Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00987
.1Ii DEVELOPMENT SERVICES DATE ISSUED: 12/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102AB - 03600
SITE ADDRESS: 12285 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
.OA -510 140a5
FEES
Description Date Amount Reg #: ELE 5 - 55C
[TAX] 8% State Surcharge 12/30/200' $4.28 LIC 151939
[ELPRMT] ELC Permit 12/30/200' $53.50 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- 9b-33 2344.
Issued By: ,c�%� Permittee Signature: ,27 a g
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 01:02p GOLD STAR ELEC 5035434025 p.5
'lectrical Permit AigErtigli j V E D FOR O F l f (' k USE O N L1 ed
City of Tigard 9 Date/By: W OS 66 Permit gae —oa r
13125 SW Hall Blvd, Tigard, OR 97223 DEC 2 9 200 Plan �
Phone: 503.639.4171 Fax 503.598.1960 . R a' I .. ; Date/By. Pe1m
Inspection Line: 503.639.4175 CITY OF TIGARD ! ' ' �-. Dam Read '°� See Page 2for
Internet: www.citigard.or.us BUILDING DIVISION Notified/Method: 11 I supplemental Information
TYPE OF WORK PLAN REVIEW •
❑ New construction El Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other ❑Service over 225 amps, comm'l ['Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. f,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑ 1- and 2- family dwelling II Commercial industrial ❑ Accesscay building ❑System over 600 volts nominal units in one structure
❑M builder ❑ Other
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - famil
Multi-family ❑Occupant load over 99 persons 0 Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
J o b n o . : i ' J o b s i t e a d d r e s s : / L r S l y , v ( t a n . c T ❑ f ty El Other ��� I ! ��O Submit 2 sets of plans with any of the above.
City/State/ZIP: 77'-?' „, 7,2 The above are not applicable to temporary construction service.
Suite/bldg./apt no.: _ /� FEE* SCHEDULE
I Project name: . Y P�11 L � ��� Description I Qty. I 6m I Total I ••
Cross street/directions to job site: New residential single- or multi- family dwelling met.
o Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add9 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
. Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
In
dwelling service and/or feeder 90.90 2
C i ( 2 ) � 10 /0.. / e C:9/1/ K --C ��� Services or feeders efallation, alteration, and/or relocation
/t // s � e 7C /9t.- / 200 amps or less 80.30 2
PROPERTY OWNER 1 d4 ❑ 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: ( ) 200 amps 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 600 amps 133.75 2
Owner signature: Date: Branch results — new, alteration, or extension, per panel
❑ APPLICANT ❑ 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,
each branch circuit f . 46.85 Zi[� 2
Address: Each add'l branch circuit / 6.65 _ 2
City/State/ZIP: • Miscellaneous (service or feeder not included)
one: ) I Pump or irrigation circle 53.40 . 2
Fax:: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuits) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business Warne- 7G� , s - / :„.,.... &f,, „1,
Address: r 9 /� Each addilhmal limited-
over allowable in any of the above
t� /,�i� ��! Per inspection 62.50
City/State/ZIP: . C /i ,� ? . �� S -? „ 9-,- 5Z Investigation per hour (1 hr min) 62.50
Phone: (50 � 7C-1. - L L 3 1'Fac (yn) 5 ,) 5 plant per hour 73 -75
ELECTRICAL PERMIT FEES'
CCB Lic.: /37 93 `/ Electrical Lic.: "73 V I Suprv. Lic.: C Subtotal 5 3
•
.
`"�^ Plan review (25% of permit fee)
Suprv. Electrician sivlature, requited / -(ifs
/ � r + State surcharge (8% of permit fee) (,/, r `'
�1
Print name: "-el -1 C ,� n ,� ( _ D �R ` f 0� TOTAL PERMIT FEE S (/�
Authorized signature: J % ` % � 1 /(1,�. y , i /,-- '. _ `. . This permit application aspires if a permit h not obtained wf D 180
/' ✓. ( days after It has been accepted m complete
Print name: 41 }n l � I Date: X d - i rT • Fce methodology set by 1ti- County Building Industry Service Board
3
•
Electrical Permits Completed a/o 1/31/06, 12297 SW Main St., Tigard
•
Permit Address Scope
EL 2005 -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.
EL 2 005 -00984 12271 SW Main St. 6 branch circuits and compliance repairs.
ELC2005 -00985 12259 SW Main St. 5 branch circuits and compliance repairs.
ELC._2005 -00986 12255 SW Main St. 4 branch circuits and compliance repairs.
ELC2005 -00987 12285 SW Main St. 2 branch circuits and compliance repairs.
ELC._2005 -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 #: ELC200500M7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/31)/701)5
Phone: (503) 639-4171 4 0 4 ,1610,1
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/31/2006 TIME: 7:01AM PAGE:
f•1
SITE ADDRESS: 12285 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ESP PROPERTY /VACANT SP.
DESCRIPTION: 2 branch circuits for compliance repairs.
OWNER: JOHNSON!, WARREN W + BETTY TRS AN, PHONE #:
CONTRACTOR: GOLD STAR ELECTRIC PHONE #: 503 - 274-4E
Inspection Request Scheduled For: , • Date: 1/31/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical 'I 026005 -02 971 - 219.2810 N
Correctio - • -: • /Instruc 'ens:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Al 68 t.C' Date: ` 3 8'6 Phone #: (503) 718-
1
t t
CITY OF TIGARD
BUILDING DIVISION PERMIT #: E C2005..001:?87
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12130/2.005
Phone: (503) 639 -4171 '% I(Ill'
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/30/2006 TIME: 7:01AM PAGE: J3
SITE ADDRESS: 12285 SW MAIN ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ESP PROPERTY/VACANT SP.
DESCRIPTION: 2 branch circuits for compliance repairs.
OWNER: JOHNSON, WARREN W • BETTY TRS AN, PHONE #:
CONTRACTOR: GOLD STAR ELECTRIC PHONE #: 503 274-4653
Inspection Request Scheduled For: Date: 1/3012006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 025947 -05 971 - 219 -2810 N
Corrections /Comments /Instructions:
CO I2nvlb gi ActOs b Nat.. `fo G-ititv nt CLt Y
c.iat lot.) 4 ( W FI-L._ .
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL A CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 V V) Date: ‘" . 60 ^ 6 0 Phone #: (503) 718- 1 82