Permit CITY OF ELECTRICAL PERMIT
F ° - TIGARD RD " T VHS( PERMIT #: ELC2008 -00330
COMMUNITY DEVELOPMENT DATE ISSUED: 6/11/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 125DC -02900
SITE ADDRESS: 07160 SW VENTURA DR ZONING: R -4.5
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT : 022 JURISDICTION: TIG
PROJECT: JOHNSTON
Project Description: Installing (1) branch circuit for laundry room remodel.
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: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 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:
MICHAEL & MARY JOHNSTON DAN CORRELL ELECTRIC INC
7160 SW VENTURA DR PO BOX 16785
TIGARD, OR 97223 PORTLAND, OR 97292
Phone: Contact #: PRI 503 - 761 -7299
FAX 503 - 761 -2178
FEES
Description Date Amount Reg #: ELE 26 -103C
[ELPRMT] ELC Permit 6/11/2008 $46.85 LIC 67336
[TAX] 12% State Surchar 6/11/2008 $5.62 SUP 4686S
Total $52.47 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 -0010 through OAR 952 - 001 -0100 You • - • • -in copies of these rules or direct questions toe • at 503.246.• •99 or 1.800.33 44
Issued B `
Y ` rs � ` � �' ` rmittee Sig nature: / . � /I /-
' NER 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 Application FOIi OFFICE USE ONLY
City of Tigard
��"� ?Li! DDate/13y ✓ ✓J✓ y // G Perinit No p� '} f��u1Z j� n 13125 SW Hall Blvd., Tigard, OR 97223 b88b�44� J� Plan ReviewT Other Permit •3i4•t.
' C Phone: 503.639.4171 Fax: 503.598.1960 1 O vuu Date/By
ww�` Date Ready/By Suns 65 See Page 2 for
T f p
C n R Inspection Line: 503.639 4175 ,U1v
Internet' www.tigard or.gov , G p,R� Notd;ed/Method. Supplemental Information
VOI TYPE OF WORKC` � g A �r Sl � P LAN REVIEW
El New construction liAddition/alteratiot ment Please check all that apply (submit 2 sets of plans w /uems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
100HP or more occupancy
Job no.: Job site address: 7/ ) ..,54) de,/...)6r4, ❑ Six or more residential units ❑ Recreational vehicle parks
City/State /ZIP: 71 ❑ Health facilities ❑ Supply voltage for more than
�� ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: , / r� ❑ Service or feeder 600 amps or more
, ' ' FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 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
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. 0) 75.00 2
Limited energy, multi - family
14/1 tin( C 1 fr ® residential (with above sq ft.)
75.00 2
_` �/ ! Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: Q S � [p B. Fee for branch circuits Yr
Contact name: / without service or feeder fee, 46.85 Y� 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
•
' CONTRACTOR Sign or outline lighting 53.40 2
- / ' ' Signal circuit(s) or limited-
Business name:
d- _i .0 iG _.../A energy panel, alteration, or
Address: f )/ /6 71(5 extension. Describe. Page 2 2
City/State /ZIP: *,1A- e v (/ie..... - z- -- Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: f ) d , Fax: }- T� Investigation per hour (1 hr nun) 62 50
CCB Lic.: a ---7 = • Electri .j 0 Suprv. I�� Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, t .' � �� / , / � Subtotal: , r , 3
Print name: / Date: Plan review (25% of permit fee).
4-' ` I r � State surcharge (12% of permit fee). S F-
Authorized signature: / . TOTAL PERMIT FEE: 52 , 7
This permit application expires if a permit is not ob aE ined within 180
Print name: Dat days after it has been accepted as complete.
f
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008-00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/2008
Phone: (503) 639 -4171 ,is
Inspection Requests (24 Hrs.): (503) 639 -4175 s 61- IL
INSPECTION WORKSHEET FOR DATE: 6/1212008 TIME: 7:02AM PAGE: 34
SITE ADDRESS: 07160 SW VENTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT #: 022 TYPE OF USE:
PROJECT NAME: JOHNSTON
DESCRIPTION: Installing (1) branch circuit for laundry room remodel.
OWNER: JOHNSTON, MICHAEL & MARY PHONE #:
CONTRACTOR: DAN CORRELL ELECTRIC INC PHONE #: 503 - 761••7299
/0 i
Inspection Request Scheduled For: Date: 6/12/2008 Pour Time: . #0 /0
/'v o
Code # Inspection Description Confirm # Contact # Message /�
1 2 5 Wall cover 071280 -01 503-201-7138 Y ,l�dv Gf Cai5
Corrections /Comments /Instructions:
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• / PASS ❑PAR L APPRO ❑ CANCEL ❑ NO ACCESS
_ FAIL ❑ • . FOR 1 51 3 - ON El ADDITIONAL FEES SSESSED .
2 .,/
Inspector: 7 ' ' Date: / Phone #: (503) 718- ) 7
CITY OF TIGARD -
BUILDING DIVISION PERMIT #: EL-C2008 -00330
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/11/20011
Phone: (503) 639 -4171 i l l
Inspection Requests (24 Hrs.): (503) 639 -4175 ':� -
INSPECTION WORKSHEET FOR DATE: 6/27/2008 TIME: 7:01AM PAGE: 10
SITE ADDRESS: 07160 SW VENTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT #: 022 TYPE OF USE:
PROJECT NAME: JOHNSTON
DESCRIPTION: Installing (1) branch circuit for laundry room remodel.
OWNER: JOHNSTON, MICHAEL & MARY PHONE #:
CONTRACTOR: DAN CORRELL ELECTRIC INC PHONE #: 503 - 761 - 7299
Inspection Request Scheduled For: Date: 6/270000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 071951 -01 503 - 309 -0763 N
Corrections /Comments /Instructions:
Nb cc—` 1 c 160 13
(k. a \)N■a_e 0 wie Vt
6 Fl. 1.i\Nzi c
J,
'!) PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
II FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: • N91_ - - Date: 6(11M) Phone #: (503) 718 -2N%-