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Permit C ITY OF TI GAI$D ELECTRICAL PERMIT PERMIT #: ELC2005 -00664 DEVELOPMENT SERVICES DATE ISSUED: 9/9/2005 • 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 BD -00309 SITE ADDRESS: 09945 SW PEMBROOK ST ZONING: R -3.5 SUBDIVISION: PEMBROOK HEIGHTS LOT : 009 JURISDICTION: TIG Project Description: (1) 200 amp service, (1) branch circuit. 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 WIO 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: BRIAN HOWE ELITE ELECTRICAL CONSTRUCTION CO. 9945 SW PEMBROOK ST PO BOX 306 TIGARD, OR 97224 ALOHA, OR 97007 Phone: 503 - 944 -3963 Phone: 503 - 848 -8766 FEES Reg #: LIC 162845 ELE C61 Description Date Amount SUP 31010 1 [ELPRMT] ELC Permit 9/9/2005 $86.95 [TAX] 8% State Surcharge 9/9/2005 $6.96 REQUIRED ITEMS AND REPORTS Total $93.91 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 direct questions to OUNC at 503- 246 -6699 or 1 -800 2 -2344. _ /� Issued By: 27,,JZ, Permittee Signature: / _ d46 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. Electrical Permit Applica } -' ECEI1 FOR OFFICE: USE ONLY • ; City of Tigard Received Permit No.. tY g DateB . _ � • �. - ()„ 13125 SW Hall Blvd., Tigard, OR 97223 SEP 0 9 „.1! Plan Review ' Phone: 503.639.4171 Fax: 503.598.1960 ' ", i '• Date/8 • Other Permit: Inspection Line: 503.639.4175 -.- ' Date Ready/By. ® See Page 2 for Internet: www.ci.tigard.or.us CITY OF TI - - D Notified/Method: Supplemental Information TYPE PUMP P UNISIUN PLAN REVIEW ❑ New construction gAddition/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. ft., CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential 21 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family ❑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/lighting plan RV park Job no.: I Job site address: Yfgs /'e .k. 6cs ❑Health -care facility ❑der • � - Submit 2 sets of plans with any of the above. City/State/ZIP: / i 6.. Die The above are not applicable to temporary construction service. Suite/bldg. /apt no.: Project name: FEE* SCHEDULE Description I Qty I Fee. I Total I .. Cross street/directions to job site: / e 6 74 New residential single- or multi - family dwelling unit. • Includes attached garage. 1,000 sq. R or less 145.15 4 Subdivision: Lot no.: Ea. add'I 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 dwelling, service and/or feeder 90.90 2 F A' A N C / ` ^e _ � Services or feeders installation, alteration, and/or relocation /j �P r i% c „d 200 amps or less 4 80.30 R' 031) 2 EI PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: g, r �N .// ,.., , 601 amps to 1,000 amps 240.60 2 Address: 9 57 7S 5�.„ /02 Over 1,000 amps or volts 454.65 2 7/ - 0 - b y „� Reconnect only 66.85 2 . City/ State/ZIP: �e.1) © Temporary services or feeders installation, alteration, and/or relocation Phone: (gay) 9 Lf z,/_ 9,7 C 7' Fax: ( ) 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 s. APPLICANT I ❑ CONTACT PERSON A Fee for branch circuits with , / // service or feeder fee, each Business name: !� � G-r �e �LQC 'tC,e. s.� 7 ...:-.A - branch circuit / 6.65 0 -. �` 2 � Q � /1 / B Fee for branch circuits Contact name: � h/ service servicic feeder or feeder fee, Address: / C s' 7, 7 ' /ILe each branch circuit 46.85 2 Each add'I branch circuit 6.65 `a. 2 City / State/ZIP: / / /(r ba v0 e)1 1 3 Miscellaneous (service or feeder not Included) Phone: (Sp,? ) �/ ,9 b 6 Fax: : ( ) Pump or irrigation lig lighting 53.40 2 circle 53.40 2 / Sign or outline lighting E - mail: 'e if & e/e 4 - t c�cbN. - fC'c , (� 74 - rry Signal circuit(s) or limited - CONTRACTOR energy panel, alteration, or D extension. Describe: Page 2 2 Business name: 'L /. b-2. A�-( . c ` 6viar Address: /..?...".‘ . - 4 7p 742 / /../..e._ Each additional inspection over allowable in any of the above aos • /� Per inspection 62.50 City /State/ZIP: /-4 /. A6rro Q/1? 77/2 3 Investigation per hour (I hr min) 62.50 Phone: (5i31) 4 -k' 7a";'' Fax: ( ) Industrial plant per hour 73.75 ELECTRICAL PERMIT FEES* �� CCB Lic.: /j 7 a) L� S' Electrical Lic.: '' ,,5'( Suprv: Lic.: 3/c/ )3 K.,0 i�� e 'a J --- Suprv. Electrician signature, required: ,�/ � /”. 4e�2 Plan review (25% of permit fee) s / � 9 State surcharge (8% of permit fee) y-" �� �c Print name: j, �. / Date: l p ^ S TOTAL PERMIT FEE Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board •• Number of inspections per permit allowed. 1:\ Building \Pennits\ELC- PennitApp.doc 12/03 4404615T(I0/02/COM/WID 9,3 n Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined........ $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* • ❑ Vacuum Systems* • ❑ Other: ( COMMERCIAL WORK ONLY Fee for each commercial system. $75.00 (SEE OAR 918- 260 -260) Check Type of Work Involved: ❑ Audio and Stereo Systems • ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation • ❑ Fire Alarm Installation ❑ HVAC • ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* • ❑ Medical ❑ Nurse Calls • ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other • • Total number of commercial systems: • • *No licenses are required. Licenses are required for all other installations • i:'Bui !ding \Perm itslELC- Penn itApp.doc 04/03 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2005.00664 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/9/2005 Phone: (503) 639 -4171 Ayid i ' Inspection Requests (24 Hrs.): (503) 639 -4175 ;' "LL. INSPECTION WORKSHEET FOR DATE: 9/12/2005 TIME: 7:04AM PAGE: 86 SITE ADDRESS: 09945 SIN PEMBRO + ST CLASS OF WORK: SUBDIVISION: PEMBROOK HEIGHT, LOT #: Q09 TYPE OF USE: PROJECT NAME: HOWE DESCRIPTION: (1) 200 amp service, (1) b ch circuit. OWNER: HOWE, BRIAN PHONE #: 503 -944 -3963 CONTRACTOR: ELITE ELECTRICAL CONST'' CTION CO. PHONE #: 503 -1348 -8766 Inspection Request Scheduled For: Date: 9/12/2005 Pour Time: Code # 1 section Description Con" rm # Contact # Message r i15 Electrical sery 01538 `, 01 503 - 944 -3963 N \6\ %0 fils■—. Corrections /Comments /Instructio s: K ________________L PASS ❑ PARTIAL APPROVAL ❑ CANCEL 111 NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: �, cit— ---7 Date: 9- 1)- Phone #: (503) 718 -