Permit CI TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00084
DEVELOPMENT SERVICES DATE ISSUED: 2/3/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S111 AD -06300
SITE ADDRESS: 14815 SW HALL BLVD ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Service for private street lights, see map.
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:
HAMBACH, CATHALEEN TRUSTEE NORTHSTAR ELECTRICAL CONTRACTORS
14815 SW HALL BLVD 19450 SW CIPOLE RD SUITE 107
TIGARD, OR 97224 TUALATIN, OR 97062
Phone: Contact #: PRI 503 -612 -0840
FAX 503 - 612 -0891
FEES
Description Date Amount Reg #: LIC 90454
[ELPRMT] ELC Permit 2/3/2006 $80.30 ELE 34 -359C
[TAX] 8% State Surcharge 2/3/2006 $6.42 SUP 6615
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: i 21 r Permittee Signature: ,.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.
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.
01/31/2006 17:46 2036120891 NORTHSTAR PAGE 01/03
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R ece i ve d Al Electrical
17atefBy: `' 0 ' - t N
' Perm o. { a — MO ,V
City of Tigard Planning Approval
Sign
Date/By: Permit No.:
13125 SW Bail Blvd. PEa Revi O t h er - –
\
Tigard, Oregon 97223 � EI '/ . - '= Date/By: Permit No.:
Poops: 503 639 -4171 I'ax: 503 - 5'98 =1960 Post- Review Land Use
1h,M � # 1� up ,i;11 A l l 1 '�' Date/By! Case No,:
Internet: www.ci_tigard.or.us B - p - Contact 24 -hour Inspection Request 503- 639 -4 F7F5 �.� Name/Method: !u See Page 2 for
Su leroenta! I nformation.
New c` ....
CITY gtiolO TIGARD
i SIGN
vO :rt:r;. {i;�;�% I'isl3i>i <t:`:� ;��' . '.;:.. .. ,rri .:.'PLAN AEV]E:W (Piteasle cheek a1l�Iiat aFp1Y3 ,-? .. ;:.a;.
construction _ n Demolitio El Service over 225 amps- �l { ealch Hazardous location
care facility
commercial •
Addition /alteration lacemelzt ID Other: ❑Service o ver 320 amps rating of
,:.,, .,. Building over 10,000 square feet,
,; :
, a^.:. /,CATECOR .S • NS..parCTII?1 ; ; ; ..iiA,, , ,i,,, ,.:, , 1 R. 2 family dwellings four or more residential units in
71 1 & 2- Family dwelling it ommercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ feeders, 400 amps or Mort
1 1 Accessory Building 11 Multi - Family ❑ Occupant load over 99 persons p Manufactured structures or RV park
f Master Builder n Other: 0 Egress/li plan ❑ Other:
�" : . ' . � .,;: ;,. ::.', Submit set of plans with ��;, �. :JO ` 'SITlv . INFO 1V1A�`ZQN'sr�i�`'I� �,TdON �� . ,{:,: p th
„ any of the above.
Job site address: �. 'AWN G
'The he above are not a licable to tram or construction service.
Suite #: I ' / :,T p. '..a��,7SK�IE',iD it l +s' ! : 4' i %7: '1�
pi� Bldg A t . per s d
,..r� ...,, rQ P #� Numbe X o� inspections pe>i peXbaiit allowed Name: A Q 4 �,
/ • Description _ Qty Fee (ea.) Total
New residential - single or multi - family per
Cross street/Uiz'eetions to job site: dwelling unit. Includes attached garage_
Service Included:
1000 sq. ft. or less _ 145.15 4
• Each additional 500 sq. 0. or portion thereof 3140 1
SubdiVisi011: Lot Limited energy, residential. 75.00 .. 2
Lintitcd energy, non residential - 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
,�:• _ n .a +�• r ? :'a service anCV feed
1'' ;DES T i�r: hsi 90.90 2
.�f ?.� ,,;;,1,r l� x4I!l';;'Qk >���;;.:�i:rPl ��'n.� -; :.�;::�1•:�,�',�:
Services or feeders - tristaflatioo,
alteration or relocation:
$'r Q /9 4. v 200 amps k / i` - 201 am ps to or 400 ss amps 80.30 2 106.85 • 2
tt�-r ` 401 amps to 600 a mps 160.60 2
`:p • ®dam :',,X!' d Mt; e y .�sr T:I i K wi;: -, ,t ,: 1 .i,�, 601 amps • to 1000 amps _ 240 -60 ? • Over 1000 amps or volts 454.65 2 .
Name: Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.55 I
Phone: ,— ax: 201 amps to 400 amps 100.30 2
• [�,AP ICAN .. ,..,l.4,, ...ElCO �w :lyF.�+ktS.�i�f'�ii,.,• 401 to 600 amps .' 133.75 2
T .. • .... •,, !; Branch ci - new, alteration, or •
Name: extension per panel:
Address: service Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46,85 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: Misc.(Service or feeder not included):
�9 l r to <y is =' { �: 'C V:' a M�r ' ; C O�NTRAiCfI'OR�'i '.: % I • y i? ' � -4 �.; =:i4i''' ' I , .., " Each pump or irrigation circle 53.40 r 2
— Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business xi NorthStar Electrical Contractors alteration, or extension Page 2 - 2
19450 SW Cipoic Rd, #107 Description:
Address: Tualatin, OR 97062
_
Cit /State✓, (503) 612 -0840 Fax (503) 612 -0891 Each additional Inspection over the allowable in any of the above:
}r Lic #34 -359C CCB #90454 Metro #1911 Per ins. Orion - 1 - hour loin. 1 hour 62.50
phone: Investigation fee:
CCB .µ .µ Other:
CCB Lic. #: I Lic. #: i,vPy vTd'�!• !'sNt '',. w<;k
Supervising ;,. : �::';.. ,, :Ele ctrlcitl`�ex'iailt Fed "5. r t� � rl %��;�:: ":,:
; , �1 Supervising electrician Subtotal $
s'ig'nature required: - „� Plan Review (25% of Permit Fee) $
Print Name In 4s z' , Lic. #: 66.4c . State Surcharge f8% of Permit Fee) $ ^ )� ,_
TOTAL PERMIT FE E $ �
Authorized Notice: This permit application expires If a permit Is o o - taiolwithio
Signature; Date: 180 days after It. has been accepted as complete.
'Fee methodology set by Tri- County Building Industry Service Soard.
(Please print name) ' ) :.: f, _]
is \Dsts\Permit Forms\ElcPermitApp.doc 01/03 I
01/31/2006 17:46 2036120891 NORTHSTAR PAGE 03/03
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Northatar Electrical Contractors i
19430 s.w. apple Road, Suite 107
Tml , °''e6pa 97062 - 7111
Pliant 503.612 -0$40 1
--„—, N, a 1 i iSh ir Fax 301 -612-089J
w -Z [rr -rra '., Entail inf f
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CITY OF TIGARD
BUILDING DIVISION PERMIT #:206 6 0'0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 a �lpu�i k
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: f 8 s - CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3- 9 -O Pour Time:
Code aspection Description Confirm # Contact # Message
orrecti • -- ' . . tructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Gin ve`"' Date: 31/-64 Phone #: (503) 718- 2itilf0
CITY OF TIGARD ; ,• Ecc___
BUILDING DIVISION PERMIT #: J _��� 8 if
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 i alt;" � l
Inspection Requests (24 Hrs.): (503) 639 -4175 AE419k __„
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS:
t Li 8 f C CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: — 3-0(0 Pour Time:
Code # Inspection Description Confirm # Contact # Message
I / C (7a,a - 7 7-o` (,,, ia -ONO
•
Corrections /Comments/ Instructions:
cam: -2
14 ® o of G. 6o c o `P a t to. i N (rti h i oN .
vJ WrY 1 g pc z i 6 `Po e-0
•
PASS PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
�I I FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • N l.•* Date: 2-3 - ® b Phone #: (503) 718- 20 L it •