Permit !p CITY OF TIGARD ELECTRICAL PERMIT
PER #: ELC2007 -00238
COMMUNITY DEVELOPMENT DATE IS 4/16/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103CC -10500
SITE ADDRESS: 13545 SW 122ND AVE ZONING: R - 4.5
SUBDIVISION: WHISTLER'S WALK LOT : 052 JURISDICTION: TIG
PROJECT: ABOUMENGEL
Project Description: Job No 07 -404 NC and service/ outlet
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: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
HASSAN ABOUMENGEL BOB'S ACTION ELECTRIC INC
13545 SW 122ND AVE 2700 NE BURTON ROAD #A
TIGARD, OR 97223 VANCOUVER, WA 98662
Phone: 503 - 524 - 7220 Contact #: PRI 360 254 - 7200
FAX 360 - 254 -8219
FEES
Description Date Amount Reg #: ELE 37 -431C
[ELPRMT] ELC Permit 4/16/2007 $53.50 LIC 53136
[TAX] 8% State Surcharge 4/16/2007 $4.28 SUP 4322S
Total $57.78 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.
Issued By: I ltrla • Permittee Signature: .. //1i /,, ✓� .
/ 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.
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Electrical Permit Appl* l'. : �E�V E •' . „ i "., FOR OFFICE U ONLY , ` I } E „, ,
City of Tigard Date/By:
WVALe 41 Permit No.:QaCZ) 7 — 00....3e
13125 SW Hall Blvd., Tigard, OR 97223 ' t.) Plan Review
AP 1 201 ;[ !Ww„ el Other Pernut�t,2 - 0') 175
Phone: 503.639.4171 Fax: 503.598.1960 r 9Y D ate B
Inspection Line: 503.639.4175 J % 'k I Date Ready /By: Jnl'IS B See Page 2 for
Internet: www.ci.tigard.or.us
CITY OF rio " -- -� Notifed/Nlethod: Supplemental Information
BUILDING DIVISION
;, , / - . TYPE OF ,WORK ,. "PLAN - REVIEVS
� 1 ❑ New construction ❑ Addition/alteration /replacement Please check all that apply
❑ Demolition ['Other: ❑Service over 225 amps, comm'l Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
v °r t ,, ' . CATEGORY :OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
at 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
t . _ 'JOB SITED INFORM'EITION 'AiND "EO,CATTON ' - v " .. ❑ Egres sill ghting plan RV park
❑Health -care facility ['Other:
Job no.: 07 -404 Job site address: 13545 SW 122nd Avp . — Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
i ..; -° : ::.:<'> ° " : -, i -'''.1' a' FEE *;::SCHEDULE .- -
Suite/bldg. /apt. no.: Project name: j
Description Qty. Fee. Total
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: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 l
Limited energy, residential 75 00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
`� +, r, - " 4 "" i '', ` D OF WO r � :i- f Each manufactured or modular
dwelling, service and /or feeder 90.90 2
A/C connection 4 service outlet Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
, 201 amps ro 400 amps 106.85 2
= aF " 'I'''' ® PROPERT- 1';OVVNER .,,. .. r w o ,., ®ITENANT .,.
401 amps to 600 amps 160 60 2
Name: Hussan Aboumengel 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
Address: 13545 SW 122nd Ave. Reconnect only 66.85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503 ) 524 -7220 Fax: ( ) 200 amps or less 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
. _ ' f ,., ; :„ A. Fee for branch circuits with •
A< °_ ® APPLIC > i,fk t . � _1. .'I . .. COrTCT *PERSON i:. .
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 46.85 46.85 2
each branch circuit
Address: Each add'l branch circuit 1 6.65 6.65 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 circurt(s) or limited -
=. , , a i energy panel, alteration, or
` :CONTRAGIOR- <.. .r _ .fig
extension Describe: Page 2 2
Business name: Bob's Action Electric
Each additional inspection over allowable in any of the above
Address: 2700 NE Burton Rd. "A"
Per inspection 62.50
City /State /ZIP: Vancouver. WA 98662 Investigation per ho (1 h r nun) 62
Phone: ( 3 6 0) 254 -7200 Fax: ( 3 60 ) 254 -8219 Industrial plant per hour 73.75
r:. E,LECTRIG'o7,tERMIT,,:FEES
CCB Lie.: 53136 Electrical Lie.: 7_ 31C Suprv. Lic.: 4322S Subtotal 53.50
Suprv. Electrician signature, required= � Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4
Print name: Kevin Broselle Date: 4/9/07
TOTAL PERMIT FEE 57.78
Authorized signature: This permit application expires it a permit is not obtained within 150
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed
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CITY �~��� ����� �� ���� ' ^
��n n m OF n o�m�mn���
BUILDING DIVISION ^ PERMIT #: ELC2007-00238
| 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4110/2007
Phone: (503) 639-4171 *NAP d116% i
Inspection Requests (24 Hrs.): (503) 639-4175 ���� "��-
INSPECTION WORKSHEET FOR DATE: 2/2 013 TIME: 7:00AM PAGE: 28
SITE ADDRESS: 13516 SW 122ND AVE CLASS OF WORK:
SUBDIVISION: WHISTLER'S WALK LOT #: 082 TYPE OF USE:
PROJECT NAME: AB0Uh4EN(9EL
DESCRIPTION: Job No 07-404 NC and sevice outlet
OWNER: ABOUk8ENGEL. HASSAN ' PHONE #: 603-524-7220
CONTRACTOR: 8013'S ACTION ELECTRIC INC PHONE #: 560-2547300
Inspection Request Scheduled For: Date: 2/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Elect|iCalYinal 065553-01 380-2547200 Y
Corrections/Comments/Instructions:
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PARTIAL APPROVAL �ACANCEL n NO ACCESS
CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
I n Inspector: Date: 4/ g' Phone #: (508) 718-«~'~^ x y
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