Permit CITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00138
�,A DEVELOPMENT r ERV ( 503) 639 -4171 DATE ISSUED: 3/9/2005
-- 13125 SW Hall PARCEL: 25111 BB - 01300
SITE ADDRESS: 14180 SW 103RD AVE
ZONING: R - 12
SUBDIVISION:
BLOCK: LOT : 014 JURISDICTION: TIG
Project Description: Furnace, A/C & plugs, (3) 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: 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:
PROPST, MELVIN R DEKORTE ELECTRIC
14180 SW 103RD AVE PO BOX 12379
TIGARD, OR 97223 PORTLAND, OR 97212 -0379
Phone: 503 - 639 -2403 Phone: 503 - 288 -2211
FEES Reg #: ELE 34 -541C
LIC 159954
Description Date Amount SUP 4075S
[ELPRMT] ELC Permit 3/9/2005 $60.15
[TAX] 8% State Surcharge 3/9/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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: S
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 639 - 4175 by 7:00pm for an inspection the next 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.
DEKORTE ELECTRIC LLC 5032882231 03/09/0S 11:47am P. 002
, . V
El Perm A _
f ; .& 1 .ii' FOR OFFICE: USE ON LI
City of Tigard [ Da ir3 3 4, -- ��,� snit No.: �C..4,2 ) S c1 /n
13125 SW Hall Blvd., Tigard, OR 97223 p O / 9 200;1 P lan Revicw )
Phone: 503.639.4171 Fax: 503.59R.19694 i! c G _ Other Permit: �) �- t7'l� 0 9 !
Inspection line: 503.639.4175 r � 1( "� j,. "" i , a
g Date Rcady/By: R1 Sec Page 2 f
Internet: www.ci.ti ard.Orms • ig c . Notiticd/Methnrl: Supplements[ Information
lI' • i � 4411 .i .: a%►: •
u -:t"' PLAN REVIEW
•
".� I
❑ New construction 1.14: Please check all that apply:
Ilion/alteration/replacement y:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other:
❑Service over 320 amps - rating ❑Bulking over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
- F),.,1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑Master builder ❑Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION _ ❑E plan RV park
y, Job no.: /! ,A Job site address: V ii c O gg //� 7 r a. ,
I
01- Icalth -care facility ❑Other:
��. ' 11 ' �`1 �C J 1r) I l / • __ "" _,k,d-_ Submit 2 sets of plans with any of the above.
City/State /ZiP: 0 t ef _,y''A, ) 1% ° The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE
Description Qty. i Fcc. I Total I "'
Cross street/directions to "job site: New residential single- or multi - family dwelling unit.
- Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: J 1,ot. no.: Ea. add'l 500 sq. ft, or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
pc nn _ dwelling, service and /or feeder 90.90 , 2
1, , Lk-re' r t e c ). 'L -o t - )1 -. • t , Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Eva e- ti v ; trk r^ 601 amps to 1,000 amps 240.60 2
Address: j 4- 1 60 S G.3 RV 3 r A''I (7_, — Over 1,000 amps or volts 454.65 2
Reconnect only I 66.85 I i 2
City/State /ZiP_ cy V C! 0 R C-)1. `a �,_ "- k Temporary services or feeders installation, alteration, and /or
Phone: ,'ii Fax: _ relocation
�) � �(' "t �.� I ( 200 amps or less r 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 600 amps 133.75 2
Owner signature: .. Date: ____. _ Branch circuits - new, alteration, or extension, per panel
1:1 APPLICANT • � ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: _ branch circuit
--- B. Fee for branch circuits
Contact name: without service or feeder fee, 1 •
Address: each branch circuit I 46.85 2
Each add') branch circuit 2-. 6.65 L-.3.30 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) 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: DeKorte Electric Vic •
Each additional inspection over allowable in any of the above
Address: PO Box 1 — 2379 -[--
Per inspection 62.50
City /State /ZIP: Portland, OR 97212 Investigation per hour (! hr min) 62.50
plant per hour 73.75
Phone: (503) a..- aZ
a � \ Fax: (503) 288 -2231 Industrial p ELECTRICAL PERMIT FEES*
—
CCB Lie.: 159954 Electrical Lie : 3 54 ' Suprv. Lie.: 41755 Subtotal 690 , )5-
Suprv. Electrician signature, required: / �~
Plan review (25% of permit fee)
c , Date: "� 6-1 IL ,.., e• State surcharge (8% of permit fee) (".1 _ i
Print name: . E � I� (' t. } L ; _ '., TOTAL PERMIT FEE
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
CITY OF TIGARD .. z.. .
BUILDING DIVISION PERMIT #: ELC2005 -00138
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 3/9/2005
Phone: (503) 639 -4171
Ai
Inspection Requests (24 Hrs.): (503) 639 -4175 JoriiivilP �
INSPECTION WORKSHEET FOR DATE: 3/17/2005 TIME: 7 :13AM PAGE: 116
SITE ADDRESS: 14180 SW 103RD AVE CLASS OF WORK:
SUBDIVISION: LOT #: 01 4 TYPE OF USE:
PROJECT NAME: PROPST
DESCRIPTION: Furnace, A/C & plugs, (3) branch circuits.
OWNER: PROPST, MELVIN R, PHONE #: 503633 -2403
CONTRACTOR: DEKORTE ELECTRIC PHONE #: 503 - 288 -2211
Inspection Request Scheduled For: Date: 3/17/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 001985-02 503- 2835183 Y
1� �v
Corrections /Comments /Instructions:' '
0 Of V C'cKLf. 13.: a-
C-
y PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
: _ Inspector: � Dater`/ 9 ! U o Phone #: (503) 718-