Permit IN CITY OF T I^ A R® ELECTRICAL PERMIT
° V PERMIT #: ELC2008 -00036
COMMUNITY DEVELOPMENT DATE ISSUED: 1/18/2008
TI 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 111 DD -03400
SITE ADDRESS: 08915 SW HAMLET ST ZONING: R - 4.5
SUBDIVISION: STRATFORD LOT : 024 JURISDICTION: TIG
PROJECT: KOBLEGARDE
Project Description: panel change
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: 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:
KOBLEGARDE, B RUPERT WEST SIDE ELECTRIC CO INC
510 MAYER BUILDING 1834 SE 8TH AVE
1130 SW MORRISON ST PORTLAND, OR 97214
PORTLAND, OR 97205
Phone: 503 - 222 -3135 Contact #: FAX 503 - 736 -0677
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
IELPRMTI ELC Permit 1/18/2008 $80.30 LIC 13306
FAX] 12% State Surchar 1/18/2008 $9.64 SUP 4654S
Total $89.94 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: t/ P�� - Permittee Signature: /, />C/'l
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.
~ r
e le
Electrical Permit Applicatio j Cfr •�i roR err cE LISE
'' ` r City of Tiburd ' ��` � , , .. R « etvCd l . . y ✓ r/ >
\ P \ v s, ` `f ... ` OQS U ( K1 Permit No . r C1 _ h -rJ e e�C ��
13125 SW Hall Blvd., Tigard, pit 7223 OJ D'11`/B 9r . f
si_ Plan Review n ; `'y , Phone: 503.639.4171 Fax: 503.598.196 [['' ````��
�• � Date Ready/By: Date /By: Other `
i';jSiq CA6. Inspection Line: 503.639.4175 ` ®�� /B
•'r> Internet: www.li'ard- or.'ov i`, Y Y �uris: age ?fur
DSceP
www.ligard-or.gov
�,� Nonfted/Mahud: Supplemental Information
_ TYPE o1 lvoltl. I L AN REVIEW —
New construction Addition/alteration /replacement Please cheek all that apply (submit 2 sets of plans w /items Checked below):
[..] Demolition El Other: ❑ Service or feeder 400 mops or more ❑Building over three stories.
---")' . where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to 1- and2 family dwelling ❑Commercial /industrial ❑ Accessory building amps for allnothrinswl!tions. Q hutlrrunyeial- useagricuiuu :d
11Uh1 ❑ Master builder ❑ Other': ❑ Fire pump. ❑ I ildin ion of 75 KV,u ur
J013 SITE INFORMATION AND LOCA'T'ION - ❑ Emergency system. larger separately derived system.
/ CI Addition of new motor load of ❑ "A", ••E ", •' 1 - 2 • ' • ° 1 -3"
Job no.: ` U .. 6 `/ 7 3 Job site address: 8 Lll.c 5' L -J �d p� t e ' f ,f 1
c,1 100111' or mute. occupancy.
`,
n l ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /StaterZlP: (� 9 2- ? L. L ❑ Health -care facilities. 0 Supply voltage for m th
ire an
v�
0 Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 4 / 1 ` I ❑ Service ice or h 600 amp or mom
1 e1 e,v / n L' ,, e 1( 1 1 1 _ _
Cross sere t/directions to job site: ) PEE; SCHEDULE
— Description I Qty. L 1 l Total I •
New residential single- or multi-family dwelling unit.
- -- Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 ( 4
fax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I!
Limited energy, residential • DESCRIPTION OF WORK' ` (with ubovc sq. ft.) 75.00 2
Limited energy, 75.00 2
`�� C\ y � „ � ^ l ( multi-family
above sq. ft .ly
` ( \�l v residential (with ab s)
Services or feeders installation, alteration, and /or relocation
200 amps or less E 80.30 1 i)'• . (i 2
PROPERTY :OWNER • . ❑ • 'TENANT;'' 201 amps to 400 amps 106.85 2
Name: 1 /� � -y 1/6--o L • d01 amps to G00 amps 160.60
V 1 c. '
• - 601 amps to 1,000 amps 240.60 2
Address: 1 1 r ) [� Al
C. ? G f i ; S r> •„ `2•I �( c) �) Over 1,000 amps or volts 454.65 2
City/State/ZIP: 1� �/ �1 Temporary services or feeders installation, alteration, and /or
o� ( cunC r / 7 7.E
Phone: � 7 . 7 . -� --. relocation
(5� 0 ) 22Z (7 S Fax: (. ) 200 amps or less 66.85 I 1 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 I 12
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 9
Owner signature[ Date: Branch circuits - new, alteration, or extension, per panel I
- -- — A. Fce for branch circuits tvith
Eg . APPLICANT 0 CONTACT ` PERSON above service or feeder fee,
each branch circuit 6.62 2
Business name: NEST SIDE ELECTRIC CO. B. Fee for branch circuits
Contact name: GLENN GROSSMAN
without service or feeder fee, 46.85 2
first branch circuit
Address: 1834 SE 8111 AVE.. Each add'I branch circuit I 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: PORTLAND, OR 97214 Each manufactured or nodular
90.90 I 2
Phone: (503) 231 -1548 Fax: : (503) 736 -0677 dwelling, service and /or feeder
Reconnect only 66.85
E - mail: GLENNG a WESTSIDEELECTRIC.COA'I Pump or irrigation circle 53.40 1
N.: CONTRACTOR I Sign or outline lighting 53.40 2
Business name: WEST SIDE ELECTRIC CO. Sigmal circuit(s) or limited-
energy panel, alteration, or
Address: 1834 SE 8 .111 AVE. • extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable 111 any of the above
Phone: (503) 231 -1548 Fax: (503) 736 - 0677 Per inspection 62.50
Investigation per hour (1 lu min) 62.50
CCI3 Lic.: 13306 1 Electrical Lic.: 26 -135c Suprv. Lic.: 4654S industrial plant per hour I 73.75
�` J _ ELECTRICAL. :PERMIT' FEES '
Suprv. Electrician signature, required:�`� i -C . Cis Subtotal �/ i
Print name: RANDALL ROBERTS Date: ) Plan review (25% of permit fee):
_. - ( /1 , / s State surcharge (12% of permit fee): rl r (� LI'
Authorized signature: TOTAL PERMIT FEE: 2 C' . 2
This permit application expires if a permit is nut obtained withitl 1 0
Print Inl name: Dale: days after It has been accepted as complete.
• Number of inspections allowed per permit.
Ianuilling'd'cnnitsU_I.0 -t'er ,itApp.doc 05/23.Uu 440-46151(11/05,1:M1/WEB
19661£Z£09
P/ lr 900Z V1.0 9Z lZ £Z
CITY OF TIGARD c, 0)
to oimin
BUILDING DIVISION PERMIT #: f_C20f8 -00036
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/18/200 :3
Phone: (503) 639-4171 d�.��� p�1�t�
Inspection Requests (24 Hrs.): (503) 639 -4175 ,__..
INSPECTION WORKSHEET FOR DATE: 1 /22120(}0 TIME: 7:01AM PAGE: 52
SITE ADDRESS: (WM SW HAMLET ST CLASS OF WORK:
SUBDIVISION: STRATFORD LOT #: 074 TYPE OF USE:
PROJECT NAME: KOB.ECARDE
DESCRIPTION: I ) : -.ii el i
OWNER: KQI3LEGARDE:, F3 RUPERT, PHONE #: 503-722-3135
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 603.231.11AB
Inspection Request Scheduled For: Date: 112.2'008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 053597 -01 503 - 231 -1548 ', � (. � ew- „
Corrections /Comments /Instructions: v' �
I C
Xt PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
n FAIL ❑ CA L FOR INSPECTION _ ADDITIONAL FEES ASSESSED
, r ■
Inspector: WO Date: II ■ Phone #: (503) 718-
,