Permit ELECTRICAL PERMIT
CITY OF TIGARD) J k PERMIT #: ELC2005-00658
DEVELOPMENT SERVICES DATE ISSUED: 9/8/2005
'el II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S103DC -01000
SITE ADDRESS: 11265 SW GAARDE ST ZONING: R -3.5
SUBDIVISION: • LOT : JURISDICTION: TIG
Project Description: (6) branch circuits. Job #63190.
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: 5 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:
TIGARD ASSEMBLY OF GOD FRAHLER ELECTRIC CO
11385 SW FAIRHAVEN ST 11860 SW GREENBURG RD
TIGARD, OR 97223 TIGARD, OR 97223
Phone: Phone: 503 - 639 -4627
FEES Reg #: LIC 37410
Description Date Amount SUP 1816S
ELE 34 -13C
[ELPRMT] ELC Permit 9/8/2005 $80.10
[TAX] 8% State Surcharge . 9/8/2005 $6.41 REQUIRED ITEMS AND REPORTS
Total $86.51
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: 112 Permittee Signature:
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.
Elec' rival Permit Application FOR OFFICE V SE ON l_l
City of Tigard RE0E — I 1 .. W` �g y - Y -05-.'Peg- PermitN 6ce -oJ0 1 - aio k 7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 501639.4171 Fa,c 503.598.1960 QfIF' I' DateBy. Other Permit:
Fl Date Ready/By: J am' ® See Page 2 for
Inspection Line: 503.639.4175 SE s 0 ° L _. r_Nor ' __ 1 .. /'
Internet: www.ci.tigard.or.us Notified/Method: 11 Supplemental Information
..
:xr ,jam > «iaf,,,8 - ',,: �, Ul2't� -1`, 1: �, . 'sP; ,RE'VIEW ..,., _. -_... ;; #,
. � r '` ._... '' .: ti x: �= - ��� �'�ttF` , _.. - - . . .. - . I±�N'•
❑ New constnlctian
AddiiiW/illiation/l�eplacement Please check all that apply:
['Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other:
., �..,..,-;..::-_,._...,,, t. �:.• .•_-:.:_= r�: z.:::,_ s, �':_.:::<.-, �:,:-,, � .:::...:...:::....:: r<=:..:.:,. �;<<...; <:,,.�.;:,;<::,::.:.- _,:..4:,_ ❑Servtce over 320 amps -rating ❑Buildng over 10,000 sq. &,
4 Y „_ , „, ,. ..-
''; - ° OIYSTRII(:.'CIUPI�: - °`n `t of 1 -and 2-family dwellings 4 or more new residential
zGATEGOR'Y- "OFt >C Y
1- a nd 2- famil dwelling [1 Commercial/industrial ❑ Accessory ' building • 0 System over 600 volts nominal units in one structure
fi.
El 1- g..
❑Building over three stories [Weeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other. 0 load over 99 persons 0 Manufactured structures or
;�,;. . s` RV park
, <• kSTf'E,'INFOR1tif,., .,„; ?:AND;= >:LOG E ess/li lap
Job no.: 63190 Job site address: 11265 SW GAARDE STREET ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City /State/71P: TIGARD OR 97224 The above are not applicable to temporary construction service.
'6 SCHE T3,:t* ^`a` - ---
- _ - "` " ` -` - >'. - � ��
Suite /bldg. /apt. no.: Project name: TIGARD ASSEMBLY OF GOD
r.D es Q lptioe ,.; - . Qt7 „I ,_ . Fee ,..; I,, ,Total
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4 -
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limiteden
fl=;.sex_;.,.�_ -.., „ = ;,= energy, non-residential 75.00 2
;i"w,Ft r ;- =i r17E$C`107 . 0 OF * - , a d
VOL- L , _ - , . , _�: us .: ^. _ .,.. .._ .:: -a k.v Each manufactured or modular
dwelling, service and/or feeder 90.90 2
INSTALL LIGHTS PROVIDED BY CUSTOMER Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
;. - '"''',: „, ' 5_- ,.E, - + -•_ =,F. 201 amps 400 amps 106 ^85 2
- amp mp
z -. [] PROI'RTI OV1!kERN lml T +EIYANJC ' 401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 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, and/or
relocation
Phone: ( ) 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
'q, ,.: ...m a :4 1;_ ” : :i.- _ '::r A Fee for branch circuits with
.,,. v, :w,; Ul�iTACY °13�EASODT'' , ::14
c :•. : � _ ; .,! , ®-�APPT: CA1VT,. _ 's�';:C. T , , .mo ,
_ �� - <. „ service or feeder fee each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46,85 46.85 2
each branch circuit
Address: Each add'l brands circuit 1 I 6.65 133.25 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: Signal circuit(s) or limited-
:_ ever p anel ' - gYP
extension. Describe: Page 2 2
Business name: FRAHLER ELECTRIC COMPANY
Address: 11860 SW GREENBURG ROAD Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: TIGARD, OR 97 223 Investigation per hour (1 hr min) 62.50
Phone: ( 503) 639 -4627 Fax: ( 503) 639 -4673 Indu s trialptantp erhour
i 73 75
';,, fir., L: ELEGTRIGAI� =PER1GiT1' FEES !'
C— CCB Lie.: 37410 Electrical Lic.: 3 —13C Suprv. Lic.: 1816S Subtotal 80.10 •
r d d j � l/‘� Plan review (25% of permit fee)
� Suprv. Electrician signature, / !/�'� ,
1 k Print name: R . W . FRAHLER Date: 09/07/05 State surcharge (8% of permit fee) 6.41
TOTAL PERMIT FEE 86.51
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections Der nemrit allowed.
O F TIGARD
NG DIVISION ^ � f PERMIT #:
! SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELC00 5-0
Phone: (503) 639 -4171 Au�l @��iul �l
f 0
Inspection Requests (24 Hrs.): (503) 639 -4175 ...' ' :_.1
INSPECTION WORKSHEET FOR DATE: 127/2005 TIME: 7:05AM PAGE: 81
SITE ADDRESS: 11265 GAARDE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: TIGARD ASSEMBLY OF GOD
DESCRIPTION: (6) branch circuits. Jab #63190.
OWNER: TIGARD ASSEMBLY OF GOD, PHONE #:
CONTRACTOR: FRAHLER ELECTRIC CO PHONE #: 503- 639 -4627
` Inspection Request Scheduled For: Date: 912712005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 016670 -01 503 - 639.4627 N
Corrections /Comments /Instructions:
•
-----' PASS I 1 PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
I I FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
r
Inspector: � Mae LET Date: q V7 d Phone #: (503) 718- 2'44 •
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