Permit ! CITY OF TIGARD
PERMIT
PERMIT #: ELC2008 -00083
COMMUNITY DEVELOPMENT
DATE ISSUED: 2/15/2008
iGRp' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S102BB -00833
SITE ADDRESS: 10050 SW JOHNSON ST ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT : 016 JURISDICTION: TIG
PROJECT: BEISER
Project Description: installing (2) branch circuits for AC and GFI outlet
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: 1 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:
MIKE BEISER WEST SIDE ELECTRIC CO INC
10050 SW JOHNSON 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 639 - 5633 Contact #: FAX 503 - 736 -0677
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
jELPRMTI ELC Permit 2/15/2008 $53.50 LIC 13306
•
[TAX] 12% State Surchar 2/15/2008 $6.42 SUP 4654S
Total $59.92 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: �` / ii Permittee Signature: $.P�
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.
Electrical Permit Apulic j lire C E V ED
rr �Vl t ' OR OFFICE U bE O NLY
f t
Cit of Tigard Received
:.,...v,„ " 13125 SW flail Blvd., Tigard, OR 97 ((�� 1 A �f1 �0 Date /13 : / �,� Permit No.: 141. ._ - Ma
i' Phone; 503.630.4171 Fax: 503.598.ri 1 `1 U 0 Plan I1JBy Review
!'` I Line: 503.639.4175
D Uale /ev: Other Permit;
lf'a.4-' RD ate Ready /By: Jens:
'..; .,. Internet: ,,.,v„'.l or.0ov' CITY OF TIGARD o see Page
N oti f ied/MetltoJ:
Supplemental Information
_ TYPE p1 G PLAN REVIEW
New construction .Additiotl/altcration /replacement Please check all that apply P! Y (submit 2 sets of plans u• /items checked below):
❑ Demolition 11] Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
t where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ bloating building;.
1 - and 2 - family dwelling ❑ Commercial /industrial le ground, r x « l 1,0 m»ercial -use agricultural
❑ Accessory 1)alldl(l am ps to for all other o c i eds inn,, 00 ❑ bCotuildings.
❑ Multi family _ ❑ [Master builder ❑ Other: ❑ Fire pump. .
❑ Installation of 73 K\ .\ or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derive) system.
❑ Addition ofnew• motor load of ❑ - A•' ••E• "1-2", ••I 3•'
Job 11o.: ,) 3 C Job site address: 1 00 - O cc J J ` 4�t LI,SD t,,t • - maim or more. occupancy.
❑ Six or more residential units. 0 Recreational vehicle )arks.
City/State/ZIP: (, I , !'
cV•it i ('j '7 7 - 7 „ 0 Health -cafe facilities. ❑ Supply VOI195C 101' mm
ply I Project / ) 10 Hazardous locations. 600 volts nominal. r /apt. no.: 1 1 t oject natlle: r ,, I c more.
0 Service or feeder 600 amps or ore.
Cross street /directions to job site: FEE sCllis'DULP
- Description I Qty. I tee. I Total l •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less I 145 ! I 4
Tax map /parcel no.: — Ea. add'I 500 sq. 6. or 901'1100 33.40 I 1
DESCRIPTION OF WORK Lnnited energy, residential
(with above sq. ft.) 75.00 2
1 J (_ L energy, multi - family
l r) nC.t111 { 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation __
ig 200 amps or less 80.30 2
PROPERTY OWNEtt
❑ TENANT 201 amps to 400 amps 106.85 2
Name: �1 I ( ( 401 ants to 600 amps ,.r � ,, ( .,,P / P P 160.60 12
Address: 1 601 amps to 1,000 amps 240.60 I
Cti. IAA . k_ Over 1,000 amps or volts 454.65 I 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /ur
` — relocation
Phone: ( ) ) / 1 _ c6 Fax: (. ) 200 amps or less 66.85 I I
Owner installation: This installation is being made on property that 1 own which is not 201 amps [0 400 amps 100.30
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: — __ llale: !;ranch circuits - new, alteration, or extension, p_er panel
A. Fee for branch circuits with
• ® APPLICANT I Q CONTACT' PERSON above service or feeder fee,
Business name: \VEST SIDE ELECTRIC CO.
each branch circuit G.GS
B. Fee for branch circuits
Contact name: GLENN GROSSMAN
setvicc or feeder fee, 1
first branch circuit 46.8 Lfr 0 2
Address: 1834 SE 8” AVE., • Each add'l branch circuit ( 6.65 j .(i.) 2
City /State /ZIP: PORTLAND, OR 97214 Miscellaneous (service or feeder not included)
Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 231-154S Fax: : (503) 736
Reconnect only 66.85 2
E -mail: GLENNG@\VESTSIDEELECTRIC.COI\1 Pump or irrigation circle 53.40 2
CONTRACTOR I • Sign or outline lighting 53.40 • 2
Business name: WEST SIDE ELECTRIC CO. Signal circuit(s) r limited-
energy panel, alteeration, or
Address: 1834 SE 8rll AVE. extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any of the above '
Phone: (503) 231 -1548 Fax: (503) 736 -0677 Per inspection 62.50
Investigation per hour (I hr min) 62.50
CCB Lic.: 13306 Electrical Lic.: 26 -135c 1 Suprv. Lic.: 4654S Industrial plant per hour 73.75
Suprv. Electrician signature, required: ELECTRICAL PEI FEES
G..� L _ �. \-- Subtotal: $--$ .5
Print name: RANDALL ROBERTS Date: 2_ ii (04.3 Plan review (25% of permit fee):
* State surcharge (12% of permit fee): (^ . Z
Authorized signature: TOTAL PERMIT FEE: ( ,
Print name: This permit application expires if a permit is nut obtained withitfISO
Date: days Otter 0 has been accepted as complete,
Number of inspections allowed per permit.
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