Permit C ITY OF TIGARD ELECTRICAL PERMIT
r. 1. PERMIT #: ELC2005 -00461
l� DEVELOPMENT SERVICES DATE ISSUED: 6/29/2005
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S135DB-00200
SITE ADDRESS: 11275 SW 90TH AVE ZONING: R - 4.5
SUBDIVISION: TIGARDVILLE PARK LOT : 001 JURISDICTION: TIG
Project Description: Panel change & NC circuit.
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: 1 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:
WILHELM, CLARE ROSS ELECTRIC INC
11275 S W 9 0TH AVE 2870 SW 221ST AVE #203
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 443 -1968 Phone: 503 - 642 -2800
FEES Reg #: LIC 157891
ELE 34 -436C
Description Date Amount SUP 4232S
[ELPRMT] ELC Permit 6/29/2005 $86.95
[TAX] 8% State Surcharge 6/29/2005 $6.96 REQUIRED ITEMS AND REPORTS
Total $93.91
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: Permittee Signature: p \e,p
OWNER INSTALLATION ONLY `1
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.
06/28/2005 17:41 5036425815 ROSS ELECTRIC INC PAGE 02
.- 7
. ' ‘ Electrical Permit A lie tion, nr-c-n FOR OFFE. USE ONLY
• - -- ZI! -''' '''
"? City of Tigard REbt Receive 2
Datemy: q , 7e7 -?..._.„ Permit No.....4,C AI 3 ieZL57
13125 SW Hall Blvd., Tigard, OR 97223
Plan Review
Phone: 503,639.4171 Fax: 503,598.1960 mi 2, 9 205 . -4 , sli i i\ Date/By: Other Permit:
Inspection Line: 503,639.4175 JU • ;',
Digo Rendy/By: Juri5: i See Page 2 fnr
--"
tritemet: wwweiligard.orais TIGARD
Notified/m
.<,- th-- rupplemental Information
.••'
•
IMNIVaangriZkiitZi::UNt.giggi.#00.K.:1.91•...ttn '' ' . ... ; .. : • . ..., ' ..) ' 4 ';'; i' .:,. ... ' . : :X . - : • : : : • . V -: 1 PTiLl•
0 New construction 1Z1 Alidliion/alteration/replacenient Please check all that apply:
1:1 Demolition • 0 Other: ['Service over 225 amps, comm'I 1=114azrdous location
■ittsitiv.vcoRvitrtit.•-istitetcq,R,E441.- - • i' x,r , .. • • • - tut; wt;., • , • • ;... . •••••;sr •••lidl • .; ......• rvi
f ,,., ..,. 1. ee over 320 timps - rat 171B
ing uildng over 10,000 sq. ft.,
• .• DSe Of 1- and 2-family dwellings 4 or more new residential
1- and 2-family dwelling ID Commercial/industrial 0 Accessory building 171System over 600 volts nominal units in one structure
DBuilding over three stories ['Feeders, 400 amps or more
0 Multi-family 0 Master builder 0 Other;
Occupant load over 99 persons MManufactured stmetures or
±:4 ligrkiPiliqing90111400AWitt**,;'0Wii,
I'�1 t . "
RV park
,, / t ,•.' -Aix • ... *At, 8 !;,..„A,.„;,.4,,,;it.„„.,,_.,, „.„„ „ „„.., .. .., ..,:...: ..;t:!:...;.:..,.;; •,.:...).; LJEgresillighting plan
Job no.: Job site address: ha 7 5 S t 9 0 1 ffrA-e- OHealth-care facility 00ther
Submit 2 sets of plans with any of the above.
City/State/ZIP: '11 Aar° 0 j ? , The above arc not applicable to temporary construction service.
:,,:i1.;:.iR.i'Mlt;:;1.:,t'lq•.;.'4415t l.,.. 30.:' .107aii'.',PAililii'',"Y,;,7
Suite/bldg./apt. no.: 1 Project name:
Description Oty. Fee. Total ..-
Cross street/directions to job site: New residential single- nr multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: 2a. add') 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.;
::•:' . , Limited energy, non-residential 75,00 .. 2
NM Itte . :1 Eacl„n„ufactu„d or modular ..,
dwelling, service and/or feeder 90.90 2
Pa.1-N-e-( efrktt qt.._ 1:. Sr-ru-kc.44 e4 re.) I i- Services or feeders Installation, silent ion, and/or reberition
200 amps or less ( 80.30 80.3,0 2
g rall ', 'IFt 10 . , 2 ° 1 at°1/ to 400 omPs _106.85 2
- '''''''" ' 401 amps to 600 amps 160,60 2
Name: C \ C \ \4- 1-•3 ' 1 \ V - L\_ ,. ■,, 601 amps to 1,000 amps 240,60 2
Address:
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: (155) 5/915- j '9 6y Fax: ( ) relocation
200 amps or less i 66.85
Owner instnilationt This installation is being made on property :kat I own which is not 201 amps to 400 amps 100.30
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
A. Fee for branch circuits with
.,.
service or feeder fee. each
Business .narnc:
branch circuit i 6.65 i , &S 2
B. Fee for branch circuits
Contact name:
without service or feeder fee,
_ each branch circuit 46,85 2
Address:
- Each add'l branch circuit L 6.65 I J 2
City/State/ZIP:
Miscellaneous (service or feeder not included)
Phone: ( ) [ Fax: : ( )
-
Pump or irrigation circle --- 53.40 2
Sign or outline lighting 53.40 2
E-mail;
Signal circuit(s) or limitcd-
1 l' Ara l ilt t alalg i nitaggeOgOlalg„lr,W. : :? : ;4: ' , . : :• ... , •'` Ii i.: : ■■:i;:j, : :, : :; .,•:!■:! energy panel, alteration, or
extension. Describe; Page 2 2
Business name: Rcr,s ete - 44tic
.
Address: a 870 5e 7 6 iii-ae... t:P 203 Each additional inspection over allowable in any of the above
Per inspection 62.5o
__
City/State/ZIP: f-
P: c) Investigation per hour (I ix- reiTo 62.50
Phone: (5D3 ) 4 Li 2__ 2...s.00 Fax; (12'3 ) (el-/Z --- Si 5- Industrial plant per hour 73.75
N ? 1M ,• Mikla w•M,13,04,2a7Ligir.5T.:,i;;••.','X'l
CCB Lie,; I 5--7 87 3 I I ElectHcal Lic.:3 I Suptv. Lie.: 11239 S
Subtotal gc • 1 15
_
Suprv. Electrician signature, requircd:- /2.124'0 Plan review (25/. of permit fee) ---
Print name: f-e_Pk.em 120 s5 I Date: 6,- 0 s- State g
surchare (8% of permit fee)
_ - to- C i 1 0
TOTAL PERMIT FEE 9.3 _ci I
Authorized signature:
This permit application expires If a permit iit not obtained withlil I z)
days after it has been accepted as eamprete
Print name; Date:
" Pee methodology act by Tri-County Building induotry Service BoaTd
• • Number of inspections per permit allowed,
1 : 11 : 1011 cling 1 P.rmitAELC-PaynitApp.do c 12/01
4 49 - 16 1 ST( I 0/02/C OTWWE11
•
CITY OF TIGARD •
BUILDING DIVISION PERMIT #: ELC2005 00451
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2005
Phone: (503) 639 -4171 1,11�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 917/2005 TIME: 7:02AM PAGE: 59
SITE ADDRESS: 11275 SW 90TH AVE CLASS OF WORK:
SUBDIVISION: 11GARDVILLE PARK LOT #: 001 TYPE OF USE:
PROJECT NAME: Wi LHELM
DESCRIPTION: Panel change & A/C circuit.
OWNER: WILHELM, CLARE, PHONE #: 503-443-1968
CONTRACTOR: ROSS ELECTRIC INC PHONE #: 503 -642 -2800
Inspection Request Scheduled For: Date: 9/7/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 03611401 503-642-2800 N
Corrections /Comments /Instructions:
•
i
N / PASS I I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL n CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Cr ' 4 \F 6v Date: _r ' l . 0 Phone #: (503) 718 - Z.14L•
•
CITY OF TIGARD
BUILDING DIVISION '- PERMIT #: ELC2005 -00461
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/29/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 - 4175 -'!� 'LL
INSPECTION WORKSHEET FOR DATE: 7/1/2005 TIME: 7:14AM PAGE: 81
ai)-K0c$ ® "X)
SITE ADDRESS: 11275 SW 90TH AVE CLASS OF WORK:
SUBDIVISION: TIGARDVILLE PARK LOT #: 001 TYPE OF USE:
PROJECT NAME: Wi LHELM
DESCRIPTION: Panel change & A/C circuit.
OWNER: WILHELM. CLARE, PHONE #: 503- 443 -1968 _
CONTRACTOR: ROSS ELECTRIC INC PHONE #: 503 -642 -2800
Inspection Request Scheduled For: Date: 7/1/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
145 A/C or heating unit circuit 010575.01 60' -443 -1968 N
Corrections /Comments /Instructions:
•
The electrical installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar Jaye per OAR 918- 271 -0030
IN PASS ❑ PARTIAL APPROVAL NC ❑ NO ACCESS
❑ FAIL ❑ ALL FOR INSPECTION ❑ ADDI ONAL FEES ASSESSED
Inspector: / / Date: (ic Phone #: (503) 718-