Permit L p i qi(14-eci 4a de\ r ( ir-L.QA•
n CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2008 -00647
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/20/2008
. Parcel: 2S103DD00435
Jurisdiction: TIG
Site address: 10650= SW :FAIRHAVEN=ST 1
Subdivision: Lot:
Project: STEVENS
Project Description: Kitchen remodel: service and (15) branch circuits. 5/29/09 ADDED (1) 200 amp panel and (8)
branch circuits.
Owner: FEES
WILLIAM STEVENS Quantity Description Date Amount
10650 SW FAIRHAVEN ST
TIGARD, OR 97223 1 [ELPRMT] ELC Permit 11/20/2008 $180.05
PHONE: 1 [TAX] 12% State Surcharge 11/20/2008 $21.61
1 ea Services or Feeders - 200 05/29/2009 $80.30
amps or less
Contractor: 8 crt Branch Circuits w /Purchase 05/29/2009 $53.20
Service or Feeder
THREE DOG ELECTRIC 16 da 12% State Surcharge - 05/29/2009 $16.02
5250 SW CAMERON RD Electrical (manual
PORTLAND, OR 97221
PHONE: 503 - 246 -4726
FAX: 503- 246 -2113
Type of Use: SF
Class of Work: Type of Const:
Occupancy Grp:
Total $351.18
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the 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 a copy of the rules or direct questions to OUNC by callin 3.246.6699 or 1.800.332.2344.
Issued By: C. X/lZ Permittee Signature: . f l C 1YAt7A
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' 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.
y .. CITY O F TIGARD R D ELECTRICAL PERMIT
CITY a PERMIT #: ELC2008 - 00647
COMMUNITY DEVELOPMENT DATE ISSUED: 11/20/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103DD -00435
SITE ADDRESS: 10650 SW FAIRHAVEN ST ZONING: R -3.5
SUBDIVISION: FAIRHAVEN COURT LOT : 003 JURISDICTION: TIG
PROJECT: STEVENS
Project Description: Kitchen remodel: service and (15) 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: SIGNAUPANEL:
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: 15 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:
WILLIAM STEVENS THREE DOG ELECTRIC
10650 SW FAIRHAVEN ST 5250 SW CAMERON RD
TIGARD, OR 97223 PORTLAND, OR 97221
Phone: Contact #: PRI 503- 246 -4726
FAX 503 - 246 -2113
FEES
Description Date Amount Reg #: ELE C188
[ELPRMT] ELC Permit 11/20/2001 $180.05 LIC 138509
[TAX] 12% State Surchar 11/20/2001 $21.61 SUP 46135
Total $201.66 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 = ! : = - TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OA : - 001 -0010 throu• • O: • 5 -'01 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 J t or 1.800.332.2344.
/
I sued By: _ � / emu _fi 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.
Electrical Permit Application V
" FOR OFFICE USE O NLY s .A:., °°
!`
t s i J � � City of Tigard c� \�ED Received � /]„ � Permit No.: �
a 13125 SW Hall Blvd., r'� /`JL,23 Date/By: 1 PO (r.......)0 �`'
h C ,� Plan Review
P a n Phone: 503.639.4171 ax: 503.598. l96Q p Date /By: Other Permit:
4 iT G t A I ,M Inspection Line: 503.639.4175w 2 Q Nuu Date Ready /By: Jurir ® See Page 2 for
P.�.. _ ,.u. Internet: www.tigard or.govN NI wt Notified/Method: � /t„ Supplemental Information
TYU lJjSlO1 PL REVIEW
❑ New construction .rA i item':' n /replacement Please check all that apply (submit 2 sets of plans vv/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Ot er: 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
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 ", "I - ", "I - ",
Job site address: / - FAIR 1 O OHP or more. occupancy.
Job no.:
�0 !o S Z Ski FAIR, (4A4. R N S \ ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: - '(' ❑ Health -care facilities. ❑ Supply voltage for more than
I G p t, ■ ��' ❑ 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. I 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
DESCRIPTION OF WORK • ' . - (with above sq. ft.) 75.00 2
l� ¢ Limited energy, multi - family 75.00 2
J �v.J Zap 40\ P S IS, RA) 1c_ R_ A4.)'0 VL LTC- LP N residential (with above sq. ft.)
Services or feeders installation, alteration, and/or re oca on _
RA 0 p It 1-- 200 amps or less l 80.30 � 0. k) 2
❑ PROPERTY OWNER . ❑, TEN ANT ' 201 amps to 400 amps 106.85 2
Name: 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: ( ) I 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, s er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLI - I ❑ CONTACT PERSON . above service or feeder fee, I 6.65 9/• 7 2
each branch circuit
Business name: 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
Miscellaneous (service or feeder not included)
City /State /ZIP: 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
Signal circuit(s) or limited -
Business name:
- 11{.4z.g, 0 1 _ D O C L. ri. L. c t L energy panel, alteration, or
Address: 5 Z S O S W C 14-M (Vas) It'L) � t/ extension. Describe: Page 2 2
City /State /ZIP: R,1"-- L CI \ ip (, °l? LL k Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (So3 ) Z'-(. , y -2 ce I Fax: ( s ) 2 . 2 . t L3 Investigation per hour (I hr min) 62.50
CCB Lic.: i3 S oet Electrical Lic.: C l f tbQj Suprv. Lic.: 44 5 Industrial plant per hour 73.75
• - ELECTRICAL PERMIT. FEES
Suprv. Electrician signature, required: • 7/ �/ /i( _ Subtotal: l ao .0 y
Print name: r Date: � l -ZO _ O� Plan review (25 % of permit fee): ��
�- < < R- W S State surcharge (12% of permit fee): ) l
Authorized signature: TOTAL PERMIT FEE: (� 1 (D
This permit application expires if a permit is not obta}"{(edPAr kip
name: Date: days after it has been accepted as comp e.
" Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11/05/COh'1/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
( IRESIDENTIAL:WORK 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*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system .
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls ,
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
n Other
•
•
Total number of commercial systems:
*No-licenses are required. Licenses are required
for all other installations
I:t BuildingPermits \ELC- PermitApp.doc 03/23/06
�n r
CITY OF TIGARD
: ,-
BUILDING DIVISION PERMIT #: ELC2008•00647
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/20/2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 : ' : � "
INSPECTION WORKSHEET FOR DATE: 11121/2008 TIME: 7:00AM PAGE: 8
SITE ADDRESS: 10850 SW FAIRHAVEN ST CLASS OF WORK:
SUBDIVISION: FAIRHAVEN COURT LOT #: 003 TYPE OF USE:
PROJECT NAME: STEVENS
DESCRIPTION: Kitchen remodel: service and (15) branch circuits.
OWNER: S' EVENS, WILLIAM PHONE #:
CONTRACTOR: THREE DOG ELECTRIC PHONE #: 503 -246 -4726
Inspection Request Scheduled For: Date: 11/21/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 078389 -01 503.421 -4879 N
Corrections /Comments /Instructions:
?( ONtW B(tAnfc)A 6 (ts .
vP
per,v 10 k o -F Gam, ® W
A a Gl l� .
s ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 1 ' 2 - 1 — 2 Phone #: (503) 718-