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Permit CITY .OF TIGARD ELECTRICAL PERMIT " PERMIT #: ELC2007 -00323 • COMMUNITY DEVELOPMENT DATE ISSUED: 5/10/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S110BA - 01400 SITE ADDRESS: 11720 SW GAARDE ST ZONING: R -4.5 SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: BUSEY Project Description: 15 amp 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: BUSEY JEFF OWNER 11720 SW GAARDE ST TIGARD, OR 97224 (00 Phone: 3- 773 -5466 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 5/10/2007 $80.30 [TAX] 8% State Surcharge 5/10/2007 $6.42 Total $86.72 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 -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: /./ j //y A .Ay Permittee Signature: _Spz, /pp I/'c, Jl OY - 1 Q .I 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. CITY .Or - TIGARD ELECTRICAL PERMIT Il up TIGARD PERMIT #: ELC2007 -00323 COMMUNITY DEVELOPMENT DATE ISSUED: 5/10/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 110 BA -01400 SITE ADDRESS: 11720 SW GAARDE ST ZONING: R - 4.5 SUBDIVISION: LOT : JURISDICTION: TIG PROJECT: BUSEY Project Description: 100 amp subpanel change. 5/11/2007 Electrician 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: BUSEY JEFF WINNER ELECTRIC INC 11720 SW GAARDE ST 5950 SW PROSPERITY PK TIGARD, OR 97224 TUALATIN, OR 97062 Phone: 360- 773 -5466 Contact #: PRI 503 - 638 -5028 N J_ FAX 503 - 638 -4242 FEES Description Date Amount Reg #: ELE 34 -150C [ELPRMT] ELC Permit 5/10/2007 $80.30 LIC 14794 [TAX] 8% State Surcharge 5/10/2007 $6.42 SUP 2825S Total $86.72 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 O 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 .1 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. �U Issued By: Permittee Signature: W 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. r 06/10/2007 13:53 FAX 3606940321 j 001 /002 1° v;,' c-P,.. 9 2007` 4:49PM. aLB00NES FERRY RIC No. 7761 P. 2 e City of I'igard� ?: , ELECT - FOIZ OFF 1 1: 115E ONLY 2 r '"• / Y 13125 SW Hell131vd„ Ti' ar l; Rewind g Phone_ S g - R �9 72 23 Date�B ; Permit No O ,: IN 03.634.4171 Fax 50�, S9B 1960 plan Review � d �'� — CO t t; AR ►r Line: 503.639.4175 Li AV 10 2001 O lr R Other Permit: Dote ed /M /t ho r:. 1 ,'• C'� tm •>Z Notified/Method: t Bas Pap c 1;.:6211 1 t`� ' �ttl a1�.`a,''�'_«F�x'�' � a ^^¢ ,r.'• r �0.-t o � �", P 2 for �,.-• d s� r q� t �� t v � r '` tnS {ti5 I I r � Sup • lemeatallnrormaden ❑ Naw corLSlruclian r.. ii , ,1. . _� .� .A_ nl'1H! •. '>f.{'� . 4' •Its f n 4 c l ,,r 1 *h , r t 7 �l f" 1 fi r 5 rr - lit4nLalteratioy/ 1• * c r1' .3 '` . 4"�n ❑ Dt rttolltlon t" i t \ I K Please shade all that L �� 1 < < 1 ❑' o p,..t _ = 1 OT\ ❑ 8 ■rwee 4 0 0 Y nu6rnit 1 p lens Ic..s- +Iv lam' r,^� L or ruder d oou o g over epee a rLa0, - ,o1r t 4 yTra IT..a,rrst, T r 0 f amp or ❑ current v ) r 1x + a r : Ei ? l }?� tt` ;1i1" u n t' rrT ,mot i r'� wham Ilia available fault current 8 o cr,area stasis-, " ~..3.t�+ 5 u - 1 :.��:t�r` +tsar? RT -. i��r} �o��J" l f '. ; i ' I' Il exceeds la.coO 0 M artina and boatyards. 1 - and 2 - family dwelling J'u i g' l h , _t l „ amps at 150 volts or y rda' g ❑ Commercia�ndttgtrial _I ❑ multi-family A eeSSOry building ❑ Floating buildings - less to ground, or exceeds 14,000 � -•• l a: , K ,_ .•.. Masts builder, El Othe s't'nsPbr.ilother QCorttmorc ('�tSeagticUllural . ',` 11w1 S '# .. � n i t rym += � ::,.,. r- -. _ � ,. r ❑Flrepump. bulld{eya. �s� +p!��'!i Y t�Jt `o� 1 � r t" is. � t.. a �� l� `, T- IT, ❑ Emer en ❑ letstaltstioa of73 KYA Or Job no• . ' at �' L �' 'd hL. _ l t tidt CI Addit on of new motor load OF fart ceoat aC y derived syslecn to011Por y. EJ " ",E.. "`I- 2 ", 3" • occupancy. 1 ') AA /� O Sitc o r -co rosideRti , ♦Hi lo. V 2 El Recreational vehicle parks - Suite/bldgJapt. rut).: � DI-Nan-care factliliee, Supply vollege for more then Pr0)OCL name: ❑ Hazardous locations, Cross street/dlreetlon5 t0 Job site: (0 seNloe or feeder OW am or more. 600 olio nominal. I� L.._� L irQ 0 y.l , ���,'1�'r ` Da lice r� t ► I �M New residential single or multi- family dwelling unit. Subdivision: Includes attached : arage. Tax map /parcel no.: Lot no.; 1 000 •, ft. or less PAW h , :3 i t 4 ; ,1� - . - :,, Ea. add'I 500 s d. or o ' 0 pi' Q• p It1on A •. ` 1.f u aatlt1p i .1�' ,1 . ,, .,i c'i T Lhttitndenergy,residontial 33.40 0 1i� r a J Jr I tl tiE3. 'ss, xtlt., " 1� ` �t.. ` � t III 75 Me Pr/rt.( � � v r - lh above s ..A. K Limited view, with s , tnulli- Jbmily -11 iris a.. R tallati 1111 75.00 t,rA l !T . 'r�x �__ r SIT rtr, s Service. or feeders installation al UL.L.11;t,' `� ;„ yt'� S, { 'tF y 4 •�.� � ' tiny: alteration ancUorrelocation ' td , ,�I, ��op�-.'�7 � �.tLe tl.l�L Il{ 1 �'li Ji 1 ti � l alit Sor less `fl t 1 , 3.•..:}l tj )' i l 1, j �ti l�i tit 201 amp" to 400 arnp9 80.30 106.85 MINIM 4 01 temps to 600 amps Address: , `' — Z� 601 am "s to 1,000 snips al 160.60 11111.111/ W • / 240.60 �© Over 1,000 amps er volts - �� am ry Phone: ( j ) •--7-� 3 - C.l, r on se rvices or feeders installation alteration, and/or Owner insEallatlan; This lnstellati0 is being made on roe 200 sire "S or less _�� intended for sale, lees, rent, or e! y$e, according to ORS 447 449, 67 and 70 t not Branca amps to 599 ern. v Owner Signature; 0 100. Date: s p s 13175 � '� "g ? y J ?— �. O 7 tletleoite_nn, alteration X 13•.ulY�`L -;I .�r7L +!,rp1,,�1,:' r;. F J'3,� � 5 , ,, 02 ;_i,: .:,.,,. aFet nch on or extension ter lflnet >.J ...11`.;: -� � .,11r�1;i�;�1sj 1`I ;�!�� l ,1 �'� 7 4 . ;te 1 �,k ��'i,l „� oireuits lt+lth J " �'2 :_,: 'r' i_�J @liL. g {SJ� A. above for serv or Feedor fee, i L� each branch circuit Contact Hemet B, fee for branch circuits • � without service or t fee, . first branch aifcuil 46 ES 11111 Each add•I branch circuit _ 6.65 _© Miscellaner no service or feeder not included Phone: ( ) nccX Each manufactured or modular l,J..uallt dwellin service and/or feeder III 90.90 t 1.'l, "' f Fr. ! ¢u 5 = t� T,� RocOnon _ ® :a. ( Y• .�. r. r phi r� _© �+1 !rl; a�1 �q� 9 t V2dE it ` t u of tt,�,rt + T, r , �.. Pump or irrigation circle 53,40 $ign or outline lihtin 5 �© IIIIIIIIEI ress; `, Signal circuit(s) of limited- energy parcel, alteration, or Add extension. Describe_ Page 2 Each additional Ina - eoon over allowable in an of the above Per Inspection II Electrical Lic.: Invcstlgallon • or have (l hr rein) . EN 62.50 _al Suprv. Lic.: Industrial plant par hour 11111 62.50 Subtotal: s p ■ Date; plan review 5% of 3 O Authorized signature: (� permit f8b Stab surcharge (d% of Permit foe): • TOTAL PERMIT FEE: MINIM Date; r h0a bean Thia p►rtnir application expires if a permit is nal obtained w1Ih1 1:\BuddinaTcr ills \Et -GpennitApp.doc 0523/06 days niter r n 18q aee,plal ao complete. aao•ratsrlt iros✓COhywra • Kuacbet of ieapeatione allowed per permit. 1 Rx Date /Time •MAY- 1a- 2007(FRI) 15:05 5035981960 P.001 05/11/2007 14:30 FAX 5035981960 CITY OF TIGARD 0001 CITY OF. TIGARD • °. COMMUNITY DEVELOPMENT TIGARD 13125 SW Wall Blvd.. Tigard, OR 97223 503.639.4171 Electrical Signature Form IMPORTANT PERMIT NOTICE WINNER ELECTRIC INC 5950 SW PROSPERITY PK TUALATIN, OR 97062 Permit #: ELC2007 -00323 Date Issued: 5/10/2007 Parcel: 2S11 0 BA -01400 Site Address: 11720 SW GAARDE ST Subdivision: • Lot: Jurisdiction: TIG Zoning: R-4.5 Project Name: BUSEY Description: 100 amp subpanel change. 511 Electrician change. Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from your company sign below and return this Electrical Signature Form prior to the start of the,work. Please mail the form to: City of Tigard. Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681. If you have any questions please call 503.718.2433. • No electrical inspections will be authorized until this completed form is received OWNER: ELECTRICAL CONTRACTOR: BUSEY JEFF WINNER ELECTRIC INC WI, 11720 SW GAARDE ST 5950 SW PROSPERITY PK TIGARD, OR 97224 TUALATIN, OR 97062 • Phone #: 360 773 - 5466 Phone #: 503 - 638 - 5028 • Reg #: .a.L 34 -1500 LIC 1.4794 SUP 28255 • AN INK SIGNATURE IS REQUIRED ON THIS FORM Sign to a of Supervising Electrician Name (printed) SUP LIC # 100/100 'd Zt V8£9£09 (XV) OId1O3-] d3NNIM : 80 (NOW) L00Z -171 AIN CITY OF TIGA,RD , s BUILDING DIVISION PERMIT #: ELG(4)07 —t)O? - 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: Phone: (503) 639 -4171 AM Inspection Requests (24 Hrs.): (503) 639 -4175 J �. . INSPECTION WORKSHEET FOR DATE: TIME: PAGE: SITE ADDRESS: CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: Pour Time: Code # Inspection Description Confirm # Contact # ssage I /S 4ce____ o-4, — In/'9 1._---- 049 W0 ?----- Corrections/Comments/Instructions: I. gm._ aglirW' i — Aa 4' 4. . c (9/ i 1, t D' y< ASS , PART!' APPROVAL ❑ CANCEL n NO ACCESS n FAIL FOR INS' ," —• I ADDITIONAL FEE ASSESSED Inspector: ' D ate: v ' Phone #: (503) 71 - CITY OF TIGARD . , I , BUILDING DIVISION PERMIT #: ELC2007 -00323 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 511012007 Phone: (503) 639 -4171 k 4n 6�"I1I Inspection Requests (24 Hrs.): (503) 639 -4175 A- __.. INSPECTION WORKSHEET FOR DATE: 5/15/2007 TIME: 7:00AM PAGE: 42 SITE ADDRESS: 11720 SW GAARDE ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BUSEY DESCRIPTION: 100 amp subpanel change. 5111/2007 Electrici • . • - • je. OWNER: JEFF, BUSEY • ONE #: 360. 773.5466 CONTRACTOR: WINNER ELECTRIC INC 3t0"--if?`- ° P ONE #: 503 -63 5028 Inspection Request Scheduled For: Date. 15/2107 Pour Time: Code # Inspection Description Confirm # Contact # Ma‘`c I 115 Electrical service 048303 -0 360 -773- 6 N II 0 1 03 30 0 Corrections /Comments /Instructions: 4L . P---- , ‘‘,0.4f)viDE__ „ii"Deseoi, ..:74 , ,416 reAmez4-c2vR S ci ,C` cV 'l✓ s e9 / o / s9-/� ,,, 7N /a /&.,>7 2 s--10--tiee)-p©AC A4 cp> --- /-ig,./}e-5, Ne 7-= /1lc5F 7 CD/ N I e ?u /ic . / / •/,, off)z-- � Z - .. f , prIP- - ' ASS n PA' IAL APPROVAL n CANCEL n NO ACCESS Z _ , AIL • ILL FOR j ; ` " • n ADDITIONAL FEES ASSESSED Inspector: 'M '��44 Date. 4 / ' Phone #: (503) 71 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00323 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1012( }07 Phone: (503) 639 4171 478401 Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 5/11/2007 TIME: 7:01AM PAGE: 89 SITE ADDRESS: 11720 SW GAARDE ST CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: BUSEY DESCRIPTION: 15 amp panel change. OWNER: JEFF, F3USEY PHONE #: 360 - 773 -5466 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 6/11/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 196 Misc. inspection 048120-01 360-773-5466 N Corrections /Comments /Instructions: c, �� NittA C1 1\ki ‘AtiV 6C s PaNtUttY FOL n PASS ❑ PARTIAL APPROVAL ►7/ CANCEL (l NO ACCESS I I FAIL I I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: G- ' , v�"�' Date: 61111 0 1 Phone #: (503) 718- _°1