Permit C ITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00690
DEVELOPMENT SERVICES DATE ISSUED: 9/19/2005
.V1111 13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171
PARCEL: 1S135CA-00301
SITE ADDRESS: 09645 SW NORTH DAKOTA ST ZONING: R -12
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: New service.
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
OREGON, STATE OF DEPT OF VETS AF WILSONVILLE ELECTRIC INC
Go JONES, RICHARD C C -01927 PO BOX 845
9645 SW NORTH DAKOTA ST WILSONVILLE, OR 97070
TIGARD, OR 97223
Phone: Phone: 503 - 638 -5353
FEES Reg #: SUP 3854S
Description Date Amount LIE 75752
ELE 3 -307C
[ELPRMT] ELC Permit 9/19/2005 $80.30
[TAX] 8% State Surcharge 9/19/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72 •
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 i :.. nce, or if .: 's suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility No • -tio' Center hose rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or dire• que ••ns to 0 NC a .03- 24..699 •r
1- 800 - 332 -2344.
Issued By: % Permittee Signat 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.
!? 05 07:47a Wilsonville Electric 5036389804 p .2
'Electrical Permit AppliTAtt A FOR OFFICE USE ONLY
City of Tigard G Received t /
13125 SW Hall Blvd., Tigard, OR 97223 ) U Plan . 1 L n R Review
Phone: 503.639.4171 Fax: 503.598.1960 I trSEP + v it" ' <v ", I prte/B . Other Permit:
Inspection Line: 503.639.4175 = a 41. j - ' I Date Ready/By: IIEM 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Methott Supplemental Information
CITY OF TICiARQ
Ib VISION PLAN REVIEW
❑ New construction .
A(TYPfityff Th ddition/alteration/replacement Please check all that apply:
❑ Demolition Other: ❑Service over 225 amps, conun'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lightingplan RV park
Job no.: Job site address: g f i/S �'
he .> T i`f ❑ Health-care facility 0 Other:
`�- . !ltcr'!t4 5 ":: Submit 2 sets of plans with any ofthc above.
City / State/ZIP: fi 4 , (2 v /'� The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I QTY. I Pea I Total I -'
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
1.5 � f A tA-4 ti Includes attached garage. _ _
• 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
`� dwelling, service and/or feeder 90.90 2
) L't..a/ . .j.411 Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 ft) ;=kj 2
❑ PROPERTY OWNER I ❑ 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
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 circuits — 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 46.85 2
Address: '
Each add'l branch circuit 6.65 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
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: J. } ^
L(/ / u �,%+1 V' .091...t-e" t3Ga:e - i r„ '�-- -n S L - -
Each additional Inspection over allowable in any of the above
Address:
eL e se. � -' Per inspection 62.50
City/State/ZIP: L . I., - !i ..t..� Investigation per hour (1 he min) 62.50
E Industrial plant per hour 73.75
S��
Phone: (.5u3) ,' r .. ,.J` .3 ,..9 .--3 (SI) J ' . ,r
) • 6 - S - 6- y ELECTRICAL PERMIT FEES*
CCB Lic.: 75 -7 ' Electrical __._ .; z 3 7 Z prv. L ' . 3,.r -41,/ `S Subtotal
Suprv. Electrician signature, req�t. ` Plan review (25 % of permit Fitt) Li L / r
J ' — L `�� State surcharge (8% of permit fee) ?
Print name: cdpi A r � L,t -f /4 ± O . D e. x. f .�
L•" % TOTAL PERMIT FEE d r e , - . J y
Authorized si r . This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print n w, " a ,_ / i` / / ell? i I Date: ,1 pe, • Fee methodology set by Tri- County Building Industry Service Board
`� • • Number of inspections per permit allowed.
istBuilding \PemiitsiELC.PenaitApp.doc 12103 440.4615T(I010?JComwEa
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00690
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/19/2005
Phone: (503) 639 -4171 v
Inspection Requests (24 Hrs.): (503) 639 -4175 "�I
_ I
INSPECTION WORKSHEET FOR DATE: 10121/2005 TIME: 7:08AM PAGE: 108
SITE ADDRESS: 09646 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: EVANS
DESCRIPTION: New service.
OWNER: EVANS, KATHY PHONE #: 503- 699 -3045
CONTRACTOR: WILSONVILLE ELECTRIC INC PHONE #: 503 - 638
Inspection Request Scheduled For: Date: 10/21/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 ° . Electrical final 018929 -01 503.638 -5353 N
Corrections /Comments /Instructions:
Pt
g PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: / 'L/ � Phone #: (503) 718-
.