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Permit CITY OF TIGARD ELECTRICAL PERMIT PERMIT # : ELC2009 -00054 COMMUNITY DEVELOPMENT DATE ISSUED: 2/9/2009 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S111CA-04400 SITE ADDRESS: 09700 SW LAKE SIDE DR ZONING: R -7 SUBDIVISION: SUMMERFIELD NO.12 LOT : 664 JURISDICTION: TIG PROJECT: SPEAR Project Description: Panel change. Job No. J43087 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: MARY ANN SPEAR WEST SIDE ELECTRIC CO INC 9700 SW LAKE SIDE DR 1834 SE 8TH AVE TIGARD, OR 97224 PORTLAND, OR 97214 Phone: 503 - 624 - 2122 Contact #: FAX 503 - 736 -0677 PRI 503 - 231 -1548 FEES Description Date Amount Reg #: ELE 26 -135c [ELPRMT] ELC Permit 2/9/2009 $80.30 LIC 13306 [TAX] 12% State 2/9/2009 $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 - - -- • th 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..: • 9 or 1.800. 4. Issued l =y: , = � J / f Permittee Signature: f��f}! • 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: . z.(iJi' DATE: V . 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 ; '�, H FOROF fV A` O3^� ��, s le , s Clt ' Of T and 12ccutcd b _ Du eive i `/ ey .1„ Pcrmit E -- � 13 125 SW H all Blvd., Tigard. OR r 2 (((///"''��� 111 9 2009 Rey,c,y .. Phone: 503.639.4171 Fax: 503. Ihtd Other Permit: " 4 P 'N n I i 11 GAM nspecton Line: 503.6 D Date Ready /By: )ur IZI See Page 2 fur ' ktot4 + "•' e I ntcmct: w\vm.ligard- or.gov Noti / . Supplemental Information TYPE OF 41% ®� TIGARD t e DIVISION PLAN REVIEW ID New construction El Addition /al tl'1ttTP)Iacement Please check all that apply (submit 2 sets anions tv /Items checked below): ❑ Service or feeder 400 :Imps or more ❑ Building over three stories. El Demolition ❑ Other: where the available Paull current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural © 1 - and 2- faintly dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations, buildings. ❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND 1,OCA'1'lON ❑ L'niergencysystem. larger separately derived system. 0 Addition of new motor load of ❑ "A" "}" "I -2 "I -'S" Job no.: J43087 Job site address: 9700 SW LAKESIDE DR. 10011P or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: TIGARD, OR 97224 • ❑ Ilealth -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg- /apt. no.: Project name: SPEAR, MARY ANN ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qis. ) Fee. I 'Coral ( ' New residential single- or multi- family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4 Ea, odd'1 500 sq. ft. or portion 33.40 I Tax map /parcel no.: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above R.I. Il.) Limited energy, multi-family PANEL CHANGE residential (with above sq. ft.) 75.00 2 Services or feeders installation, :alteration, and /or relocation 200 amps or less I 80.30 80.30 2 ® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 Name: MARY ANN SPEAR 401 amps to 600 snips 160.60 2 601 stops to 1,000 amps 240.60 2 Address: 9700 SW LAKESIDE DR. Over 1,000 amps or volts 454.65 2 City /Slate /ZIP: TIGARD, OR 97224 Temporary services or feeders installation, alteration, and /or relocation Phone: (503)624 -2122 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, per panel Owner signature: Dale: 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 widunrt service or feeder fee, Contact name: 46.55 2 first branch circuit Address: Each add'] branch circuit 6.65 2 Miscellaneous (service or feeder not included) City /State /"LIP: Each manufactured or modular 90.90 2 dwelling, service and /or feeder 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: WEST ELECTRIC CO. Signal circuit(s) or limited - energy panel, alteration, or Address: 1834 SE 8r11 AVE. extension. Describe: Page 2 2 City /State /ZIP: PORTLAND, OR 97214 _Each additional inspection over allowable in any of the above Per inspection 62.50 Phone: (503) 231 -1548 Fax: (503) 736 -0677 Investigation per hour (1 hr min) 62.50 CCI3 Lie.: 13306 Electrical Lie.: 26 -135C Suprv. Lie,: 4654S Industrial plant per hour 73.75 j ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: 6' - v v 1 `---- z.0 -- 7 "\._ Subtotal: 80.30 Print name: RANDALL ROBERTS _Date:- 2/9/09 Plan review (25% of permit fee): State surcharge (12% of permit fee): 9.64 Authorized signature: 'TOTAL PERMIT FEE: 89.94 Print name: Date: permit application expires if a permit is not obtained suitit 180 Date: days after it has been accepter( as complete. Number of inspections allowed per permit. I: 13oitdine \Pcrcnit.s \rI.C- I'cm,iiApp.doc 05 /23/06 4404615T(1 I /05ICO \ t/ \VIII] e/ e 600Z-90-Z0 th SS Ze L966 6£Z£0S CITY OF TIGARD BUILDING DIVISION PERMIT #: Et.C2009.00054 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 21912008 Phone: (503) 639 -4171 . R , ' � 1 lt Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 2//012009 TIME: 7:O1AM PAGE: 7 SITE ADDRESS: 09700 SW LAKE SIDE DR CLASS OF WORK: SUBDIVISION: St.JMMEIFIELD NO.12 LOT #: 654 TYPE OF USE: PROJECT NAME: SPEAR DESCRIPTION: R. cl ngo. Job No. ,14:-1087 OWNER: SPEAR, MARY ANN PHONE #: ?�i0:t- 624.2122 CONTRACTOR: \NEST SIDE ELECTRIC CO INC PHONE #: 603- 231 -1 'a Inspection Request Scheduled For: Date: 2/10/2009 Pour Time: Code # Inspection Description Confirm # Contact # Message • 199 Electrical final 080452 503 - 231 -15411 N , Corrections /Co m /Instructions: ( ae. 6 ' oV 3 cO. I6 -T . ma(6<)cis:ua AN s P ct` 'e't f3 tA a 0 x . ova, .cm2nLy� • = : Iectrica • s - t - • -tents noted on this = sort s :II be . . • -c • and an inspecti• eq k st ma • _ ' th • 20 calendar days p: 'JAR 918 - 0 ; .. 0 C . C5 1 g■ PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS `, 7 A FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: .� g 0z • Date: Z °.) Q ' 9 Phone #: (503) 718- IM A)