Permit
CITY OF T I G A R D ELECTRICAL PERMIT
PERMIT ELC2008-00370
COMMUNITY DEVELOPMENT DATE ISSUED: 6/25/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103D6-03400
SITE ADDRESS: 11280 SW QUELLE PL ZONING: R-4.5
SUBDIVISION: GENESIS NO. 2 LOT : 032 JURISDICTION: TIG
PROJECT: GIANNI
Project Description: Installing (5) 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: SIGNALIPANEL:
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: 4 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:
PAMELA KUJALA CHANCO INC
11280 SW QUELLE 3521 SW CARSON
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: 503-245-7774 Contact PRI 503-245-7774
FAX 503-244-4804
FEES
Description Date Amount Reg M ELE C209
[ELPRMT] ELC Permit 6/25/2008 $73.45 LIC 171892
[TAX] 12% State Surchar 6/25/2008 $8.81 SUP 688S
Total $82.26 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 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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: ELC2008 00370
° DATE ISSUED: 6/25/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103D B - 03400
SITE ADDRESS: 11280 SW QUELLE PL ZONING: R -4.5
SUBDIVISION: GENESIS NO. 2 LOT : 032 JURISDICTION: TIG
PROJECT: GIANNI
Project Description: Installing (5) 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: 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: 4 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:
PAMELA KUJALA CHANCO INC
11280 SW QUELLE 3521 SW CARSON
TIGARD, OR 97223 PORTLAND, OR 97219
Phone: 503 - 245 - 7774 Contact #: PRI 503 - 245 -7774
FAX 503 - 244 -4804
FEES
Description Date Amount Reg #: ELE C209
[ELPRMT] ELC Permit 6/25/2008 $73.45 LIC 171892
[TAX] 12% State Surchar 6/25/2008 $8.81 SUP 688S
Total $82,26 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 - 503.246.6699 or 1.800.332.2344.
Issued By,"
Permittee Signature NM
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 Application FOR OFFICE USE ONLY
City of Tigard Recei\ed Permit No.:
13125 SW Hall Blvd., Tigard, OR ~ Plan Review
C Phone: 503.639.4171 Fax: 50 Date/B : Other Permit:
Inspection Line: 503.639.4175 ' Date ReadY/BY m
a h.\ Ia ) 0 See Page 2 for
Internet: www.tigard-or.gov Av Notified[Method: Supplemental Information
TYPE ORK PLAN REVIEW
❑ New construction Q-Aadition/alterat Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: :11,\\`,°. 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 agricultural
9-1--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 derived system.
❑ Addition of new motor load of ❑ "A", "E", "1-2", "1-3
Job no.: Job site address: 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: V- ❑ Health-care facilities. ❑ Supply voltage for more than
❑ 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: Dean tioa Fee. 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'1 500 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
Qwvti 0 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: K G 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: ( ) 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
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit 1/10 ,
Address: Each add'I 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
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: t G V- C- energy panel, alteration, or
Address: C extension. Describe: Page 2 2
City/State/ZIP: Z Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone:( ~ 5 = 7 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: )71 g Q2~ Electrica Lic.: C Su rv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Date: `z J Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: ,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1'. \BuildingTermits\ELC-PermitApp. doc 05/23/06 440-4615T(I I/05/COVt/wEB
Electrical Permit Application - t FOR QFFICEtUSE;ONLY�� �, _ ; �
�t I1 � Cl of Tigard Rece _
f `J g r cc
Date/B : i / � ,f�. Permit No .� . -' �� ' ,fir r, a 13125 SW Hall Blvd., Tigard, OR ' i ` P lan Review
„ ® Phone: 503.639.4171 Fax: 50 CO \ ' . � � 1 U. n ' Other Permit:
q DateBy:
° * - i ` Line: 503.639.4175 Y Inspection Date Ready /By: m 63 See Page 2 for
T I GA It D p w\ Y Notified/Method Supplemental F ,, ,ig ,� \v ; Internet: www.tigard or.gov A �V � pp emental information
R k �
TYPE WORK ��(- ` ``!,S\ P LAN REVIEW
❑ New construction dition /alterat 1 � � Please check all that apply (submit 2 sets of plans w /items checked below):
El Demolition El Other: Ow . Service or feeder 400 amps 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 ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
- 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 derived system.
❑ Addition of new motor Toad of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: A '� [/ / Job site address: 100HP or more. occupancy.
{ 1 l� ' ( 1 / t e ( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ; ("ff ❑ Health -care facilities. ❑ Supply voltage for more than
f I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE ' .
Cross street/directions to job site: Description 1 Qty• 1 Fee. 1 Total 1 •
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'I 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
V e, ` {SL residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY ❑ TENANT 201 amps to 400 amps 106.85 2
/� // p� 401 amps to 600 amps 160.60 2
Name:
A'� ` K CSI �/ I 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: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ❑ APPLICANT - . 1 - ❑ CONTACT "PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name:
without branch n crvi r or i feeder fee, / 46.85 �/ 2
first branch circuit /
Address: Each add'I branch circuit 4- in I 6.65 r 0 2
Miscellaneous (service or feeder n included)
l9
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
CONTRACTOR Sign or outline lighting 53.40 2
• Business name: Signal circuit(s) or limited -
B �, energy panel, alteration, or
Address: 3 � �C �7.� C---i_ extension. Describe: Page 2 2
City/State /ZIP: �`t'7, ' p Z_ R 7 Z ( C/ Each additional inspection over allowable in any of the above
) , � �� ? 77 I ( ) (( Per inspection 62.50
(
Phone: Fax Investitigation tion per hour (I hr min) 62.50
CCB Lic.: ' 9� Electrica Lic.: a At Scion/. d , . Lic.: Industrial plant per hour 73.75 •
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: x� t 1� Subtotal: 7 , K f
Print name: Date: _� g--- , ■ Plan review (25% of permit fee): • State surcharge (12% of permit fee): , W
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I : \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
•
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
L RESIDENTIAL WOI 1C ONLY: :.
•
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑. Vacuum Systems*
❑ Other:
a 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
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
. ❑ HVAC
• Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• ❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION T " PERMIT #: ELC2008.00370
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0125/2008
Phone: (503) 639 -4171 ifix4 " iliti
Inspection Requests (24 Hrs.): (503) 639 -4175 R,I
INSPECTION WORKSHEET FOR DATE: 6/27/2008 TIME: 7:01AM PAGE: 42
SITE ADDRESS: 11280 SW QUELLE PL CLASS OF WORK:
SUBDIVISION: GENESIS NO, 2 LOT #: 032 TYPE OF USE:
PROJECT NAME: GIANNI
DESCRIPTION: Installing.(5) branch
OWNER: KUALA, PAMELA PHONE #: 503-245-7774
CONTRACTOR: CHANC() INC PHONE #: 503 - 245 -7774
Inspection Request Scheduled For: Date: 6/27/2008 Pour Time:
Code # Inspection Description / Co irm # Contact # Message
1' lAf_ili -r=rer / 071909 -03 503 Y
12 O R,• %AA -;O PM
Corrections /Comments /Instructions: i °2
PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: e lK\ Date: 27 08 Phone #: (503) 718- 1
,
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