Permit ELECTRICAL PERMIT
il CITY OF TIGARD
° PERMIT #: ELC2008 -00010
o COMMUNITY DEVELOPMENT DATE ISSUED: 1/7/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S125DC-02900
SITE ADDRESS: 07160 SW VENTURA DR ZONING: R -4.5
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT : 022 JURISDICTION: TIG
PROJECT: JOHNSTON
Project Description: Service and (4) branch circcuits HVAC.
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: 1 W /SERVICE OR FEEDER: 4 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:
JOHNSTON, MICHAEL R + MARY ELLEN EVERGREEN ELECTRICAL CONTRACTOR
7160 SW VENTURA DR PO BOX 1212
TIGARD, OR 97223 SANDY, OR 97055
Phone: 503 - 235 -5895 Contact #: PRI 503 - 668 -4608
FAX 503 - 668 -0308
FEES
Description Date Amount Reg #: ELE 3 -472C
LIC 136311
I;LPRM "fi ELC Permit 1/7/2008 $106 90 SUP 4581 S
ITAX 112% State Surchar 1/7/2008 $12.83
Total $119.73 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 may obtain copies of these rules or direct questions to OUNC at 503 246 6699 or 1 800.332 2344
Issued By: Permittee Signature: � � '
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.
J-S•
Electrical Permit Applic. it.CEIN/ FOR OFFICE USE ONLY 13
71 City of Tigard 2008 Date/By: / — e7 - og 6 13 Permit No ...... p2,. 66) b /f)
u 13125 SW Hall Blvd., Tigard, OR 972'231
7223 I I ^p Plan Revie
� Phone: 503.639.4171 Fax. 503.598 T Q F riGI B® Date/By. Other Pe t
TI G A R D Inspection Line: 503.639.4175 'jfl 0 Date Ready/By Suns RI See Page 2 for
Internet. www tigard - gov 3131104G Notified/Method / Supplemental Information
TYPE OF WORK PLAN REVIEW '
Please check all that apply (submit 2 sets of plans w /items checked below)
❑ New construction cg Addition/alteration/replacement
❑ Demolition El Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones
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 agncultural
a l - 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 denved system
❑ Addition of new motor load of ❑ "A ", "E ", ' l -2 ", "1 -3 ",
Job no.: Job site address: --'� ' u D 5 v�l v e ` _ . Six or or more residential Recreational occupancy
TNYG> � 1 . ❑ Six or more residential units. ❑ Recreational vehicle parks
City /State /ZIP: ❑ Health -care facilities
0 Supply voltage for more than
1 Y Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description P I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 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 75 00 2
DESCRIPTION OF WORK (with above sq ft )
^� Limited energy, multi - family 75 00 2
r eI - e \ e a rct o� `+ V AC residential (with above sq R )
Services or feeders installation, alteration, and/or relocation
200 amps or less I 80 30 20.3 j 2
❑ PROPERTY OWNER ❑ 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: (coleA 35-685 5 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 ❑ CONTACT PERSON above service or feeder fee, if
each branch circuit 6 65 0 264 0 _ 2
Business name: B. Fee for branch circuits 1°
Contact name: without service or feeder fee, 46.85 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
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53.40 2
�� �� pt, s t. ,,. k - � ,�; 4 ^- �• -_�� ���;„ � �:.` x- Si n or outline lighting 53 40 2
-;z x�aCrt -.'x� .. -e< � .. � -t",� 5� _ � l �. *�:43Sr.'� ,�i- o. „ fi_''r'a•:: ;_w. =rg.. _..Ka a' -� g g g
Signal circuit(s) or limited-
Business name: ? e r) e C (, I energy panel, alteration, or
Address: `PO \ ()., I D, extension. Describe: Page 2 2
City/State/ZIP: Sal • ( v - f , s5 53 -la a3- Each additional inspection over allowable in any of the above
Per inspection 62.50
•
& — F a x . ! ► \ ' 1 11 i V i •,.i; 4 4 . O P Investigation per hour (1 hr mm) 62 50
CCB Lic.:1 3 l I Electrical Lic.. I) Suprv. Lic.:!g ` S Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES /+�
Suprv. Electrician signature, req • :.: fir Subtotal. / Q (p . GU
� / Plan review (25% of permit fee) - Print name: V1 l 1 Date: 1 - - O � ' State surcharge (12% of permit fee) r 3
Authorized signature: 1 TOTAL PERMIT FEE / - 0"
^ — y_ r y This permit application expires if a permit is not obtained within 180
S
Print name: I l Y -1.,n' pate: I days after it has been accepted as complete. 19 74,3 Number of inspections allowed per permit �j�
1 \Building\Permits\ELC- PermitApp doe 05/23/06 440-4615TO I /05 /COM/WEB
h
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:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other
Total number of commercial systems: _ . .
*No licenses are required. Licenses are required '.
for all other installations
I \Buddmg\Permrts'ELC- PermuApp doc 03/23/06
CITY OF TIGARD • .�..
BUILDING DIVISION PERMIT #: ELC2008- 00010
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/712008
Phone: (503) 639 -4171 ', „ �►
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/31/2008 TIME: 7 : 00AM PAGE: 39
SITE ADDRESS: 07160 SW VENTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SQUARE ESTATES LOT #: 072 TYPE OF USE:
PROJECT NAME: JOHNSTON
DESCRIPTION: Service and (4) branch circcuits HVAC.
OWNER: JOHNSTON, MICHAEL R + MARY ELLEN, PHONE #: 503236-6895
CONTRACTOR: EVERGREEN ELECTRICAL. CONTRACTOR PHONE #: 503- 6688 -4608
Inspection Request Scheduled For: Date: 1/31/2008 Pour Time:
Code # Inspection Description Confirm-# Contact # Message
199 Electrical final 064261 -01 503-209-1050 N
Corrections /Comments /Instructions:
per` tvir t T car.' 5 V G • wits - zo 1/41 c�nl
6> v ► cE- i)tyLoA .
vet/anal kW0 •
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: v - N(46 L-tt Date: I ' Si b b Phone #: (503) 718- 2.44\1'
CITY OF TIGARD +.
BUILDING DIVISION PERMIT #: ELC200B- 00010
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I /7 /20j8
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 1/14/2008 TIME: 7 :04AM PAGE: 29
SITE ADDRESS: 07160 SW VENTURA DR CLASS OF WORK:
SUBDIVISION: WASHINGTON SOUARE ESTATES LOT #: 022 TYPE OF USE:
PROJECT NAME: JOHNSTON
DESCRIPTION: Seivice and (4) branch circuits FIVAC.
OWNER: JOHNSTON, MICHAEL R + MARY ELLEN, PHONE #: 503-23&5895
CONTRACTOR: EVERGREEN ELECTRICAL. CONTRACTOR PHONE #: 503668
Inspection Request Scheduled For: -Date: 11/4/2008 Pour Time:
Code # Inspection Description Confirm Contact # Message
199 Electrical final 0631413 -01 503-258-7993 N
Corrections /Comments/ Instructions:
aci 2S - tk wA5Ka2 14(N L.1--, 144 Ag A
G.Ro J14=1 D coot Or 6iCZ..
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
A FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C tA 6e) Date: -14- 01 Phone #: (503) 718 - VA