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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00202 DEVELOPMENT SERVICES DATE ISSUED: 4/1/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S114BB - 01000 SITE ADDRESS: 10165 SW SERENA WAY ZONING: R -4.5 SUBDIVISION: PICKS LANDING NO.1 LOT : 009 JURISDICTION: TIG Project Description: Alteration of existing 120v service #TG26d4 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: JACKSON, JOAN G DRYER ELECTRIC INC 10165 SW SERENA WAY 9409 NE COLFAX ST TIGARD, OR 97224 PORTLAND, OR 97220 Phone: Phone: 503 - 771 -5667 FEES Reg #: ELE 26 -1142C Description Date Amount LIC 153466 SUP 2876S [ELPRMT] ELC Permit 4/1/2005 $80.30 [TAX] 8% State Surcharge 4/1/2005 $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 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 -800- 332 -2344. Issued By: � � .e 1 4 10- -- Permittee Signature: 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. 03 -30 -2005 13:46 FROM- T -933 P.021/043 F -594 01/ 2005 15:12 FAX 5035NS1Uuu , ...1.1.1 i.' • � "•6.6"' CI" Electrical Pern lit Application t 0 a E r1Sl: (1):11 V • (fi of Tie•d ILaJ / _ � _ �' PsrmltNo.: 'Li.ns �� t! ZS SW FIaI! Dlvt1� Tigard, OA 9722 Van Revie !�� 1 one: 503.639.x•171 Fax 503.598.1960 k::' Jil 1 DaDate/E1 : _ _ Other Ye tut rfspectlon Line:, . 403.0394175 _ a_ !t►- Pato Peady/ y: - — Jur • 121 Sce PagaaZ for ! ::ttcretet wor ::ai tigsrd•or,ui NatUFedtMetbod: --- / $upptemen9tl lnform3tioa _j • r; - : 1 - I F - s . ; , r rr i '' +,, - i • .' -• . c rialfRi ,, u; a. ' ' . Ytrs r ,. :tQ:1 ' i r e 4 ` ! y ' ; ha y , � � 10 ', • f! !t . Jl ! ..wis.... :.i -.,, ..r. ?: '. -_ ` -! New tIon8huction ❑ Addition !alteration /ztrplaoement Please check all rhs r,pp1Y ❑Service over 225 stop_, comtn'1 ©bi:rzardol:.; :ocatioi .: Dr molLtic n [] Other: ❑Service over 320 amps - raring ©BT.:Wing ol/er 10,000 ;q. ft. e1, .:' ` ,'' -Ir n . ' _I , _ ... L- �j l :1,1 ,; of i- and Z family dwellings 4 or more'ew residential ] 1 - and 246rrrly dwelling • MI Cammerc3a]1lndat6ttial a ,ttccasaory building ' C]Systtrn over 600 volts nominal units in orie structure ©Building over Mice stories OFccders, 400 amps or no% ] Multi food! • ❑ Master b>atlder ❑ Other: ❑Ocwpent lual: mac 99.pasons . ❑ivlanufaottlred strt100_u - es or •({ �s ^ !I IT ` r � � � I . \t . i . - � . I � _ 11 I .�.. r Y i � ` 0 E RV k gtess p lob no.: Job site = dress: • � � • _ ' 1 � r, ■ Health-core facixy [1Other: - . • .� •bmit 2 sets o1' p!•uts with any of the above. °ity/State /ZIP_- ',j • rank above are not applicable to temporary cons Ilion serv,ce. >. ,_. r ill 1 ' +• ;li >I! ..: °' .. i ll,.• Vii, • . ..Aire/bldg./apt. , W.: : j eat name: - ' . Ws ,.. s .. ' _ Dud ption :I::• YI .. :! ;- ity .• Fair `; „ 'Corn! 1 Toss strcet& ire ctior,s to job site: — tfcw residential single- or multi -1 imliy dwcllim1 unit — --• -- I.nclndes attanccd 1 =u r age. --_ I _ 1,000 sq. it, or leis 14-5.15 1 4 ubdivisicn T Lot no. Ea_ sdd'i 500 aq, t. or portion 33.40: 1 Limited coat &r, tesideriria1 75.00, 2 1' ax map/parc.el no_: Limited mall, ztoniesidentia► 75.0 + '- - , : � :, ' , i 1 ',''',:t7-,',"'.--- ; � ._ ` � .-...2:. - _ ..:, . 1 ' - - - - - --• :; . ` - 7n9nutaC:Bnd )r modular ' ` dweltin _,seiv;.ece'll�'orfeeder 40.98 2 � '� �, i �� � _ Services or faadl,rs Installation alt an relocation Jill y:. ! `,�L . 200 am or less MINI 80.30 '�i/ ` ► • � • -, : 201 tunes to 400 aznps 10681 Z 1; , l l -;;;1_2' r a _ 1 , _ . , , lr , a 401 amps to 6110 amps 160.60 i 2 ;�, ., CC 4 . : i. 41 ....A, ,. �_ . 60I amps to 1,000 an ps 24O.60 T _.. i 2 -- rldress• ^ / - Over 1,000 aa•.ps or volts III 454.65! 2 _ D (� ��GC�_N� 1' ` � Reconnect on 66.85 2 ityt'State/ZIl' q_a- ell_ , a-`-f Temporary 6e rvicas o r feeder4 ins aallatto alter atiot►, and/or relocation "Snide= ( ) Fax ( ) 200 asrlps or Ices , 66.85: - 1 i )wirer 11Sta11* lout This installation is being male on property that I own which is not 201 amps to 400 amps _ 100.30; ' 2 trended for sell:, Tense, or exchange, according to ORS 447, 449, 670, and 701. 401 argil w 60 arm 13335! 2 Jwndr signal lltlr: ,_ Data: c Branch circuit -uohw, alteration, or ox ntion,A, er a nel - r 1 A. Fee for brut; . circuits with ,+ ' � I :. . .. . l o_ "� .:- _. . .._ r service or feed et '. et', each 2 sss Business note! branch circuit _ 1 —... ---- -- - B. Fcc for bratict circuits "Ontaet RAMC: without sender. a :'ceder fee, 46.85 2 I each branvt circuit I Address: y — _ Each add'lbranc7 rc�it 6.65; 2 'ity /Starch! ?: 11lscellaneoue (ter 'ice or feeder pot included) _____ �-� — - �-- -w Pump or irtigodca circle 53.4 1 2 0011!:: ( ) : ( ) I Signor outline li ghtDSSt —.--.----.. _ 53.40 2 ' - mil. T Signal cirouit(;,) - -, l! T %ial+ energy tanliva•or I 16 ti 1 en ei, l lb 9. 1 _ extension. Desce.be. . Page 2. ' 2 - - w; r � . .4� .. .. -- 1 - ddress. — / I f /it -43114,1141.00. r I Each additional In! prctlon over allowable In any of the above Per inaeetior: — 1 E 62 ' s �' t ity/State/Z1P: / • tr.. ' Investigation per hour (r hr thin) I .t/ i r _ ! � 52.50 , t„,i,,et + .1-- + � Induatrlid lantea boor 73 7� 1 - / - ' Nif1 . Wa 1�' 7;Vei J i J9 il s ' '''' '+�;Fj ; I tl vB Lid : ,� I r >3lectrical Lie.: ,_ . Suprv. Lic. : . � ■ / , ' AA • • • • Subtotal d '',1prv. Electrician sip* ire, ragtlit'ed: 4 / Platt reric:v (25% of pe:mir fee) H 2._ p St 3 o ha rge ( of perrrut fen) •, cirtt name! 16'L , I.:7 �j �J l � `Z I paw TO xAx PEIIIV 1T FEE <I - _uthtnized 6pli; t This pertuitapplicarlva expires If a permit is cot obtain with a 1:0 - deyt :t;cr !rhos been avicepeed as complete ' - ' Tint name: Date: • Fee medtudo esy :r_t by Tri- County I: tattling [rdwiryl Servtoe 3oard • • Number of in:poetir per permit allowed. vul!d•IUa\PoradaaX l'intiMapdoc 1.'Y03 44o- 4 dint tworicoM/wES CITY OF TIGARD • . BUILDING DIVISION PERMIT #: ELC200Er00202 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 4/1/ 2005 Phone: (503) 639 -4171 44 � `� Inspection Requests (24 Hrs.): (503) 639 -4175 '°I — INSPECTION WORKSHEET FOR DATE: 4/8/2005 TIME: 7 :10AM PAGE: 32 SITE ADDRESS: 10165 SW SERENA WAY CLASS OF WORK: SUBDIVISION: PICKS LANDING NO.1 LOT #: 009 TYPE OF USE: PROJECT NAME: COMCAST DESCRIPTION: Alteration of existing 120v service #TG26d4 OWNER: JACKSON, JOAN G, PHONE #: CONTRACTOR: DRYER ELECTRIC INC PHONE #: 503- 771 -5667 Inspection Request Scheduled For: Date: 4/8/2405 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 004118 -16 503 - 516.3125 N Corrections /Comments /Instructions: PASS Ij1 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: Date: y- /If - OS Phone #: (503) 718-