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Permit CITY OF T I G A R D ELECTRICAL PERMIT PERMIT #: ELC2001 -00582 1 " � ;; � 1 � DEVELOPMENT SERVICES DATE ISSUED: 11/20/01 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S 110BA -06800 SITE ADDRESS: 12036 SW WILDWOOD ST SUBDIVISION: SHADOW HILLS NO.2 ZONING: R -2 BLOCK: LOT : 051 JURISDICTION: TIG Project Description: Install 4 branch circuits to 2 furnaces and 2 A/C. 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: 3 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: KEN DAWSON SHARPE ELECTRIC INC 12036 SW WILDWOOD 22605 SW RIGGS TIGARD, OR 97224 BEAVERTON, OR 97007 Phone: 503 - 624 -2013 Phone: 642 -7937 Reg #: LIC 81518 SUP 3344S ELE 34 -217C FEES Required Inspections Type By Date Amount Receipt Wall Cover PRMT CTR 11/20/01 $66.80 2720010000( Elect'I Final 5PCT CTR 11/20/01 $5.35 2720010000( Total $72.15 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 -0080. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Permit Signature: n PLtc �,.) j Issued By: . A 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: Cf (- DATE: LICENSE NO: 3 J (/4 Call 639 -4175 by 7:00pm for an inspection the next business day Nov 19 01 04:31p Specialty Heating 503 598 0718 P.3 'I r Electrical Pe . . :6 , aton I Date received: I If AO-01 Permit no and of Ti ,0(.),� _ t "'''`'I'I City y ° • " - --- J g 110 1 2001 Project/appl.no.: Expiredate: City of Tigard Address: 13125 SW Hall Blvd , 1 and O id a ) Phone: (503) 6394171 CIA OF nee Date issued: By Receip 1o.: Fax: (503) 598 -1960 BUILDING D I V ISION Case file no : Payment type: Land use approval: TYPE OF PERMIT I fe(l & 2 family dwelling or accessory O Commercial/industrial 0 Multi - family O Tenant improvt . nent 0 New construction , 'Addition/alteration/replacement O Other: O Partial JO8 SITE INFORMATION I . Job address: : — ,. (,J( , MI' Bldg. no.: Suite no.: Tax map /tax lot/account no.: Lot: Block: Subdivision: Project name: /, S ©^/ Description and location of work on premises: , • „_, Uili►1Qc e A t Estimated date of completion/inspection: /a t/ 'O( . s r CONTRACTOR APPLICATION FEE SCHEDULE I Job no: R D 1 304 Fee Max sh�Pk &/�� k /'j Deormulon Business name: Qt (ea.) ee Total no. limp Address: 6l6 0 ) i Newt attachedg geper � l A dweWngwit .lncludesattadredgarage. Ci ty: 8/4-.' {t '-,-t, tate:Ok I ZIP: 9 70 0 7 Service Included: Pholle:sv3 4 J92/ Fax: E -mail: 1000 sq. R or less 4 CCB no.: '/ s/ 7' I Flee. bus. 11c. no: al -,A / 7 C.,,,109•"" Each ed energy, 500 sq. ft. or portion thereof Limited energy, residential 2 City /metro lie. no.: 6" 3/ Limited energy, non- residential 2 / Each manufactured home or modular dwelling Signature of supervise g electrician (requited) Date Service and/or t 2 Sup. elect. name (print): L.. • • p �_ License no. 3 L( q S' Services or feeders – installation, • alteration or relocation: _ PROPERTY OWNER 200 amps or less - 2 Name (print): e- 4/ 4.0 -4-1/ 201 amps to 400 amps 2 36 ,' /W / 4e 9 d 401 amps to 600 amps 2 Mailing �� address: / ` W 601 amps to 1000 amps 2 • City: "rig a - I State: . ZIP: q,..2..2. 41 Over 1000 amps or volts 2 Phone: q- aO I Q I Fax: 1E-mail: Reconnect only 1 Owner installation: The installation is being made on property I own Temporary services or feeders • which is not intended for sale, lease, rent, or exchange according to insta llation , alteration, orrelocation: ORS 447, 455, 479, 670, 701. 200 amps or less 2 201 amps to 400 amps 2 Owner's signature: Date: 401 to 600 am.s . 2 ENGINEER Branch circuits - new, alteration, Name: or extension per p anel: A. Fee for branch circuits with purchase of Address: service or feeder fee, each branch circuit � �� I 2 City: State: ZIP: B. Fee for branch circuits without purchase of service or feeder fee, first branch circuit: j 2 Phone: Fax: E - mail: Each additional branch circuit. I PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not Included): • O Service over 225 amps- commercial 0 Health-caiefacility Each pump or imgalion circle 2 0 Service over 120 amps - rating of I &2 0 Hazardous location Each signor outline lighting 2 family dwellings 0 Building over 10,000 square feet four or Signal circuits) or a limited energy panel. 0 System ove, GOO volts nominal more residential units in one structure alteration, or extension* 2 O Building over three stones 0 Feeders, 400 amps or more 'Description: 0 Occupant load over 99 persons 0 Manufactured structures or RV park Emit additional inspection over the allowable in any of the abo /e: 1 '.1 Egress/lightingplan 0 Other Per inspection I 1 I 1 Submit sets of plans with any of the above. Investigation fee The above are not applicable to temporary construction service. Other — /IAA Nu luncdredons eccepl credit cards, please call jurisdicuar for more information. Notice: Th is permit appheation Permit fee $ fv .2_:_ esa O 1vlas teeCard expires it a permit a not obtained Plan review (at _ To) $ — . _.� c '1 card num. - within 180 days alter it has been State surcharge (8%) $ _ 3 J i / 1• Exp. as accepted as complete. TOTAL $ _ . - 7 Nunn of t. 4 d, s s . wn .i radii card' ,1 • 4 4 S. • .♦ S ` :1 htti&irr RIgna111re Amount / 44 1.4615 (6 /OO/COM)