Permit III CITY OF TIGARD
COMMUNITY DEVELOPMENT ELECTRICAL PERMIT
PERMIT #: ELC2007 -00545
D ATE ISSUED: 8/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S136CB -00212
SITE ADDRESS: 10870 SW 82ND AVE ZONING: R -4.5
SUBDIVISION: SHANNONDOW LOT : 011 JURISDICTION: TIG
PROJECT: SCHULTZ
Project Description: (3) branch circuits for wall heater installation.
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: 2 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:
SCHULZ, DAVID LINDA M WEST SIDE ELECTRIC CO INC
19105 NE HWY 240 1834 SE 8TH AVE
NEWBERG, OR 97132 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 736 - 0677
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 8/6/2007 $60.15 LIC 13306
[TAX] 8% State Surcharge 8/6/2007 $4.81 SUP 46545
Total $64.96 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 OA' 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
n
Issued By: • / '/ Permittee Signature: 5 Q , 9 , *ad, J ad, an
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.
Flu, 06 07 09:26 -• .. est. Side Electric Co. (503)736-0677 p.2
�
t
l trice! Pelrm• • � • )'.,:. _ A� salt UHl ICE. USE ONLY
City of Tigard Received No.:
y 17125 SW Hall Dlvd. "r; �)7�3� 2007 Dro clb : s ��
Other Permit:
Phu: Review
rill!
C Phone: $03.639.4171 Fax: 503,598,1960 Da! /By Ot
TtGARD inspection1,ine: SO t5S OF �I (� j Uatc %J ty: Jar; I See 1
Internet: www,ti r -n rov V t lg\D Date l'icu/MGhod:
_ r Supplemental la(urmation
.PLAN REVIEW •
❑ New eonStrilction Addition /alteration/replacement '- I'lca.Ne check all that apply (submit Z sets of plena w /ileum Checked below);
❑ Demolition ❑ Other: ❑ Service u r :m,
feeder 400 or more ❑ Building over three stories.
. whue the available fault currant ❑ Marinas and boatyards.
m CATEGORY OF CONSTRUCTION I eAceea+ 10,000 arum at 150 volts or ❑ Floating buildings.
Ieo; to ground, Or exceeds 14.000 ❑ Commercial -use agricullursi
1 - and 2 - family dwelling ❑ C'ornmcrcial /industrial El Ac cessory building amps fo, all other installations. baitditms8
❑ Muhi- family ❑ Master builder ❑Oilier•: O Fire pima,. 0 imatallationof75KVAor
JOB SITE INFORMATION AND LOCATION i El limergeney system. larger separately derived aysmem,
_ ❑ Addition anew mano In at of 0 "A ", "J:;°, "1.2 ", "1.3 ",
Jot. 110.:3 L I u,;J 3 S� 1 Job site ad(1rcS5: e _ 7 , 75 ,,,, .,.0 10011P or more. occupancy.
.__ . _.. �D - �• _..a! ❑ Sin ur MOM reaiddni:J wits. 0 Recreational vehicle parka.
City /State/Zll': / r 0 • C Supply vonage for more than
L ❑ t Icauh -care facilities. CI > • ❑ t inutrdoua Inflations. 600 vents nominal.
Suite/bldg. /apt. no.: Project narllo: O service or !Ceder 600 cunpa ur more. _
FEI! SCHEDULE
Crotis street/direr:tions to job site: - — Ucrrrq,nva _ --- 57 , 7.1.1___.1 , 21___L.,..1 , .. l
New residen r tial single- nr multi-family dwelling unt.
_ •- Includetc attached garage.
Subdivision: Lot no,' ; 1,000 sq. tt. or less L I45, IS 4
- • • ` Eli add'1500 sq. ft. or portion 33.40 - 1
Tax map /parcel nu.: _ Limited energy, residential
DESCRIIYI'ION OF WORK. (widmalx,vc sq. R,) 75.00 2
1 ' 4 Limited cncrdy, multi- family
(t^`) GI 1 . , ... \'-' ` I r•.. `1-.. w S - _ _ re_aidenlial (with: s(1. 75.00 2
—
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER - . _ 0 TENANT 201 amps to 400 a
5 106.85 2
Nestle; : . .,� �
2
( T ' 401 160.60
C • __.._ 0 1 alm lps to 600 amps
- -
amps to 1,000 amps 240.60 2
601
Address: j p S me:, � # z . 1 4 /d �� Z • � ? d, Over 1,000 amps volts 454,65 2
City/State/ZIP: i (<_, .f r T "2) 3 2 Temporary services or feeders In><JtAllatiun, elteration, and /or
relocation
Phone: (4..f> ) 53? 7 a 7 Fox: ( ) 209 lungs or less 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 2(11 amps to 400 amps 100.30 2
intended for sale, lease, fern, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 _ 2
Owner signature: Date:
Branch circuits - new, alteration, or exteoslon,perpanel
- A. Fee I•or trench circuits with
0 APPLICANT 1 ❑ CONTACT l'ERSOM above service or feeder ice, 6.65 2
Business name: each branch circuit
D. Fee for branch circuits
without service ar fonder fcC, 46,85
Contact name: - - first branch circuit I -/ 4• JS 2
Address: Each udd'I branch circuit r ' 6.65 13,3 0 2
• — - - Miscellaneous (service or feeder nut included)
City /State /"Ell': Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fox :: ( ) Reconnect only 66.115 2
E-mail: glcnngnwestsideeleetrie.cum _ Pump or irrigation circle 53.40 2
- .._._— ." _ CONTRACTOR - ^^ I Sigtt or outline lighting 53.40 " 2
Business name: West Side Electric Co., Inc, Signal circuit(S) r ration, d-
_ ,•_ energy panel, alteeration, , or
Address: 1834 SE 8th Ave. extension. Describe: Page 2 2
(Sty /State/ZIP: Portland, OR 97214 _ Each additional inspection over allowable in anYnf the above
• Per i„speelion 62,50
Phone: (St)3) 231 -1548 Fax: (503) 736 - 0677 --•
--- Invcstity,tion per hour 0 hr min) 62.50
• C.Cl3 Lie,: 13306 f Electrical lie,; 26-135C Suprv. Lie.: 4654$ Industrial plant per hour _ _ 73.75
Suprv- Irlectrici:rn signature, required: � r ELECTRICAL PERMIT FEES
- i �li _ . �0 : -' ;.- � Subtotal' - .. * c,
Print name: Randall Roberts Dale:
8/ •
y ) flan review (25% of permit fee):
T .. ,........._ State surcharge (8% of permit tee): • (�r�
Authorized signature: - - n _ TOTAL, PERMIT FEE: • � a •
This per,uit application expires if a permit is nor obtained within 11{11 ..
Print name: Y M Date. days after it bus been accepted as complete.
• Number of inspections allowed per permit.
I:(I jlJingU'rnniuua .('•Fe m l App,l. a :05 /IV00 440- 4013T(!IN15/t'0$vwIill
` l
CITY OF TIGARII
BUILDING DIVISION PERMIT #: ELC2007- 00545
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/6/2001
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 !. °'�
INSPECTION WORKSHEET FOR DATE: 8/9/2007 TIME: 7:00AM PAGE: 40
SITE ADDRESS: 10870 SW 82ND AVE CLASS OF WORK:
SUBDIVISION: SHANNONDOW " LOT #: 011 TYPE OF USE:
PROJECT NAME: SCHULTZ
DESCRIPTION: (3) branch circuits for wall heater installation.
OWNER: SCHULZ, DAVID LINDA M, PHONE #:
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 503
Inspection Request Scheduled For: Date: 8/9/2007 Pour Time:
Code # Inspection Description - . # Contact # Message
199 Electrical final 053685 -01 503-231 -1548 - Y
Corrections /Comments /Instructions:
[go/
•
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS •
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V 4 N Date: 1 • tr) Phone #: (503) 718- •.