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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00878 DEVELOPMENT SERVICES 9 503 - 639 -4171 DATE ISSUED: 11/9/2005 13125 SW Blvd., r PARCEL: 2S103BB - 02500 SITE ADDRESS: 12115 SW 124TH AVE ZONING: R -4.5 SUBDIVISION: BROOKWAY LOT : 025 JURISDICTION: TIG Project Description: New service. 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: JOHN GROSS AMERICAN ELECTRICAL SERVICE 12115 SW 124TH AVE PO BOX 1057 TIGARD, OR 97223 SHERWOOD, OR 97140 Phone: 503- 421 -0212 Phone: 503 - 537 -2121 FEES Reg #: LIC 101587 tion Date Amount SUP Description 36 p ELE 36-59C [ELPRMT] ELC Permit 11/8/2005 $80.30 [TAX] 8% State Surcharge 11/8/2005 $6.42 REQUIRED ITEMS AND REPORTS Total $86.72 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- 0- 2 -2344. Q� Issued By: u�, Permittee Signature: e4� �eQ 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. Nov 09.,Q5 10:44a David Haupt 503- 554 -8506 p.1 1.10/4U/ZUlla V r :90 r a aIJ } OLeVU '.bas VA la V1LLW •rl ....� Electrical Permit A p p l i c a t i o n � c v ! n c � � ] j 1 , , 1 , , t , : t t i . i , t» i .' City of Tigard uo . I > eNQ.: �r 13125 SW Hall Blvd., Tigard, OR 97223 PisaReuiew , _ : 0 • ..i DO i V Phone_ 503.6394171 Fax 503598.1960 , l� `to o5 ' 11 Dse ere Omer Parsic Inspection Line: 503.639.4173 G� • _�i ' � . -. Daeeiteady�sy: 74o- lid .SesPanel For wtu:d Intermit w.tigrd.orus tatodierVasedwd: / / C i I bmmsk.ecruatIsrooaao.n © New asish'ucban G I AddjtontaltWatiniiiiiiiacement Prone {11 c& that apply: Q Demolition 0 Ot11Cr: DSQVice . 225 amps. C01111 13 DHazsrdoas ioratiull _ _ 4 .�� _ QServicc • 320 amps -sating 0Bui�Ig war 10,000 sq. A., _' ?i .; , , _ = S ,; of I- and • • • , dm:Ricgs 4 a more new tesidratial 1- and 2- fa ❑ Master builder ❑ Accessary building Mu D dtn . - throe scoriae DFeede ore ne amps a more Multi - family ❑Masse bttilrlar Q Other: p ,t ory 99 3 'a :' ;.`,ce �1' : -- " , . ti , , • ''; r: -t =-� 1r'"" f` .. , , 5.. OED . uAst9rrd structures or =' • rye.: .: � •-.',........ • .�...::' : ' ; ` a,:..c =•. _ �•:- ,..:•i �"�3'?tii� - :, . _ p , /21 ❑Heald: -. .facility 1:3011m7. 3ab no.: Soh site address; i� ] �J �) Submit 2 . ; orphans with ply of be above. City/State/ZIP: 1 ( - f /J ` The above are ... applicable to temporary oottsaaaien service. Suit&Jbldg./spt no.: a I Project name • • - ae,a;a- QM I rage ) Tar .. . . Cross saee/direcon5to job site: New res'. • single- oraamllK.allIy dwelling snit. Iael.dts • • ttw•a!- 1,000 se,. R • lass 145.15 4 Subdivision: I Lot no.. 1:a. add'l 500 . ft. or Feign 31.40 1 Tax map/pareel ma: Limited afar , residential 73.00 2 Limited - ., , nm•RSideatnd 75.00 2 _ •. . � .. . '�•�.�, • �r� . Esob uisao • or modeler (Welke& - ce and/or 4xder f 90.90 2 Services or f . • .. i.ADatioa, niteratiao, asdlor rdaettiw 200 tams or1 - -- j 80.30 "cKt.,i 2 k;- :t . m:>� _ - k j fii".: � • r 1 *-- c., 201awtp0to • . II at1tPs 106_15 2 a !" . A�- <: ,. . �+ " k' :firf ` 401 amps to • • , amps 160.60 2 NnITC: .--71. J N bS > 601 sums to 1 " t •1 amps 240.60 2 Address: oZ f 1'S � LU Off- -1 Over 1,000 or volts 454.65 2 Q � /� Reconnect 66.85 2 Clty/Statc/ZIP: f 1 r�/J + ee - V/ 772-3 Temporary g ar feeders iastallarior, aMoratio*. aadier Phone: ' ) 11.0( ) [) Zj Fax:( ) rel°r'tiem 200 amps or - 66.85 1 Owner installation: This installation is being made on property that lawn which is not 201 nmps to ., , „m„, 1 0030 2 intended 6o - sale, lease. rant. or exchange„ according to ORS 447.469, 670. and 701. 401 ampsto i t amps i i 133.75 2 Owner sig iattae: • hate: Bra.ei ' . - sew, .IlNYtioa, ar exaeaaioa,, per panel ,:i5 P.: ,. • - iC •.• -nr- =: �*° a Fee far • • - • Means with ... , i.. "Fa' .it»o�.,� . �.s �?ii• `. : . - �' service or fee, Lath Business waive: �-�l e A .d t . G. 2 7I 62 ,•� r— /�9"I/ bnr+d. -, .' r " 6.65 2 / �, -/ v` " � ` y B Fee for • _- • circus Contact steins„ • 7 !/ !mot *thou, 3 - se or Foxier fee. 46.65 2 f � etch • . circuit Address: f . 0 - h ((` ' Each Mal . circuit 6.65 , 2 City/State/M: �1 'ie., f O....., q'7 ( 6 Waal. • ., - (service or feeder not included) - C' �7 2 Pimp or ' ' •'on circle 53.40 2 P1100e ? ! �/ �/ I Fax: : (�3) [� Sign oroaf • lighting 53.40 I 2 E -mail: Signal cilwi. s) or Marital- . ::;,•r. 3 .-FA S' , " lgiTtle 4 r4WW.r: a'agy panel .ketsaoa, °r exaxsiou. a - • 'bc Pagel 2 Business name• ,�I ¢-� I I .f G .re.6.� _ Address: "" l( ' Eac add 1 sapect:0a over al i o gay of tie above 1�` /t a (� 7 Pa in . - -. • , 62.50 City /Staz&ZIP: 0• m � 1 - a� e,7 / C- t� lnvestigetios per hanr(tlrmin) 62.50 p.(7) £ l f Z) t 1=ax ` �,�3 ' SW i,S( lailaara>l p • • t Per hour .. ' . 73.75 CO3 Lie.: 10/ I Electrical Lie.: L f /p6 I Suprv. Lie.: _3l, c) --5 � Subutotn to, . Suprv. Etectridnn signature, requl -„ _� . Plan (25%ofpa,nit fee) Print name f - 4 1 , / S atc sa:ci r5c(ax ofpermit the) 6Q_ � ��/ • 1 (/ J7 x)-- TarfA1 ERMET E �j - 72 A, a Authorized sigwhe:0 _ t Th posit separatist expirea ira peLm ob I ia is sot hwce vatein 1 20 dare afterk kat bees arsepeal scNCplam Print name: Date: 0----- • Fee osebomiojy ea try Di-Comp 13 MinaIndvtry Servioc Bow] I fd / � % re s t.. , -•• •• jVa, nbcrofiaapcctieas per pea,ae — K awiasvau•wr,icos,c- roseivicesor IVO, 446461S1t1W07/C01MPa'6B CITY OF TIGARD ----,., BUILDING DIVISION PERMIT #: ELC2005-00878 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639-4171 :l I l Inspection Requests (24 Hrs.): (503) 639-4175 INSPECTION WORKSHEET FOR DATE: 11/23/2005 TIME: 7:00AM PAGE: 54 SITE ADDRESS: 12115 SW 124TH AVE . CLASS OF WORK: SUBDIVISION: BROOKWAY LOT #: 025 TYPE OF USE: PROJECT NAME: GROSS DESCRIPTION: pieVi f.feiViCe OWNER: GROSS, JOHN PHONE #: 503 CONTRACTOR: AMERICAN ELECTRICAL SERVICE PHONE #: 503-537-2121 Inspection Request Scheduled For: Date: 11/23/2005 Pour Time: Code # Inspection Description . Confirm # Contact # Message 115 Electrical service 2337-01 503-421-0212 -----4 Corrections/Comments/Instructions: \At (t Ov**(t. i V a_d .,_._ ay.-, • „.... - ---• li i / , NW /6/trasal ..._ c.f-- _A E) P,q_A/ • ...- 0 4 /- / " 30 oC - it, 4, 'I/ , gc - ----- 2 PASS I 1 PARTIAL APPRO A L El CANCEL 0 NO ACCESS IFAIL M(CA - OF' w- .PECTION ADDITIONAL FEES ASSESSED Inspector: Date: l f 0 d Phone #: (503) 7121z:. CITY OF TIGARD X:. : BUILDING DIVISION PERMIT #: ELC2005 -00878 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/14/2005 Phone: (503) 639 -4171 i '41 +���puy�lli(il Inspection Requests (24 Hrs.): (503) 639 -4175 ! ■■•• INSPECTION WORKSHEET FOR DATE: '11/18/2005 TIME: 7 :17AM PAGE: 106 SITE ADDRESS: 12115 SW 124TH AVE CLASS OF WORK: SUBDIVISION: BROOKWAY LOT #: 025 TYPE OF USE: PROJECT NAME: GROSS DESCRIPTION: New service. . ')/\ OWNER: GROSS, JOHN i it PHONE #: 603-421-0212 / CONTRACTOR: AMERICAN ELECTRICAL SERVICE D F / y �L ry � r PHONE #: 50'3 -537 -2121 Inspection Request Scheduied For: Date: 11/18/2005 Pour Time: • Code # Inspection Description Confirm # Contact # Message 115N Electrical service i i 021773 -01 503 -421 -0212 N Corrections /Comments /Instructions: 0 d't . ` C N Q MO I fi 5 Mice Sr ,,.: \\o\ i::. PASS PARTIAL APPROVAL ❑ CANCEL n NO ACCESS ›FAIL I I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: / yc---') Date: / /8 Phone #: (503) 718 -