZU/ZUU4 09:38 FAX 5035981960 CITY OF TIGARD Z 001
Electrical Permit AppliBEP
FO,R OFFICE USE ONYX i!
it
City of Tigard SEP 2 4 2M)* Received
thitcfE 5 i permit Na.: 4z.2.00 d (
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503.639.4171 Fax: 503.598_1960 "' 141vil Y. Datc/13 ! Other Permit;
Inspection Line: 503.639.4175 D Reuly/By:
Internet: www.ci.tigard.or PLANNINGIEN - -
.tis CITY OF TIG ,:ia....I'''7'i.^7.Al - im
Notir.diMethod: IIIM Tup f
ii GI i -- ;7 •
! !:' , It : '. •: . ::• .......: : .. : Wi fi 'ai i F ; :. 1 i.. , .. 10 ' i T. [ j'..' . .' , "' - '. !1 ' :1 'V.It' 6 P 1 '. 1 0*§Ml'i::' , ..6.1::A!!il;1-''":':' '''' 7 . , . 7 . 7 777': . !TIA 4t
V S] New construction U Addition/alteration/replacement Please check all that apply:
OService over 225 amps, comml lHazardous location
0 Demolition 0 Other:
.„ „ ,., ..„ OService over 320 amps - rating LJBuildng over 10,000 sq, rt.,
111,1n.i.:ii.:10;17A,1::c4j:1700i*FotigOsist#470*, .:.::::!;,Ai:li,i,i '1.:; of I - and 2 dwellings 4 or more new residential
id I- and 2-family dwelling 0 Commercial/industrial /necessary building ' OSystem over 600 volts nominal units in one structure
DI3uilding over three stories OFecders, 400 amps or more
Multi-family 0 Master builder 0 Other:
00ceupant load over 99 persons :Manufactured structures or
J ; 1 7 4.1:'1t r 1;4:' :.': gEgr.ssnig,hci„ plan RV park
Job no.: Job site address: 74 20 S k i „6-a...144.., ( j CHeallh-eare facility C:10ther:
Submit 2 sets of plans with any of the above.
City/Statc/ZIP: 7 ARA 04., ci 3 The above are not applicable to temporary construction service.
------' 1.,,AP0?..Th ........,M*PO4044YOLtan'L'n..;1!.1...,..-,
Suite/bldg/apt. no.: _ Projec . !lanic; A so s i ll __ , ipii .' n
1 Qry. 1 Pea [ . Total 1 .• .
Cross- street/directions to job site: dvre ri, 4." teort3 11/S4 New residential single- or multi-family dwelling unit.
Includes attached garage.
) - 7 IA
— Y..- (Z11/1 Jaii.,6 re4e-kS chi 1,000 sq. ft. or less 145.15 ' 4
—
Subdivision: - ,S0J-.4 I S4,14- Lot no.: Ea. add'I 500 sq, ft. or portion
33.40 . I
— Limited energy, residential 75.00 -,
Tax map/parcel no.;
. , Limited energy, non-residential 75.00 2
1111iili.i•iii.:):•1i;.111 i! • :!!! • 1:11ii!. ;! ;;0 . 1 *.***.0 , k0k*.P.* .' ililqjlliFt.'!1!!': '! !,.;i :I ri: . r ., • *i' ' . Each ma„facturcd or modular
1 __ .
dwelling, service and/or feeder , 90.90 ' 2
I I Ten PO(Ake-A Pot,- Services or feeders installation, alteration, and/or relocation
WV/ 1-1 g bvp I 4 k e-cpilthA' 200 amps or less 80.30 I 2
- :: g4 , !:;;::k • •• :.111.141:1:10.11.Q t :::.0"iti . .. ::i 2°1 arn TA) 4 °° am ,, 106.85 2
a HT.' .' •• • - - . • . . ..... ...,.."".."' .". • • • "' ,IV :.... • - ' . -' ' ''' I "• • ".' • • • lt • s' & n. '
--
Name:
601 amps to 1,000 limps 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, ancUor
relocation
Phone: ( ) _ Fax: ( )
200 amps or less 66.85 1 44 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 10 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
i
l';F::i:i.:':;12)140, A ' F 0 13r r a i r ,: c h d a circ fe u e i ta
6.65
Business name:
branch circuit
. .
B. Fee for branch circuits
Contact name:
without service or feeder fee,
46.85 2
each branch circuit
Address:
Each add"' branch circuit
2 _ 6.65 6, 36 2
City/StateJZIP:
Miscellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 ' 2
Phone: ( ) I Fax: 1 ( )
Sign or outline lighting I 53,40 2
E
Signal circuit(S) or limited-
iloght........L'...H...•.., Hi.;I:;1. ;.:: .:: ..1 trier panel, alteration, or
extension. Describe; Page 2 1
_
Business namc: 10 i ,v rig-A- C. 1“--'it
E ach additional inspectioo over allowable in any of the above
Address: --- eiso sw -kospe-ti-6 -Pfa 2 kt ie
Per inspection 62.50 i
City/State/ZIP: Ciiilin "l• thIL-4-1 on_ 4 1161 - L. Investigation per hour (1 hr min) 1 62.50
Phone: ( ) L " `-' - Q 4: is )u rj Q [ax: ( Edig ) 6 4,1 Z Industrial plant per hour 73.75
1 '.,...2-.'=_.. f-
7,11ii!i'l;!;!ii: . .:i•'; 101;:..PERI■irr..'PEES"H.;:...
CCB Lie.: / .- Elecnical Lic.: 3a/- t 645C_ Suprv. Lie.: ag,4 s
Subtotal Sio,t.
,
Suprv. Electrician signature, required: n Oka Plan review (25% of permit fee)
• State surcharge (8% of permit fee) 6.41
Print name: s‘ttOit/L tAJA vL Date: el .. 1 1 ...... 0 7 _.
TOTAL PERMIT FEE fic 5
.
-
Authorized signature:
Thin permit Application expires if a permit IS not obtained within 120
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Di-County Building Industry Service Board
•• Number of insnecrinns newr nArerlif n11....hatt
CITY OF TIGARD ,•
BUILDING DIVISION PERMIT #: ELC7007- 00661
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/2007
Phone: (503) 639 -4171 /min Iii
Inspection Requests (24 Hrs.): (503) 639 -4175 ..
• A IL.
INSPECTION WORKSHEET FOR DATE: 9/28/2007 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 07420 SW DURHAM RD CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: JOHNSON FAMILY TRUST
DESCRIPTION: Install temporary power pole with (2) duplex recepticals.
OWNER: JOHNSON FAMILY TRUST, THE, PHONE #:
CONTRACTOR: VV1NNER ELECTRIC INC _ 'Po Cr� ` PHONE #: 503 - 030.5028
Inspection Request Scheduled For: Date: 9/28/20177 Pour Time:
Code # Inspection Description _Confiim # Contact # Message
110 Temporary electrical service 056570 -01 503 - 638 -5028 Y
Corrections /Co men'ts /Instructions:
N
\ .
,- \
\ __ J \ (\ i \`
01 PASS) PARTIAL APPROVAL I I CANCEL I I NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: r r V L" Date: i 2 (37 Phone #: (503) 718 -1.9yk)