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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00382 d i DEVELOPMENT SERVICES DATE ISSUED: 6/6/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 AA -08700 SITE ADDRESS: 08930 SW GREENSPARK LN ZONING: R -4.5 SUBDIVISION: GREENSWARD PARK NO. 3 LOT : 071 JURISDICTION: TIG Project Description: Circuit to AC. 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: AMOS, SUSAN EVERGREEN ELECTRICAL CONTRACTOR 8930 SW GREENSPARK LN PO BOX 1212 TIGARD, OR 97224 SANDY, OR 97055 Phone: 503 - 639 -1038 Phone: 503 - 668 -4608 FEES Reg #: LIC 136311 ELE 3 -472C Description Date Amount SUP 4581S [ELPRMT] ELC Permit 6/6/2005 $46.85 [TAX] 8% State Surcharge 6/6/2005 $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. 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: �1 "4:6,66-e- Permittee Signature: , .. 6( C-e- 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. Th is 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 Atuilicatimkg E D FOR OFFICE USE ONLY City' of Tigard Received / n g Date/111 : / or R Penult No.: / S,il/ '0673 o (f � 13125 SW Hall Blvd., Tigard, OR 9722 I N 0 2 Plan Revie Phone: 503.639.4171 Fax: 503.598.1'90 205 ��` - %'h S; ; f�i + Date/By: Other Permit: Inspection Line: 503.639.4175 1 a Date Ready/By: 3 H See Page 2 for Internet: www.ci.tigard.or.us 'CITY OF T1GARD Notified/Method: ✓ Supplemental Information t ms"�'� � tx: ".�°rii,�{ '�° F` ; �nR� ^' �,�. a �: x - c rx t� �:e. y.•..r�= .�:a,..� 4 '' , �� •. psi 6 ''d . _a e sa a.eg 17-ge a. §;;iA,.` tliV g ti.T {y}��� ' .s' �3 �..+' ^ . Y'ii.'yq x �§y q'S •, i �. 'S -- � ` .E S7f ��a� Si'�t``+S - . �8 ��'v� � - -AT fl?I:J�Y�� 1�'r:li3lF.r' .i .b,.¢. i t- W+ Stu, ...A S ..t. ❑ New construction E4 Addition/alteration /replacement Please check all that apply: ❑ Demolition Other: ['Service over 225 amps, comm'l ['Hazardous location w A r y ,, ,i bxa ,,�. _ ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft., .�`.' but B?p . FJ 3 + �.'avr.: - r=as "Cra;s 4 y `t,5,e '".I _ six , �� ; ., ; � t - _ � , s ; „ „ f C� �� : ,.. 4 ' _ ; of 1 -and 2- family dwellings 4 or more new residential �_1 1 and 2 family dwelling NI Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family DI Master builder ❑ Other ❑Building over three stories ❑Feeders, 400 amps or more ,� a • .t ❑Occupant load over 99 persons ❑Ma park turgid structures or <� i , �r b © a -°"- ! i ;�.: -. ❑ Egress /lighting plan P Job n�"�'" 1, Job site address: ob�� & Ln• ❑Health care facility ❑Other: Submit 2 sets of plans with any of the above. City/State /ZIP: I The above are not applicable to temporary construction service. Suite/bldg. /apt. no.: Project name: ` , , 7 T;:S:?=11TMr ° � S.4OA IsEi' ; .:t;.. . Deserfption E Qty. I Fee. 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: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1 Tax map /parcel no : ■ Limited energy, residential 75.00 2 t d ,. Limited energy, non - residential 75.00 2 S . ;,:kit• 1 7i . , ' • -,zY sl Each manufactured or modular j� . . - 1. dwelling, service and/or feeder 90.90 2 �(� Services or feeders installation, alteration, and/or relocation I 200 amps or less 80.30 2 1 a� v 201 amps to 400 amps 106.85 2 t. ;;; . : . ? ..,_ s';� ,..• .", .t� J a ''2 amps amps 401a sto s 160.60 2 Name: F 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 Phone: ) ( )03% I Fax: ( ) relocation 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 ii, ":'' a ii- "r 3 >, d Vy` - t * r ' °� " ` T A . Fee for branch circuits with 5�g a�_ ' ���, ° . �,.,„ service or feeder fee, each Business name: branch circuit 6.65 2 Contact name: B. Fee for branch circuits without service or feeder fee, l 46.85 • 2 Address: each branch circuit 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: ( ) I Fax: : ( ) Sign or outline lighting 53.40 2 E - mail: Signal circuit(s) or limited - t k a.. . ; x s ".: Ft . i i o f 4 ;; n `_ i , ' 14, energy panel, alteration, or �` extension. Describe: Page 2 2 Business name: E f j .F le r..h.. \L Address: �j ``''11 x f Each additional inspection over allowable in any of the above �� `'` ` r l - ` Per inspection 62.50 City/State/ZIP: , CV_ C31-1b5S Investigation per hour (I hr min) 62.50 Phone: (U)-,) IA$- 1. `` - I Fax: S)3) ;PtD% tr3Og, Industrial plant per hour 73.75 • CCB Lie.: I 31 ( I Electrical Lic.: > -� . Lic.: +S'' S Subtotal ill c Suprv. Electrician signature, required: Plan review (25% of permit fee) .. - Print name: C -hr1` 0n -. 'Date: 5--23 --r5 State surcharge (8% of permit fee) r TOTAL PERMIT FEE SO (c, Authorized signatur. a � � " • This permit application expires if a permit is not obtained within 180 ` - " - � t � � . days after it has been accepted as complete Print name: k�a � • • 1 Date: v �3495, • Fee methodology set by Tri- County Building Industry Service Board " Number of inspections per permit allowed. i :113uilding\Permits\ELC- PemutApp doc 12/03 440- 4615T(10 /02/COM/WEB • CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005 -00382 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/512005 u Phone: (503) 639 -4171 . �i•�ry���i�f �l l� Inspection Requests (24 Hrs.): (503) 639 -4175 ��� INSPECTION WORKSHEET FOR DATE: 7/1W2005 TIME: 7 :07AM PAGE: 60 SITE ADDRESS: 08930 SW GREENSPARK LN CLASS OF WORK: SUBDIVISION: GREENSWARD PARK NO. 3 LOT #: 071 TYPE OF USE: PROJECT NAME: AMOS DESCRIPTION: Circuit to AC. OWNER: AMOS, SUSAN, PHONE #: 503 - 639-1038 CONTRACTOR: EVERGREEN ELECTRICAL CONTRACTOR PHONE #: a03 -668 -4608 Inspection Request Scheduled For: Date: 7/18/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 011596-01 503 - 650-5014 N Corrections /Comments/ Instructions: • v. PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 7'7 g"' (15 Date '> Phone #: (503) 718- 1