Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00988
.11.11(1 DEVELOF5MENT SERVICES DATE ISSUED: 12/30/2005
r s 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102A6 -03600
SITE ADDRESS: 12289 SW MAIN ST ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: 2 branch circuits for compliance repairs.
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: 1 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:
JOHNSON, WARREN W + BETTY TRS AN GOLD STAR ELECTRIC
JOHNSON, REES C + MARYANNE G 51627SW 5TH
3112 SW SANTA MONICA ST SCAPPOOSE, OR 97056
PORTLAND, OR 97201
Phone: Contact #: PRI 503- 274 -4653
603.55/9 $
FEES
Description Date Amount Reg #: ELE 5 -55C
[ELPRMT] ELC Permit 12/30/200' $53.50 LIC 151939
[TAX] 8% State Surcharge 12/30/200' $4.28 SUP 3305S
Total $57.78 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- 0- 332 -2344. �L�/ "_ •
Issued By: � cr,�GG ) Permittee Signature:_4E2 2
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.
Dec 29 05 Ol:Olp GOLD STAR ELEC 5035434025 p.4
Electrical Permit ApjAnfg@EIVE 1 F01: orrbci: I SE ONLY
City of Tigard - 05/ • • Permit No.: J. , . 260 - egDq I(
13125 SW 14a11 Blvd., Tigard, OR 97223 2 Q �O Phan Date D Vi
By
Phone: 503.639.4171 Fax 503.598.1960 DEC , c� �'" a� r!��. ;,, Permit:
Line: ne: 503.639.4175 '' !, - f ±� ateBy ad Seepage 2 for
Internet www.cLtigard.or.us CITY OF TIG - Notifed/Mehod: I Supplemental Information
o K DIVISION
v
PLAN REVIEW
❑ New construction Ig Addition /alteration/teplacement Please check all that apply:
❑ Demolition O�� ❑Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps —rating ❑ Buildng over 10,000 sq. it,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling V3 Cnmtnercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one stilicIore
❑ Multi - family ❑ Master builder ❑ ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RII park
O
Job no.: i7 /5 Job site address: / oZ 5e) S/a J Mutes ,S (( • ❑Health -care facility ❑Other.
Submit 2 sets of plans with any of the above.
City/State/ZIP: 2 P/ / /i9/2— The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: ' � 1 I Project name: fSA ,4 - 0f /p�,mv „// FEEC SCHEDULE C 1 Qty. I Fm I Taal I ••
Cross street/directions to job site: New residential single- or multi- family dwelling milt.
a Includes attached garage.
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
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
� C dwelling, service and/or feeder 90.90 2
� wi /( K e� � 1r� Y . Services or feeders installation, alteration, and/or relocation
/7 J/ y. 4', .5//J ,��d 200 amps or less 80.30 2
r / PROPERTY OWNER [ ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 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: ( ) I Fax: ( ) relocation
made on 200 amps to or less 66.85 installation: This installation is 3 0 2
intended for sale, being property that I own which is not 201 amps to 400 amps 10030 2
e, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Opt to 600
amps amps 133.75 2
Owner signature: Date: Branch drealla — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
Address: first branch circuit 1 46.85. t� 2
Each add'I branch circuit / 6.6S j LLL(LL r . / 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 -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 6 ,k( , 7 ce Ei/,e-X__?
Address: ! &l j . ?/0 Each additional inspection over allowable in any of the above
City /StatelZIP; G Per earOO 62.50
'ze. �7l)S<P ��� ,7 investigation per hour (l hr min) 62.50
Phone: ( ) F ( industrial plant per hour 73.75
�� � � ELECTRICAL PERMIT FEES*
CCB Lie.: / s1 Electrical Lic.: 7 9/ I Suprv. Lie.: 95.5 Subtotal �/
Suprv. Electrician signature, 5
prv. gastric, requited: G t.te Plan revie (25% of fee)
Print name: Date: C /v State surcharge (8% of permit fee)
J 1, S�
77_,;/,7_44 J� / TOTAL PERMIT FEE ,5/ -2 Authorized signature: f 1 /4 `/ f y,� ' _Le-- j 9��, ^ This permit application expires if a permit is not obtained within ISO
J ✓ C ! l e ��� Y/fGeT. ,G days after it has been accepted as complete
Print name: /l / L I Date: /..? 'i5” Fec methodology sd by Tri_Couoty Building industry Service Board
Electrical Permits Completed a/o 1/31/06, 12297 SW Main St., Tigard
Permit Address Scope
ELC2005 -00858 12297 SW Main St. Service upgrade, meter relocations,
installation of meter mains.
ELC2005 -00983 12265 SW Main St. 6 branch circuits and compliance repairs.
ELC2005 -00984 12271 SW Main St. 6 branch circuits and compliance repairs.
ELC2005 -00985 12259 SW Main St. 5 branch circuits and compliance repairs.
ELC2005 -00986 12255 SW Main St. 4 branch circuits and compliance repairs.
ELC2005 -00987 12285 SW Main St. 2 branch circuits and compliance repairs.
ELC2005 -00988 12289 SW Main St. 2 branch circuits and compliance repairs.
ELC2005 -00989 12297 SW Main St. 6 branch circuits and compliance repairs.
All complete through final inspection approval.
CITY OF TIGARD - .
BUILDING DIVISION PERMIT #: ELC2005-00S88
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/30/20m Phone: (503) 639 -4171 , e ,� i r�
Inspection Requests (24 Hrs.): 03) 639 -4175 °:_
INSPECTION WORKSHEET FOR DATE: 1/30/2006 TIME: 7:0.1AM PAGE: 31
SITE ADDRESS: 12289 SW MAIN ,T CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ESP PROPERTIES! LENT PEARL
DESCRIPTION: 2 branch circuits for co pliance repairs.
OWNER: JOHNSON, WARREN W BETTY TRS AN, PHONE #:
CONTRACTOR: GOLD STAR ELECTRIC PHONE #: 503 - 2744553
Inspection Request Scheduled For: Date: 1/30/2006 Pour Time:
Code # Inspection Description nfirm # Contact # Message
199 Electrical final 0._`.947 -06 971- 219.2810 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: NW L Date: 1/36164, Phone #: (503) 718-24114