Permit ELECTRICAL PERMIT
III CITY OF TIGARD,( PERMIT #: ELC2007 -00602
COMMUNITY DEVELOPMENT
DATE ISSUED: 8/27/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 134CA -03700
SITE ADDRESS: 11770 SW NORTH DAKOTA ST ZONING: R-4.5
SUBDIVISION: BURLWOOD NO. 2 LOT : 010 JURISDICTION: TIG
PROJECT: AUSTIN
Project Description: Installation of new electrical sevice.
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: 1 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:
AUSTIN, MATTHEW E DAN CORRELL ELECTRIC INC
9331 NW OLD SKYLINE BLVD PO BOX 16785
PORTLAND, OR 97231 PORTLAND, OR 97292
Phone: Contact #: PRI 503 - 761 - 7299
FAX 503 - 761 -2178
FEES
Description Date Amount Reg #: ELE 26 -103C
[ELPRMT] ELC Permit 8/27/2007 $80.30 LIC 67336
[TAXI 8% State Surcharge 8/27/2007 $6.42 SUP 46865
Total $86.72 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 952-001-11 0 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 =� : 1 / / Permittee Si Signature: r 1J
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.
AUG X 27 2007 12:48PM KP LASERJET 3200 5037612178 p.2
, tl -_ ec� tllcal Permit Applit>ratio gEC 1 JED I � I t ()III( i . t s 1 ( ) N I . ,
I N . 01 of Tigard ' 2 7 2007
pat :: Shr iS ` re�ir�.: _ AA. - 0 ?Pi
13125 25 SW Hall Blvd_, Tigard, OR 97223 P� Review
Inspec Phone: 503.639.4171 Fax: 503.59 AF
DITItSRIOND te/By: �� a fit- ® page 2 Ibr
Internet , ,, l? r) t ion Line: 503.639.4175
Btll� ' ,�.tigard -orgov G Wot i6edrMeth
T I ,. od (e Supplemental Information
F -.r .i: ''fir.•.
.� =' :I rti% , •`i� ..t. .., rk•e ,. "�1.'�'�� -_�� •, -. .. .f- ., � r . :,', r .. , .. : - -x*' =' t
❑ Ncw construction ' Addition/alteration/replacement Please d apply (submit sets of plum w /its checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ❑ Other: _ '::.: where the available flat current ❑ Marinas and boatyards. •
y _ ` ,;, , ti _ e ?, U. l K i : l" ';r> �'�' •P . ; '. or buildings.
i exceeds 10,000 amps at 150 volts ❑ Floating dings.
}l.':v i.' { °..'1 . '!"Ti V'. , �.;xS�',� -,, •3'/ ✓., :' :.i sj
•� dwelling lento grrnmd, or exceeds 14,00o ❑ Commercial-use agricultural
-and 2-family ng ❑ Commercial/mdustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑, Other: ❑ Fire pump. ❑ installation .owf� KVA or
'. ti. rA'::'r'7A l z ' ' 'a:.
•g' :' %� '; , =i'• .ri - °iii . ma -: ;1 ❑ cy �em, huger separately derived system.
•' °'� 3 "s''?� ���li -. _ ",; y _ '•;;:._; ❑aaditioaof loaaof ❑a a ,t •
Job no.: a,� Job site address: ! ,2,. YT� Jr ❑ Six more residential units. ❑ c at vehicle pates.
�
City /State/ZIP: b � !!! 5t. ❑ Health.cans facilities. 13 �pbp voltage for mote than
❑Iiarardoas locations. 13 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Savice or feeder 600 amps or snare.
f'_
CIO Street/dlre ■ � ° .._f4.�•.�� <,. 4 Fee. n a:i�:i7 `
,.,� ., -� '. ��,,,.,1,
C pons to job site: i ; t. e; I ;•,..: r ., }'t
.. 1 'hid i
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 _ 4
Tax map /parcel no.: _ Ea. add'1500 sq. it or portion 33.40 1
b i ""t ,Y " i r ;?, �,.Y�.'4; �h.. ., _ ..y � -� : �.�: /:• -'• - - ... l W Limited energy, residential 75.00 2
tttiM 4
. a, , '! -..1- r., . ? .�7 ; f - ' "'4! .,- - . i : ..- :'" l '�i,�
.'b ":r''= `: (with above sq. n ft)
F-^ 1 I��_ 7 Limited energy, multi +family
l f t1/4t ' 4 /,7 ! r/GUL) - l cif residential (with above sq. It) 75.00 2
Services or feeders installation alteration, and/or relocation
/2/1 200 amps or less / - 80.30 Se). 3a 2
a�rr
gi z
:
. >:;f:r';.+ ,� :. :.. ''.�- . �� "., { - ,- , : .i4±��ry`' .� ; ..,. x:;:: .,:. . _ 20L amps to 106.85 2
Name: /�. it v - Q� k s e 401 amps to 600 amps 160.60 2
/ J V 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: 62 / � �
PC' � � - /v( Temporary services or feeders installation, alteration, and/or
c P -^' � Q relocation
Phone: ( ) I Fax: ( ) 200 amps or less . 66.85 I l
•
Owner installatloa: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 1 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 ertentiion, per panel _
Owner signature: Date: = A. Fee for branch circuits with
• :A '' "a; > s " r:• ,;'~ - i l i , „.!.. , above Service or feeder fee,
f+r?u't " „•. �1: .
•: :Q s 6,65 2
r "� each branch circuit
Business name: B. Fee for branch circuits •
Contact name: l h without service or feeder tee, 46.85 2
• fast branch circuit
Address: - Each add'] branch circuit 6.65 2
a ! Miscellaneous (service or feeder not included)
• City/State/ZIP: D Each manufactured or modular 90.90 2
Phone: ( ) I Fax : ( ) dwelling, service and/or feeder
Reconnect only 66.85 2
E Pump or irrigation circle 53.40 . 2
, -g.i r7•-' v' ;:; t'J' i:• =':i. r ' lighting 53.40 2
Signal c
_ - ,r.Rvd.m �`...(',i:.;� . ��l.; : �• i,. -'.s� ..�. .i':�� ^.,'�. .'..;1 , .:,.: v yM1"/. - ��,o :`i`' "�� S m outline
Sign circuit(s) or limited-
Business name: .4� g"9/-2:ed_We . �,:ve. energy panel, alteration, or - pd� e � d p- extension. Describe: Page 2 2 J 1'.. � if
City/State/ZIP: tP,v/► /z,n rte-- Q'7.2q� Each additional Inspection over allowable in an of the above
f / � - Per inspection - 62.50
Phone: Sp ) i Z Fax: ( ) .. '- / 2- ( / Investigation per bow (i hr mm) 62.50
CCB Lic.: El ectrical 1 ' Suprv. Lic. i In plant per hour 73.75
i a
Suprv. Electrician signature, r "t• ,. ;t ''' e.,�3 i f �� S L..a,= 'i
a t�/ / /..7 �% i Subtotal: ; y
.` - _ _ _ Plan review (25% of permit flee):
Print name � � ` _ /' % /r D :1,- : 2 p '� en
State surcharge (8 % permit fee):
Authorized signature: , TOTAL PERMrr FEE: 2,
Print name' Date' This permit application expires if a permit is not ot> d within 130
days after it has been accepted as complete.
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•
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELC2007- 00602
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/27/2007
Phone: (503) 639 -4171 ��
Inspection Requests (24 Hrs.): (503) 639 -4175 I �I
INSPECTION WORKSHEET FOR DATE: 8/31/2007 TIME: 7:00AM PAGE: 50
SITE ADDRESS: 11770 SW NORTH DAKOTA ST CLASS OF WORK:
SUBDIVISION: BURLWOOD NO. 2 LOT #: 010 TYPE OF USE:
PROJECT NAME: AUSTIN
DESCRIPTION: Installation of new electrical sevice.
OWNER: AUSTIN, MATTHEW E. PHONE #:
' CONTRACTOR: DAN CORRELL ELECTRIC INC PHONE #: 503-761-7299
Inspection Request Scheduled For: Date: 8/31/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 054919-01 503 -201 -7138 N
Corrections /Comments / Instructions:
D ).--.
A PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- N&) L-G Date: 1: 1 1 Phone #: (503) 718 Z4