Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00475
dfl DEVELOPMENT SERVICES DATE ISSUED: 7/6/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S111 CA - 00104
SITE ADDRESS: 09453 SW LAKE SIDE DR ZONING: R -
SUBDIVISION: ALDERBROOK FARM LOT : 013 JURISDICTION: TIG
Project Description: (3) branch circuits. NC, furnace & plug.
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: 2 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:
WARD WILLIAMS CANBY ELECTRIC INC
9453 SW LAKESIDE DRIVE 790 S IVY
TIGARD, OR 97224 CANBY, OR 97013
Phone: 503 - 624 -7231 Phone: 503 - 266 - 7878
FEES Reg #: LIC 26071
2123S
Description Date Amount SUP 3-112
ELE 3 -112C
[ELPRMT] ELC Permit 7/6/2005 $60.15
[TAX] 8% State Surcharge 7/6/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: ]_Z Permittee Signature: � �
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 -639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
f \
electrical herm Application pplicativn F(>RQ1 HCEU
City of Tigard , ® Date '' 6$
?omit No.: 4!� ,;
• 13125 SW Hall Blvd Tigard, 01L fl, 2�3C CE •
1 \ P1LtRovicw .
Phone: '50'.,639,417 Fax: 503.59 .960 r ' r i �� r, ones :.; f Other pcw t:
Inspection Line: 503,639.4175 •-.._l., DEC eadyndy: bait; 8} 8es Yaec 3 for ' •
Internet: www,cl,[igard.or•us t
[15i C; n� �p q Notit,ad/Metheds i i s s4pr2 a)tatorreatien
: � l: jt'{'�t t',y e '1 r c 1 { ., -/ =7,� Tod 14 1 t ` •�'f n f�...,�-I o '+ i � 4 L t
' . ; a,� - :.�. ._ '•JWf � . =�' M,6�RL F;: %*�, -b.. n ,>i���1'it, *��f�,?'.� r �. . , a �'� ,'n`p: •.. ".. •�� �� y- ��3y - k '�� G I i _ ,_
L /� 7 L ( I . •
1 .. 0 New construction igf..Adifi';Oii/alietatiVt7rep1 ctstne.nt • • ease check all that apply;
DI 1 .. QService over 225 amps, cornrn'i [Hazardous ideation
■ Detndlitiorl ❑ Qthet ` ®II�i� Service over 320 a
- r.• .,,,,,- � �q�,= ,���° 'r``'F " "� m ( "� � ❑ maps - rating ❑Buildng over 10 sq. it.,
q,. '' , , n � �n , . V ,c..i r .• too .. - ; - '' rt ,i o 1, , r oft • and 2- family dwellings 4 or more neW residential -
���� ❑System over 600 volts nominal units in one srrueture • I. 1'. and 2-family dwelling 0 Commercial /industrial 0 Accessbiy building •
D. Multi fatniJy ❑ Master bllildaf ❑. Qther; ❑ 13 uilding over three storied ❑Pcoders, 400 rumps or more •
M v _ ,.j,xL . ['occupant load over 99 persons ❑Manufactured structures Or
:t r i 4 •: t " tRao�b :i_ �t � ' �so ` ir. o c ,otr ••:, � i RV park ..
- . . 1,: 22 a rr 1. : i • Y .,rlullilAlpAr' - , - �t� Yy :t1 .. a,� ki?,: flif � ', � ]E gretsllighting plat.
[]Hearth -care facility ❑Other: _
`Job no :; Job sire address; 1 45 3 S.O. C to g �?
Submit 2 sets of plaru with any of the above. .
•
City /SS .teJZIP: '.- q atra54, The above art not applicable to tttmporary oonsrruotion set .
.. - "7 ,1116 5 •.f,. � ;. •ty' •s na.,.u G th e.,..a.T ;....
• SuitcJb1dg. /apt no.. Project name' t ..' , t ' a �-
- _ -- - osacriseen _
1 Cross streevdircctiotls to job site, Now resident .
residential single- or multi - family dwelling unit.
— ... ---, ractudes attached garage, •
• - 1.000 sq ft" or lass � " • ' ti •
•
• Subdivision: Lot no.; Ea. add'l 500 s•, it or portion 33,40' :. U
Limited energy, residential 75,00
faat•IIflp[ parcel RO -: • Limited energy, nom - resid ential 75
' ' V ." 4;44 r '� ` Jh r , i 140iTAr` a�"'t•, F . tu'�ila.7 1 ��' r ', f :717 1 W art.§ Bach manufactured or modular
:. S • `7'.. t r dtvellia service and/or feeder I 90.90 � •
an � • ,<�% �`�^ " Services or faadars Instillation, alteration, and/or relocation •
210 amps or leas • 80,30 • . • 2 1
+� �;{ r v+ , : y •�i }s , ^n r 7 m w t]l-WnI '^ f .b 7G 201 xtr,ps to 400 amps , 1 06.85 • ' 1. 2
- ec zl . z51 r 401 amps to 6 00 amps 160.60 2 '
Name' " 'IA \ 601 amps to 1,000 amps I 240, 60 ..Z .. •
et Address; over 1,000 amps or volts
454.65 ®
___
0 Rocannect,Only ME 66,85 mon
. .City/S4te/ZJP: Temporary services or feeders Installation, xlteratloa, yn.d /or '
•
phoGb, . ' Fax ) relocation
(5 3) (,Z - �1._, t 200 amps to less 66.0 ,
Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 '
' .intended far sale, lease, rent, or exchange, according to ORS 447, 0 449, 0670, ai[d 701 401 i 2t� , s to 604 amps 133.75 2
Owt1 r Signature: _- Data: • - teraneh circuits - new alteration, or extension, per panel' •
.�_ ;, ..„ xeaTO. 17-�rrg y;'i, , {+ .177;;i t T lil vary `Yl� , ?1 A. Fe branch circuits with
r ''. i' rat. :,, r zY ie 't . ;''.,z1Fy� t 'tf ,
k2. ' ; �, Nt- r:;t:4, --, y , :a `i,: !� 4 r 1 r., e t
I
Vii,.. t.,r: aF' f n' `1,� .` �-`� -' {� � l � .(��a �5,...- •fi'. ;�'71,...�:i= �S���'t;'. iL7. .:�:i�lu�l',t,:Y:JI+.. � �,
S��J y.WA
,�.:a,:,.t�` . �r: �.l •.Z,:a. t .:, .r; �Ct�` �". •_•- service or !ceder fee, each
6,65 • I 2
. Busiiteas names: branch circuit
B. cc for branch circuits
• Contiet t19II1c: Without service or feeder tee, ` 46.85 /4 2
each brunch circuit •
Address: ?daoh add'1 trrar c _ 6.65 1 3 2
City /Slate/VP: MTscellanenus (service or feeder not Included) • •
- Purrs• or irrigation circle 53.40 i '2
• Phone ( ) Fax; ; ( •) • $i , or outline lightin s 51.40 1 2.
E Signal oircuit(s) Or Limited-
• � r� ���'� (��C!!H f•� i t C i1alF,y p6z,e1, alteration, or
' v- ` :1f 1C :A , Xul' t • '. d t r- 1X--.' a :�Fb �t t mk a e, extens D escribe 1 Page 2 2
Business name: E , ,_, -
Each additional inspection over allowable in any of the above
Address: 1 cl (�_,. _ Si- • Yet ins. action I 62-50 —
`) liwtstiger!en .er h (1 `.•r miii) 62,50
city�s��z �,,b P 73.75
— �9 t �� - Industrial plant per hour
w S. Fax: (C( 3) 'ZIp 4. = `{ "'S r °S'1 I. au ' +.g' qtr,:: :;'V :
Photo: (� n.3) - 2-La 1 1 , �if'i J?tT.:ii.,,•
1 CCB Lie, ? (., p 'i i Electrical Liz - 1 . -1lZ C,,. Supv. Lc.: 2 1 Z3 a Subtotal (p Q 4
. 'j
�...a . -. —... r
�... _._...._ Plan re��c.•ti' (2 = °/ o permit fcc) _
Suprv. Eleun signature, required, t j - t h -
$1 sv-t:hargr. i'a% of permit fee) +t o i
- _.... - Darr:.— - -- ---- . _ _ •
print Hama:. . L� ) i,1 i c :� ...��. v p� — T0TAL. PP+R �T Flt . _`' - • / (o
� . (\ — [ / � � —� Tilif ptrntit a � � uY tr <.e if u peru,lt f4 not obtsla0d wfrbin 150
Authorized signature. _�/�" l 4s a steer +: +:u, ,,..nt1 Accepted 4f Complett
Prtnt name: ` I Date: j p ° Pet rlelbodolvgy let by , if ildiag mdi ne ' Service oar
�..� f -. -t , r• l) t.` -� t.C..,l "�`_(. �,J Number or_apc:'r ;;a; L'.;avtd.
CZedina • ,:.c. r _ -,V•; t . doe •.''U 4 -451 Sr(tOlOLCOU/wga
Td WdLZ : p0 SaOZ To ' I of 217SS99z2aS : '0N 3NOHd ON I 0 1 2110213 ),HNI : WO21d
„CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2005-00475
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2005
Phone: (503) 639-4171
. :4 1 411t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 7/13/2005 TIME: 7:10AM PAGE: 80
SITE ADDRESS: 09453 SW LAKE SIDE DR CLASS OF WORK:
SUBDIVISION: ALDERBROOK FARM LOT #: 013 TYPE OF USE:
PROJECT NAME: WILLIAMS
DESCRIPTION: (3) branch circuits. NC, furnace & plug.
OWNER: WILLIAMS, WARD PHONE #: 503-6247231
CONTRACTOR: CANBY ELECTRIC INC PHONE #: 503-266-7878
Inspection Request Scheduled For: Date: 7/13/2005 Pour Time:
Code # Inspection Description . ' •. # Contact # Message
145 A/C or heating unit circuit 0 '1 603-266-7878
Corrections/Comments/Instructions:
sotrft-sel s e•W E of4 LP
•
•
•
•
-PASS-- PARTIAL-ARRROVAL_ _O-CANCEL S [INC/ACCESS
[i] FAIL fl /ALL FOR IN '•E TION [1] ADDITIONAL FEES ASSESSED
' /3 03 S
Inspector: Date: Phone #: (503) 718-