Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00398
404, �� DEVELOPMENT SERVICES DATE ISSUED: 6/9/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S103CA -03500
SITE ADDRESS: 11565 SW TERRACE TRAILS DR ZONING: R -4.5
SUBDIVISION: TERRACE TRAILS LOT : 007 JURISDICTION: TIG
Project Description: Reconnect 200 amp meter base.
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: SIGNAUPANEL:
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
NOTOS, MARK N /GWEN C OREGON ELECTRIC CONST /GROUP
11565 SW TERRACE TRAIL DR 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 503 - 535 -2652
FEES Reg #: LIC 203
Description Date Amount SUP 4460S
ELE 26 -95C
[ELPRMT] ELC Permit 6/9/2005 $66.85
[TAX] 8% State Surcharge 6/9/2005 $5.35 REQUIRED ITEMS AND REPORTS
Total $72.20 .
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: h Permittee Signature: 1 \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.
JU - 2005 09:02AM FROM -OR ELECTRIC SERVICE 5035352763 T -234 P.001 /002 F -884
' r tutril.idl ,R'eraum rs.pputi:littttuu •
City of Tigard ��Q �r 6 9 CaS" Permit No.: o? .i a
ceiv
13125 SW Hall Blvd., Tigard, OR 97223 � Plan Review
Phone: 503.639.4171 Fax: 503,598. `"''" i ^ DateBy: Other Permit:
Inspection Line: 503.639.4175 ^ c ' L ± Date Ready/By: Iuris: 93 See Page 2 for i ck Internet: www.ci,tigard.or.us 60 - Notified/Method; 17 Supplemental Information
.. .: ... :' 1 YP> iV :WO NT! 6� . . . • . : ; :: .. . :PLAN REVIEW . ,
. `� 1
❑ New construction ® Addition/Qlic�l'a i � ement Please c heck all that app y
r,\ ['Service over 225 amps, come] ❑Hazardous location
❑ Demolition ❑ Other \N ['Service over 320 amps- rating ❑ Buildng over 10,000 sq. ft., •
:... CAxEGOR CONSTRUCTION of 1 and 2-family dwellings 4 or more new residential
® 1 - and 2- family dwelling 0 Commercial/mdustrial ❑ Accessory building ['system over 600 volts nominal units in one structure
❑ Multi-family ❑Master builder ❑Other: ['Building over three stories ❑Fccders, 400 amps or more
['Occupant load over 99 persons 0 Manufactured structures or
.' : .: ° ,. ; ' .: • : 'I JOB ;S E ; �NP'ORM4TION AND LOCATION • ::::. . . ❑Egress/lighting plan RV park
Job no.: 86276 I Job site address: 11565 SW TERRACE TRAILS DR. ❑Health - care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: TIGARD, OR 97224 The above are not applicable to temporary construction service.
Suite/bldgJapt no.: I Projcct name: NOTOS RESIDENCE+ SCHEDULE
nexdpdae I Qty. l Fee. I Total I"
Cross street/directions to job site: Ncw residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea, add'1500 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
RECONNECT 200 AMP METERBASE dwelling service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. , .. , .
201 amps to 400 amps 106.85 2
• . PRO1'Ys.R'1'X ;O WNER ; . • .1. ' .. .. , .
❑ TENANT • • • • :. .: 401 amps to 600 amps 160.60 2
Name: MARK NOTOS 601 amps to 1,000 amps 240.60 2
Address: 11565 SW TERRACE TRAILS DR. Over 1.000 amps or volts 454.65 2
Reconnect only + 66.85 1010 , 2
City/State/ZIP: TIGARD, OR 97224 Temporary services or feeders installation, alteration, and/or
Phone: (503)547 - 9754 I Fax: ( ) 2 00 m s
200 amps or less 66.85 1
Owner installation: This installation is bring made on property that I own which is not ` 201 amps to 400 amps 10030 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 . :. • . : : :.... , .I . :..... El • 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' I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53,40 2
Phone: ( ) Fax.. ( ) Sign m outline lighting 53.40 2
E -mail: Signal circuit(s) or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .0 O N T R A C T O R. . . . . . .: : CTOR. .: • , .. • , , . , . • .. .. energy panel. alteration. or
extension, Describe: Page 2 2
Business name: Oregon Electric Group _ -
Address: 1010 SE 11th Ave - Each additional inspection over allowable in any of the above
Per inspection 62.50
City/Stare/ ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50
Phone: (503) 234-9900 l Fax: (S03) 535 -2763 Industrial plant per hour 73.75
ELTCTRICAL::PERMIT FEES + ... .
CCB Lic,: 203 • Electrical Lic,: 26-c ,pry c.: 4460S _ Subtotal (04 . 5
Suprv. Electrician signature, required: , Plan review (25% of permit fee)
Stare surcharge (896 of permit fee) 3 _' 5
Print name: MO.Yk- a KZIn ' "/'
xo'rnl. PERMIT FEE - 72.. 20
i
Authorized signature: This permit application expires if a permit is not obtained within 180
e - days after it has been accepted as complete
Print name: Nk OM. . K 1 % • ' : 06/09/05 • Fee methodology set by Tri-County Building Industry Service Board
"• Number of inspections per permit nilOwed.
it Buildvrglpenui tslnl.C•PamitAppduc 12/03 440.4615T(10/02/COM/WEB
CITY F T
C O IGARD
BUILDING DIVISION PERMIT #: ELC2005 -00398
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/9/2005
Phone: (503) 639 -4171 � � h , } �(
Inspection Requests (24 Hrs.): (503) 639 -4175 :..:�_
INSPECTION WORKSHEET FOR DATE: 7/12/2005 TIME: 7:06AM PAGE: 57
SITE ADDRESS: 11565 SW TERRACE TRAILS DR F D Nl � 11 S A S OF WORK:
SUBDIVISION: TERRACE TRAILS LOT #: 007 TYPE OF USE:
PROJECT NAME: NOTOS
DESCRIPTION: Reconnect 200 amp meter base.
OWNER: NOTOS, MARK N /GWEN C, PHONE #:
CONTRACTOR: OREGON ELECTRIC CONST /GROUP PHONE #: 503 - 535`2652
Inspection Request Scheduled For: Date: 7/12/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 011228 -01 503. 849 -2754 Y
Corrections /Comments /Instructions:
• , AA C 061 Z1s1-\
p , PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
& 0 ( ?
Inspector: ► Date: � 7� O Phone #: 503 718-