Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT ISSUED E 2/1/2007 00078
COMMUNITY DEVELOPMENT
DATE ISSUED: 2/1/2007 -
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112CB -09200
SITE ADDRESS: 15196 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 2 LOT : 106 JURISDICTION: TIG
Project Description: (1) branch circuits.
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:
HARRY WORNATH KELSO ELECTRIC INC
PO BOX 1015 545 SE 3RD
MCMINNVILLE, OR 97128 HILLSBORO, OR 97123
Phone: 503 - 472 -1657 Contact #: PRI 503 - 648 -6360
FAX 503 - 648 -2075
FEES
Description Date Amount Reg #: ELE 34 -433c
[ELPRMT] ELC Permit 2/1/2007 $46.85 LIC 116254
[TAX] 8% State Surcharge 2/1/2007 $3.75 SUP 4270s
Total $50.60 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.
J f �
Issued By: -- 2:), ° r7A Permittee Signature: 121 ,d 4d« 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.
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Electrical Permit „ oR
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11 ,i,,, City of Tigard Received 7 - ....--
- 0 w/o Permit No. : .* . A -R» Ail
i . ,.. ,. .. 13125 SW Hall Blvd., Tigard, OR 97223
EB - 1 ? nanRe
Iliq Datem
view
Phone: 503.639.4171 Fax: 503.598.1960- . ..... .... . Date/By: Other Permit:
`.'n• - ,' ''' Inspection Line: 503.639.4175 Ul IN Or i IGARD
Date Ready/By: Juds: 0 See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLA14 REVIEW
0 New construction *Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
CAT OF CONSTRUCTION - - ' . ' . • . exceeds 10,000 amps at 150 volts or 0 Floating buildings.
1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building
Xf less to ground, or exceeds 14,000 0 Commercial-use agricultural
amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
0 Emergency system. larger separately derived system.
• '' : JOB -SITE INFORIyIATION.. AND LOCATION- , ' : • ' : • 0 Addition of new motor load of
' Job no.: Job site address: /3 / T, 56 aii.-47-ei pi- 0 ' 100HP or more.
Six or more residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: —7- 0 A q elit 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: / I Project name: 0 Service or feeder 600 amps or more.
..:,..' SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. addl 500 sq. ft. or portion 33.40 1
• Tax map/parcel no.:
Limited energy, residential
75.00 2
.--.: "' , '':.'..' . r' .. -' r - . ''.. . "'DESCRIPTION ' OE: 8'4'7611k - . '.- ' I --:: '''.".: ..-,:). ..- :. ' . .'... (with above sq. ft.)
Limited energy, multi-family
. AliiCeJ 840 eac 4 C. residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. ,
-'• .:.,- ..,....1:PROPERTY OWNER . '..-:,.' ': ., ..,- : .., ..-, • . IENANT - , - -:=., ' . = . 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 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 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
ia PLANT " ;'-':'`•=.." ' ' ,""' ''. ''-' 0 CONTACT " , :',-'" above service or feeder fee,
.... - . '' ' 6.65 2
each branch circuit
Business name: B. Fee for branch circuits ---
without service or feeder fee, /
Contact name: 46.85 4 .f.' 2
first branch circuit .
Address: ' . Each addl branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E-mail: • Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53 AO 2
Signal circuit(s) or limited-
Business name: V A z - - e .. : s a /L energy panel, alteration, or
Address: C.<Y6 C.51■4'7 ;? s extension. Describe: Page 2 2
City/State/ZIP: hl/Z.Z..giS c.:Y/2.. 6,e .?-7/z V Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( C 0 ae.:-/e.- .1.?6`-.2:. Fax: (. 6'9'& -92_// Investigation per hour (1 hr min) 62.50
CCB Lic.: //CZ Electrical Lic.; Suprv. Lic.: 4 /2 7oS Industrial plant per hour 73.75
1
Strician signature, required: _ , .
It_ f9
.././ ...... . -, ELECTRICAL PERMIT FEES .. -- 1 .
Suprv. Electrician
Subtotal:
Plan review (25% of-permit fee):
Prininame: ag: i i,74, , c
c., Date: //.?/ 0
State surcharge (8% of permit fee): , .
Authorized signature: e l 2 ,4 it t:<2 TOTAL PERMIT FEE: 3 6 6
This p ermit within 180 application expires if a permit is not obtained
Print name: - 0,707,17 1 z r:e0,5b Date /A.0-7 p ermit after it has been accepted as complete.
* Number of inspections allowed per permit.
I: \Buildineerrnits \ELC-PermitApp.doc 05/23/06 44 0-4615T(11/05/COM/WEB
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL. WORK_ ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑
•
Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building 'Permits\ELC- PermitApp.doc 03/23/06
A
•
CITY OF TIGARD .,.„
BUILDING DIVISION
Alkbk PERMIT #: ELC2007-00078
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2(1/2007
Phone: (503) 639-4171 .4:4..4 Olt
Inspection Requests (24 Hrs.): (503) 639-4175 ,„_W
INSPECTION WORKSHEET FOR DATE: 2/92007 TIME: 7:05AM PAGE: 32
SITE ADDRESS: 15196 SW KENTON DR CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 106 TYPE OF USE:
PROJECT NAME: WORNATH
DESCRIPTION: (1) branch circuits.
OWNER: WORNATH, HARRY PHONE #: 503.472-1657
CONTRACTOR: KELSO ELECTRIC INC PHONE #: 503-648-6360
Inspection Request Scheduled For: Date: 2/5/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 042954-01 603-472-1657
Corrections/Comments/Instructions:
•
\\,
•
} PASS E PARTIAL APPROVAL CANCEL NO ACCESS
El FAIL fl CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: tt 6----- 0 / ) Phone #: (503) 718- A-I-1