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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00387 DEVELOPMENT SERVICES DATE ISSUED: 6/8/2005 6 . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111DB SITE ADDRESS: 09346 SW HOME ST ZONING: R - 4.5 SUBDIVISION: KESSLER ESTATES LOT : 009 JURISDICTION: TIG Project Description: Install (1) branch circuit for new a/c unit. 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: MATSAMOTO, DANA SOHLER ELECTRICAL CONSTRUCTION 9346 SW HOME ST 41131 SW BURGARSKY RD TIGARD, OR 97224 GASTON, OR 97119 Phone: 503 - 590 -9232 Phone: 971- 832 -0807 FEES Reg #: LIC 158285 ELE 34 - 667C Description Date Amount SUP 594S [ELPRMT] ELC Permit 6/8/2005 $46.85 [TAX] 8% State Surcharge 6/8/2005 $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 suspende. e han 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules - set forth in OA' 95 e.s1 -0010 through OAR 952 - 001 -0100. You may obtain copies of these -Fules or direct question-. to OUN•C at 503 -'46 -6699 or 1- 800 -33'-234 . Issu: d By: _ L _� r Permittee Sign •: ,t. /,'�'�� 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 INSTALL ONLY SIGNATURE OF SUPR. ELEC'N: i•.i� � DATE: LICENSE NO: 595z5 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. ICCt4"l .4 '1C1IIdl1: ' = " 1? D FOR OFFICE USE ONLY City of } 3. O w .% Permute_: £ A !A" _do S 13125 SW Hall Blvd., Tigard, OR 2 97� � 3 r Mu Rcvi Phone: 503.639.4171 Fax: 503.593�1J960 0 "� 2005 "'�� }i t ' ' Dat y Oder Permit Inspection Line: 503.639.4175 - . �i - : : ''+ Dare ReadyBy. l 0 Sec Page 2 for Internet www.ci.tigard.or.us Notified/Methad: �. Supplemental Information .. - . - CIT. = TI } _ `' � .. _. � . i ' / / - . ... • : Q � e :a , . , -. - :: .: . • : . . - : / . .ELA • ❑ ew construction 31 -J `A ti elo/ 1' . ! ,,, re"cement Please check all that apply: ❑ Demolition ❑Other. DServicc over 225 amps. comm'l ❑Hazardous location DService over 320 amps -rating DBuildng over 10.000 sq. ft. CATEGORY • OF .`CONS ritucnoN,; : of I- and 2- family dwellings 4 or more new residential • vi 1- and 2- family dwelling 0 Commercial/industrial 0 Accessory building ❑System over 600 volts nominal units in one structure Other_ ©Build ng over three stories ©Feeders, 400 amps or mare ❑ Multi - family ❑Master builder . - . . _ persons D Occttpaac l oa d over 99 ivlanttaclu red structures en JOB SITE - INFORMATION AN It , LOCA.TfOPi . ' .: • ,.. .: ...:'*'•• . ' DEgress/lighting platy RV park Job no.: ( Job site address: y (a 5' w H e,�,. 57 - (]Health carc facility DOd'� 1 _ Submit 2 sets of plans with any of the above. City /Statc/ZlP: ' + / ., A l< 0 7 , .- Y The above are not applicable to temporary construction service` • / ;..:i .? ,5 :' ' . ''FEE . DIILE: • ': •. - ' Suite/bldg. /apt. no.: 1 Project name: t Fee meat -- Cross strectidirec. • ns to job site: /7 / .� id ; 5/5 �, New residential single -or multi - family dwelling unit ((( ((( r Includes attached garage e. I t ,/ L_A.:.a " Cd1(.l 1,000 sq. ft or less 145.15 4 Subdivision: - �0 � , ✓ A ' Lot no.: Ea. add'l 500 sq. ft or portion 33.40 1 Tax map/parcel n •.: 11 J Limited energy, residential 75.00 2 Limited energy, non-residential 75.00 2 • DESCRIETION ?OF "' WORK' : - '' ` r • . - • ' - Each nwtuufaeLtted or modular dwelling, service and/or feeder 90 -90 2 y� h1 /4 Services or feeders installation, alteration, and/or relocation 200 amps or less 80.30 2 -. .:•.,- .. -, amps to 400 amps 106.85 2 PROPERTY .OWKER' � -' ' - ' . ` ©TENAiKT . ... 201 �` 401 amps to amps 160.60 2 Name: DANA M / T S UPI n o 601 amps to 1.000 amps 240.60 2 Address: 3 Li (n 5 Vy f-/o M C T, Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City /State/ZIP: Ti (•7 /i ( I ' _ Temporary services or feeders installation, alteration, and/or Phone: (5e3 ) s`/ () — co 3 relocation 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 ntended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701_ 401 600 amps 133.75 2 Dwner signature: Date: Branch circuits - new, alteration, or extension, per panel • ' APPLICANT ONTArr'1PRktSoN `.. - • . A. Fee for branch circuits with V `: ! service or feeder fee, each 3usiness name: �� j branch circuit 6.65 2 S o , e rrcn N rte B. Fee for branch circuits �ontact name: TA s�.1, (e without service or feeder fee, • /J each branch circuit I 46.85 y 6, c,),,,,--- 2 Address: V - ( I ? ( s (I-' 0 , / 7 4.- r k y i `I Each add an 9 branch circuit *.- 6.65 - � 2 :ity /State/Z1P: () r 4 7 , f or Miscellaneous (service or feeder not included) ,-r< s h t� 1 - Pump or irrigation circle J 53.40 J 2 ?hone: ( 7)) ,97.. _ op 0 -7 Fax: : (5153 ) , / Li _ 6 L i c Sign or outline lighting 53.40 2 -mail: - Signal circuit(s) or limited- : . . . ' '. ' - energy lintel, alteration or n S _ ) f extension. Describe: Page 2 2 3usiness name: �a L ! eri E e cc C_o . Address: Each additional inspection over allowable In any of the above Per inspection 62.50 .7.:ity/State/ZIP: Investigation per hour (t ramie) 62.50 • ?hone: ( ) 1 Fax: ( ) industrial plant per hour 73.75 EI CTR C -lit.' ERMI7. :FEE S` .. S :CB Lic.: , 9, 2 $ S" _ Electrical Lie L f � t;b 7d Supry: Lie.: 5-7 _s ' :. Subtotal i'uprv. Electrician signature, required: ' i / Plan review (25% of permit fee) W rre if 5 . I / ' � ( State surcharge (8% of permit fee) . 7 � a not name: N l t-& Yl e S S Date: i/'�' /C i TOTAL PERMIT FEE Authorized signature: // /�M T i s t, lcation , t ^` i - -" permit pp expires if a permit is not obtained within ISO days after it has been accepted as complete ?rint name: 3-6-t " M , S O Date: Fee methodology set by Tri County 8aitdtag ladttsay Service acrd Number of inspections per permit allowed. 3 l t7 diog\Pennits\ELC- tn ne M rf..n.r m,tAoo doe 1:/03 n.Act erl.N•co a• BLOT - S86 -EOS Jai4oS aOC eiZ =8O SO LO unC CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC200S -00387 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 602005 Phone: (503) 639 -4171 i :� I Inspection Requests (24 Hrs.): (503) 639 -4175 :_.. INSPECTION WORKSHEET FOR DATE: 7/20/2005 TIME: 7:11AM PAGE: 71 SITE ADDRESS: 09346 SW HOME ST CLASS OF WORK: SUBDIVISION: KESSLER ESTATES LOT #: 009 TYPE OF USE: PROJECT NAME: MATSAMOTO DESCRIPTION: Install (1) branch circuit for new alc unit. OWNER: MATSAMOTO, DANA, PHONE #: 503- 590.9232 CONTRACTOR: SOHLER ELECTRICAL CONSTRUCTION PHONE #: 971 -$32 -0$07 • Inspection Request Scheduled For: Date: 7/20/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 011642 -02 503-887-8519 Y Corrections /Comments /Instructions: CF • • Dk SS PA; IAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL • , L FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED s ' a'( , Inspector: % `�` Date: t. Phone #: (503) 718-