Permit C ITY OF TI GARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00143
DEVELOPMENT SERVICES DATE ISSUED: 2/22/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S110BA -05600
SITE ADDRESS: 11865 SW WILDWOOD ST ZONING: R -2
SUBDIVISION: SHADOW HILLS LOT : 009 JURISDICTION: TIG
Project Description: Apartment over garage. 200 amp service install /12 branch circuits.
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: 12 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:
DEIGNAN, JOHN E + MARY FIVE STAR ELECTRIC, INC.
11865 SW WILDWOOD STREET PO BOX 555
TIGARD, OR 97224 BANKS, OR 97106
Phone: Contact #: FAX 503 - 324 -0973
PRI 503 - 324 -0948
FEES
Description Date Amount Reg #: ELE 34 - 665C
[ELPRMT] ELC Permit 2/22/2006 $160.10 LIC 158231
[TAX] 8% State Surcharge 2/22/2006 $12.80 SUP 46225
Total $172.90 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- 00- 332 -2344.
Issued By: , Permittee Signature: '9h 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: 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.
„:?, .lam • 1A S ADO S —001S
e lectrical Permit A li FOR 01 :1. l:tif ONL)
a nd g I ` i Received 1 0 � ' P �G�Oa� -190 A
Clty of Tlg .
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review pia p,�
Phone: 503.639.4171 Fax 503.598.1960 FEB 14 ';., ' f Date/
' •f � Date Ready/By- Irv. -. Bl See Page 2 for
Inspection Line: 503.639.4175 Notified/Method I`r V Supplemental Information
Internet: www.ci.tigard.or.us 'CITY OF T1UI
PLAN REVIEW
1
P ig �
� Please check all that apply:
New construction I 1 it :a e o re ac
e
® ❑ ❑Service over 225 amps, comm'1 ❑Hazardous location
❑ Demolition ❑ Other: ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
❑System over 600 volts nominal units in one structure
® 1- and 2-family dwelling ❑ Commercial/industrial ❑ Accessory building ❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑Health -care facility 0Other.
Job no.: FS426 Job site address: 11865 SW Wildwood Street 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.
FEE* SCHEDULE
Suite/bldg. /apt. no.: . Project name: Deignan Home _ Ion I Qty. I Fee. I Total V
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage. _ „/
1,000 sq. IL or less , j 145.15 -. 1
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: - Limited energy, non - residentia 75. 00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder - 90.90 2
new home electrical - Services or feeders installation, alteration, and/t e ocation
200 amps or less .1111 W l ea Ei
201 amps to 400 amps 1 � : r
❑ PROPERTY OWNER ❑ TENANT amps to 600 amps 1: ''aim 2
Name: C1.12 7 OLLg4- / "`''— " �p J ( 601 amps to 1,000 amps 240.60 2
Address: �' Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 600 amps 133.75 - 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
0 APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 O 2
Business name: branch circuit , O
B. Fee for branch circuits •
Contact name: without service or feeder fee, . 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited- . -
CONTRACTOR energy panel, alteration, or
extension. Describe: 1 Page 2 2
Business name: Five Star Electric Inc.
Address: PO Box 555 Each additional inspection over allowable in any of the above
Per inspection MI 62.51 F!it.
City/State /ZIP: Banks, OR 97106 Investigation per hour (1 br mm) 62 50
Phone: (503) 324-0948 0 4 4 Fax: (503) 324 -0973 Industrial plant per hour 73.75 ,
ELECTRICAL PERMIT FEES*
CCB Lic.: 158231 i.,i ' Electrical f1 773 Suprv. Lie.: 4622S Subtotal r J( , ,
Suprv. Electrician signature, required: Plan review (25% of permit fee) joy
4,4aiit” Print name: 7 � n a Date: 2/14/06
State surcharge (8% of permit fee) / ?j -g
� TOTAL PERMIT FEE
Authorized signs e: 5 This permit application expires if a permit is not obtained within ISO
- days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tn-County Building Industry Service Board
" Number of inspections per permit allowed.
i1Building\Pennits\FLC- PermitApp.doc 12/03 440-46157(10/02ICOMlwFB
10 • d 0 I11.1,0TIS PIS SAI3 90 :91 900Z- 1/I -83d -
CITY OFTIGARD
BUILDING DIVISION PERMIT „C1,410b.apI 4'3
13125 SW Hall Blvd., Tigard; OR 97223 DATE ISSUED:
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: - • 2.4 -'0 b TIME: PAGE:
SITE ADDRESS:' % S W 1..D UJ 6.11-0
CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE: •
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
•
Inspection Request Scheduled For: • Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
C‘ C I F -; k L-
Corrections /Comments /Instructions:
woc�K. Q —®, C: - ti 6N bo 15 1
D `i'Pcts:v EQ),
\PASS ❑ PARTIAL APPROVAL. ❑ CANCEL . ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
•
Inspector: 1" Date: D 14 1 0 6 Phone #: (503) 718- 1 — 4
CITY OF TIGARD
BUILDING DIVISION PERMIT #:S.C•OOb• OOJ 43
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 I A,
Ile
Inspection Requests (24 Hrs.): (503) 639 -4175 s s�
INSPECTION WORKSHEET FOR DATE: 6.2,1''°10 TIME: PAGE:
SITE ADDRESS: I t \ S CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
Corrections /Comments /Instructions:
—
PASS n PARTIAL APPROVAL CANCEL n NO ACCESS
FAIL CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: • N u Date: (2' Phone #: (503) 718- 2-4917