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Permit 714 q CIT�Y4 OF TIGARD ELECTRICAL PERMIT P DATE ISSUEDERMIT #: : 9/17/ ELC22007 007 -00649 COMMUNITY DEVELOPMENT TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S134DC-01700 SITE ADDRESS: 11780 SW 114TH PL ZONING: R -4.5 SUBDIVISION: 114TH PLACE LOT : 010 JURISDICTION: TIG PROJECT: TEITELBAUM Project Description: Replace panel. 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: AARON TEITELBAUM OWNER 11780 SW 114TH PLACE TIGARD, OR 97223 Phone: 956 -5449 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 9/17/2007 $80.30 ITAX] 8% State Surcharge 9/17/2007 $6.42 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. Th Issued By: � Permittee Signature: / i � ' 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. �fc,1 ON C F-_i.. Oav ` —0061' s El Permit Application ��� PP Land Use Approval -\..�� 55 N. 1 AV, Suite 350, MS 12, Hillsboro, OR 97124, Project # �/ OREdoN Phone: 503- 846 -3470, Fax: 503 -846 -3993, Permit # EZ-C,2. ∎ 7 _ Z. 5 Inspection Requests: 503 -846 -3699, www.co.washington.or.us TYPE OF WORK PLAN REVIEW ❑ New construction ( 'Addition/alteration/replacement ❑ Other: Please check all that apply: ❑ Service or feeder 400 amps ❑ Hazardous locations or more where the available El Service or feeder 600 amps or mom CATEGORY OF CONSTRUCTION fault current exceeds ❑ Building over three stories IXI and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or❑ Marinas and boatyards Multi Master builder Other: less to ground, or exceeds ❑ Floating buildings ❑ y ❑ ❑ 14,000 amps for all other JOB SITE INFORMATION AND LOCATION installations. I=1 Commercial -use agricultural buildings © i ❑ Fire pump Job no.: Job address: I 1 D 6 1. „, (I + L P L ❑ Emergency system ❑ Installation of 75 KVA or larger �h separately derived system ❑ Addition of new motor City /State /ZIP: � �� ZZ3 ❑ R ' eat "I -2;' vehicle occupancy load of I OOHP or more Suite /bldg. /apt. no.: Project name: ❑ Six or more residential units ❑ Recreational vehicle parks ❑ Health -care facilities ❑ Supply voltage for more than Cross street /directions to job site: St,/ ` q .1 � � 600 volts nominal FEE SCHEDULE Description Qty. Fee Total * Subdivision: Lot no.: Residential single- or multi- family dwelling unit. Includes attached garage. Tax map /parcel no.: 1,000 sq. ft. or less 150.00 4 DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion 42.00 Limited energy, residential \ \ ep IACe, O( C;re W 1 ea I:e pcivier Dt:c (with above sq. ft.) 60.00 2 tip 4 ,( C , (� /l Limited energy, multi- family 66.00 2 / n 0-C Cp, •{-e c + residential (with above sq. ft.) PROPER OWNER „ ❑ TENANT Services or feeders installation, alteration, and /or relocation �^ 200 amps or less I - fleVrf 0.3c Name q �O/i l e 114- I b G) t., i`'1 201 amps to 400 amps 120.00 2 Address:, 1 1 7 ) L✓ 1C Pt_ 401 amps to 600 amps 180.00 2 City /State /ZIP: `( Q !2 1 7 ZZ 3 601 amps to 1,000 amps 270.00 2 t �► `� 1 Over 1,000 amps or volts 504.00 2 Phone: 60 3) 9 S _ S i--1 G/ 9 Fax: ( ) Temporary services or feeders installation, alteration, and /or relocation Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 78.00 2 my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.5601 ). 201 amps to 400 amps I OF.00 2 Owner signature s '� Date: 17 5 p su 7 401 amps to 599 amps 150.00 2 ❑ APPLICANT ❑CONTACT PERSON Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with Business name: above service or feeder fee, 8.50 each branch circuit 2 Contact name: B. Fee for branch circuits without service or feeder 60.00 Address: fee, first branch circuit City /State /ZIP: Each add'l branch circuit 8.50 Miscellaneous (service or feeder not included) Phone: ( ) Fax: ( ) Each manufactured or modular dwelling, service, and /or feeder 102.00 2 E -mail: Reconnect only 78.00 I CONTRACTOR Pump or irrigation circle 60.00 2 Business name: C A.Thl A.... Sign or outline lighting 60.00 2 Signal circuit(s) or limited - Address: energy panel, alteration, or 60.00 extension. Describe: City /State /ZIP: 2 Phone: ( ) Fax: ( ) Each additional inspection over allowable in any of the above Per inspection 90.00 E -mail: CCB lie. no.: Investigation fee (See compliance) Electrical lie. no.: City or metro Iic.: Other: Supervising electrician ELECTRICAL PERMIT FEES signature, required: Subtotal 9'0,39 Plan review (25% of permit fee) Print name: Date: Authorized ' State surcharge (8% of permit fee) � si - TOTAL PERMIT FEE Y p / This permit application expires if a permit is not obtained Print Warne: ,{ _ vO C r ` ftf l ) Y� „ a v � Date: (7 3 t p)/'/")7 within 180 days after it has been accepted as complete lei f r *Number of inspections allowed per permit. Revision 06 /26/06 CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007-00649 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/17/2007 ■■ Phone: (503) 639 -4171 A 4@wiq '+ Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 9/19/2007 TIME: 7:00AM PAGE: 9 SITE ADDRESS: 11780 SW 114TH PL CLASS OF WORK: SUBDIVISION: 118TH PLACE LOT #: 010 TYPE OF USE: PROJECT NAME: TEITELBAUM DESCRIPTION: Replace panel. OWNER: TEITELBAUM, AARON PHONE #: 956 -5449 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9/19/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 055958 -01 503-956-5449 hl Corrections /Comments /Instructions: i PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: c 1v [ Date: illotit9 Phone #: (503) 718- 244 CITY OF TIGARD w BUILDING DIVISION 'L Welk PERMIT #: ELC2007 -00649 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9//702007 Phone: (503) 639- 4171d9p��u °'�I Inspection Requests (24 Hrs.): (503) 639 -4175 . INSPECTION WORKSHEET FOR DATE: 9/18/2007 TIME: 7 :00AM PAGE: 33 SITE ADDRESS: 11780 SW 114TH PL CLASS OF WORK: SUBDIVISION: 114TH PLACE LOT #: 010 TYPE OF USE: PROJECT NAME: TEITELBAUM DESCRIPTION: Replace panel. OWNER: TEITELBAUM, AARON PHONE #: 956-5449 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 9118/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 055876.01 503 - 956.5449 V Corrections /Comments / Instructions: fr, ,OusL C 12) Z-q)144.4A,101e, 60 _ r •-- c v) �7�� l/i/1 1~G 6.4.,,^ , -w. v-vas (o Y W ► t-00t v No , e, ' /1 ;) (jk S 2- lS e 1 PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS FAIL I ] CALL FOR INSPEC ION ❑ ADDITIONAL FEES ASSESSED Inspector: 4 Date: c ^- 9/ / " ePLione #: (503) 718 - =�1;L,