Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -10020
, DEVELOPMENT SERVICES DATE ISSUED: 3/3/2006
_,13:1,1111 ° 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S 125DA -08903
SITE ADDRESS: 09350 SW 70TH AVE ZONING: R -4.5
SUBDIVISION: KINGS VIEW LOT : 063 JURISDICTION: TIG
Project Description: Replace temporary power installed by PGE with permanent feeder.
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:
BOB KEITA CONTROL CONTRACTORS
9350 SW 70TH AVE 5000 SE 25TH AVE
TIGARD, OR 97223 PORTLAND, OR 97202
Phone: 503 - 823 - 2039 Contact #: PRI 503 - 231 - 0421
FAX 503 - 238 -1138
FEES
Description Date Amount Reg #: ELE 26 - 567C
[ELPRMT] ELC Permit 3/31/2006 $80.30 LIC 63927
[TAX] 8% State Surcharge 3/31/2006 $6.42 SUP 22675
Total $86,72 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: " '� / 3 Permittee Signature: @ cvk
OWNER INSTALLATION ONLY
The installation is being made on property 1 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
� : A BUILDING SERVICES DIVISION
",dill 13125 SW Hall Blvd., Tigard, OR 97223
° 503- 639 -4171 www.ci.tigard.or.us PERMIT #:
DATE ISSUED: 3 = .- ' O ____
SITE ADDRESS: °136:) SbL � ]OT�-/ PARCEL #:
BLDG /ST #: _-- —._ `__..._ _ ZONING: - -- -- - -- -- -
E
SUBDIVISION: #: - - -- - -� - - -- LOT: JURISDICTION: _____.__.__- -_ _
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DESCRIPTION: e b c.A C,E. ��m , u) "IV SI LL6 g`j__ -- P6 E- ____- _._ --.
RESIDENTIAL TEMP SRV EED MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: j PUMP /IRRIGATION:
EACH ADD'L 500 SF: __ _ — _ 201 - 400 amp: SIGN/OUTLINE LTG: --
LIMITED ENERGY: 401 - 600 amp: Y _ 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: PER HOUR: _
401 - 600 amp: ` __ —_ EA ADD'L BRANCH 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 FEES
Name: .. • 1.__ 6,-T-� _ _ _ Permit Fee $ - (Q. � —
Address: • 3 S) '7 H Plan Review Fee $
City /State /Zip: State Surcharge (8 %) $ _ I. &[a
Phone: Goa. .�s &- _2.0 3 ( - -- _ Other Fee: $ � —
CONTRACTOR Other Fee: $ _ —`
Name: __ A- ,�L �'A N TCCS Total Fees: $ $ l . 7
Address: _ 7 ' N
City /State /Zip: 17 DR. apy
Phone: $(,3. 2 1 31 • QL0-1
- Fax: __.4 .1 . 5___l�._3g �.- ... - - --
CCB Lic #: 3.a_n_. _ _ .� -14- o 8
Elect. Lic. #: alo- 5(c1G ________2 : _
Supr. Lic. #. (p7 LO_ -/ -. Gi _
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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -1987 or
1 : Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503- 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
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.
I:\ Building\ Forms\ ManualPermitForms \ManualELCpermit.doc 12/05/05
CITY OF TIGARD ELECTRICAL PERMIT
,, , p x l., .:. .. BUILDING SERVICES DIVISION
��:fli� 13125 SW Hall Blvd., Tigard, OR 97223
503- 639 -4171 www.ci.tigard.or.us PERMIT #: GL�.eZUt;IQr ,r p
D ISSUED: -per
J
SITE ADDRESS: g369 S r/0 rte _ _ _ _ PARCEL #:
BLDG/ #: - -- y ZONING: ---- + - - - -- -
STE
SUBDIVISION: L STE - -- —_ -�- LOT: JURISDICTION: -- --- _-- _.____.
This is an interim permit issued during computer system maintenance.
Construction work and inspections may proceed under this permit number.
The actual permit will be issued and mailed to the applicant within one week of the date issued above.
PROJECT DESCRIPTION: 1 gE(Z 1_N K_ . _E_- -.
- w.. - = 2 .J9.f V‘i1 DID • .- ---____________-----
RESIDENTIAL TEMP SRV FEED MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: _ 1 PUMP /IRRIGATION: __ __
EACH ADD'L 500 SF: __�` 201 - 400 amp: _ __ SIGN /OUTLINE 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: __________ ft W/O SRVC OR FDR: PER HOUR: _ _
401 - 600 amp: EA ADD'L BRANCH 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 FEES
Name: � � 6LZ,1a _ - Permit Fee
Address: - r M $ �Q'
�. �_�'_j0 _ Pl an R ev i ew Fee $
_
City /State /Zip: -- .6AR a_ i rm„,, `3 _ State Surcharge (8 %) $ -� .c �
_ - - Fee: --- -- $ -
- �j�- 8 � . �p 3��`( Other er -�
Phone:
CONTRACTOR
Other Fee: $
Name: i ,p C" � TaS Total Fees: $ $'
Address: _5 pp .___.25r -'r H
City /State /Zip: i��str_ _ -)ap3.
Phone: Sc) 3: A 31 • a �Lz-I
Fax: ' a,3$ . 11 38 - -
CCB Lic #: _, � a a - - 1Q- DS
Elect. Lic. #: C
Supr. Lic. # . __ A2 lo (D - - Oi--
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 -0080. You may obtain copies of these rules or direct questions to OUNC by calling 503 - 246 -1987 or
1 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. ELECTRICIAN: DATE:
LICENSE NO.:
Call 503- 639 -4175 by 7:00 AM for an inspection that business day.
Note: If you cannot schedule an inspection while the system is down, please call 503 - 718 -2433 for assistance.
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.
I:\ BuildingTorms\ ManualPermitForms \ManualELCpermit.doc 12/05/05
.Electrical Permit App," FT tI , IVED FoR OFFICI.: USE ONLY •
ed
City of Tigard MAR e/By 3 -3 -0‘ 88 Pemut No.: - / 4 l
13125 SW Hall Blvd., Tigard, OR 97223 MAR, 3 2006 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 9' - ,k r „�, , i,, i',, Date/By Other Permit:
Inspection Line: 503.639.4175 Ij k ”! 1 - , Date Ready/By: Ju is ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAR I.. --- Notified/Method 7"I Supplemental Information
BUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction 0 Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ['Service over 225 amps, comm'I ['Hazardous location
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
LE 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: %' 4 T#/ Job site address: yg ,- O 5 co 70 74. /'t ['Health-care facility ['Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: -7 6,47,..D O .12. 77 ,2a 3 The above are not applicable to temporary construction service.
Suite/bldg" /apt. no.: Project name: /. /T,ea FEE* SCHEDULE
Description I Qty. I Fee. I Tad 1 **
Cross street/directions to job site: - 729 f .z p2 S / ' e > ' New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
4 P-/-- Pa E e 7��, 4 Cc " -� � .Pa -
dwelling, service and/or feeder 90.90 2
l / Services or feeders installation, alteration, and/or relocation
/V 57 L e- r 7 3 B y 6 ,f rbm G 00 D 2 I C l-/ 200 amps or less / 80.30 2
i°r PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: B0B Kg- -r-4 601 amps to 1,000 amps 240.60 2
Address: A5 Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: (5 7), „.9 - t , 7 Fax: ( ) relocation
`--'' 3 1 200 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT 1 ® CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: e l d /r.! r,t20 C *2/4 dfo2 s �n/ C branch circuit
B. Fee for branch circuits
Contact name:
A.///. A:- " /�.0 4n/ A without service or feeder fee,
each branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
) ?O - 3 / ( ) Pump or irrigation circle 53.40 2
(S
Phone: v p Fax: :
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: eo r20 L 6 i v r ,Q4 e 7O2 5 1T/V C -
Address: 5000 54 0 2 $ Av Pri u /- Each additional inspection over allowable in any of the above
Per inspection 62.50
City / State/ZIP: PO2 r C r9,d l) 0/2- 9',7 a- Investigation per hour (I hr min) 62.50
Phone: (, 3 ) o? 3 / - Q Q A / Fax: (3 ) 3 8 -. // 3 5 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: (,3 5 7 Electrical Lic.: - 5Z 76 Suprv. Lic.: d2a 6 7S Subtotal 80,30
Suprv. Electrician signature, required: _ ./d..,.4.,„,.. Plan review (25 %ofpermit fee)
Print name: SAM /V r /,t✓ 2319 L F Date: OS - 0 3 - O 6 State surcharge (8% of permit fee) , y�
TOTAL PERMIT FEE a 6, 7a.
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard • -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
.
,RESIDENTIAL 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*
❑ Other:
I COMMERCIAL WORK ONLY:
. Fee for each commercial system. $75.00
(SEE OAR 918 - 260 -260)
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:\ BuildingTennits \ELC- PemitApp.doc 04/03
CITY OF TIGARD RECEIPT
DEVELOPMENT SERVICES RECEIPT DATE: 3.3 _ oh,
�' "' "r "' ry I ' 13125 SW Hall Blvd., Tigard, OR 97223 JURISDICTION.:
° 1 503 - 639 -4171 www.tigard - or.gov CASHIER DATE:
CASHIER RECEIPT #:
LINE ITEMS:
Case No. 1 Fee Description Revenue Acct. No. 1 Amount Due
!
I �
I j
{ I
I
i
i
r --
Total Due: $ n, .q2__
❑ SEE ATTACHED FEE SCHEDULE.
PAYMENTS: /'�
Payer: j - I - Q. 9_ �t n2A-c- S
Method j Initials Check No i Confirm No. ' Amount Paid
1
Total Paid: $ a--
►:\ Buildin Forms\ ManualPermitForms \ManualReceipt.doc 03/01/063/1/2006
CITY OF TIGARD . - ELL
BUILDING DIVISION PERMIT #: Z06( — 10" 2 -0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 L . 1
Inspection Requests (24 Hrs.): (503) 639 -4175 -.., `:_..
INSPECTION WORKSHEET FOR DATE: '< / PAGE:
SITE ADDRESS: 73 S 0 76 ►- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 -&- 0 (P Pour Time: & /1/
Code # Inspection Des • • ton C'a # Contact # Message
11 t t4kL. 8' ' - Sg3i
Corrections /Comments /Instructions: Q --P:---41A..5'. W� . le-, A .!I 41 LAS ' A-4 :1 I .,.....l
Q ' '1 V \ 1 f k t( qt.'N . ....
S ,t■)b NA% d\c'- ®■NN lak
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4,
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►��I PAS; ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL `` ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Ins ctor; 9 Date2" "� Phone #: (503) 718- VW