Permit fR
CITY TIGARD ELECTRICAL PERMIT
�' PERMIT #: ELC2005 -00776
DEVELOPMENT SERVICES DATE ISSUED: 10/13/2005
I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S111DB-01300
SITE ADDRESS: 15440 SW ALDERBROOK CIR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.8 LOT : 441 JURISDICTION: TIG
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:
KENNETH ENGSTROM OWNER
15440 SW ALDERBROOK CIR
TIGARD, OR 97224
Phone: 503 - 481 -4022 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 10/13/200` $80.30
[TAX] 8% State Surcharge 10/13/200` $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- 800 - 332 -2344. i
Issued By: - 7;J�,:6 Permittee Signature: Ar
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.
Electrical Permit Application F UR OFFICF USE ONLY
f sf r
City of Tigard li 8 te' �'I Date/Bea r - -A _AIL Permit No.: L A 00�J 1-6 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review -
Phone: 503.639.4171 Fax: 503.598.1960 !4, OCT 1'' D a l y
Other Permit:
(° ' ter .
Inspection Line: 503.639.4175 t+ 9 • �l ►,_ a _ 'f Date Ready/By: 'U 0 Sec Page 2 for
',
Internet: www.ci.tigard.or.us Notified/Method: 1� J Supplemental htformation
. �i —Y } r � GAl:ID PLAN REVIEW V V
a t r n ) p - Please check all that a I
ID New construction ® Additio a te remacement apply:
❑Demolition ❑ Other: 0 Service over 225 amps, comm'l ['Hazardous location
❑ Service over 320 amps - rating ['Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ' ❑Egress/lighting plan RV park
Job no.: Job site address: 15440 SW Alderbrook Circle ❑Health-care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service.
` FEE* SCHEDULE .
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee Total I „
Cross street/directions to job site: Durham / Alderbrook Drive. New residential single or multi family dwelling unit
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Summerfield Lot no.: Ea. add'I 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
Replace electrical panel and breakers dwelling, service and/or feeder 90.90 2
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
s" 401 amps to 600 amps 160.60 2
Name: Walter, Mary & Kenneth Engstrom 601 amps to 1,000 amps 240.60 2
Address: 15440 SW Alderbrook Circle Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
Phone: (503)481 - 4022 Fax: (e)mail: kengstrom @verizon.net relocation
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, leas" re,i a.. ex han•e according to ORS 447, 449, 670, 2 a and 701. 401 amps to 600 amps 133.75 2
Owner signature: 4 „ ' /`�
Date: /0/6
Branch circuits - new, alteration, or extension, per panel
® APPLI • ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Homeowner branch circuit
B.
Contact name: Kenneth (Ken) w ee ithoo f for branch circuits
without service or feeder fee, 46.85 2
Address: 15440 SW Alderbrook Circle each branch circuit
Each add'l branch circuit 6.65 2
City/State /ZIP: Tigard, OR 97224 Miscellaneous (service or feeder not included)
Phone: (503) 481 - 4022 Fax: : (None) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E - mail: kengstrom@verizon.net Signal circuit(s) or limited-
. V . CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: N/A
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT - FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: Subtotal '51 r/, 3 0
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) -6 , 9,z
TOTAL PERMIT FEE d 0 , 7
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
•• Number of inspections ner nernit allowed.
CITY OF TIGARD
.r 13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
MIKE'S ELECTRIC
11070 SW ALLEN BLVD
BEAVERTON, OR 97005
Electrical Signature Form
Permit #: ELC2005 -00776
Date Issued: 10/13/2005
Parcel: 2S111 DB -01300
Site Address: 15440 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8
Block: Lot: 441
Jurisdiction: TIG
Zoning: R -
Remarks: Replace panel.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
KENNETH ENGSTROM MIKE'S ELECTRIC
15440 SW ALDERBROOK CIR 11070 SW ALLEN BLVD
TIGARD, OR 97224 BEAVERTON, OR 97005
Phone #: 503 -481 -4022 Phone #: 503- 649 -6991
Reg #: LIC 50209
SUP 4230S
ELE 34 -18c
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
j_Dor,,,,944/) 7h/V24
Signature Off Supervi g Electrician
If you have any questions, please call 503.718.2433.
CITY OF TIGARD
BUILDINd DIVISION . PERMIT #: R.C2005-00776
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: i0ti3/2005
Phone: (503) 639-4171 4 * 111 1MMI\
Inspection \Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 1/912006 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 15.140 SW ALDERBROOK CIR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.8 LOT #: '141 TYPE OF USE:
PROJECT NAME: ENOSTROM
DESCRIPTION: Replace panel.
OWNER: ENGSTROIV1, KENNETF , PHONE #: 503-481-4022
- ,
CONTRACTOR: MIKE'S ELECTRIC \ PHONE #: 503.6496991
. \
Inspection Request Scheduled For: . Date: 1/9/2006 Pour Time:
‘: \
Code # Inspection Dekription Confirm # Contact # Message
• 1,99 Electrical firial . 02457741 • 503-649-6991 N
\ '.
Corrections/Ccmiments/Instructions:
\
, \
.
, \
'
• '.:•
PASS n PARTIAL APPROVAL Ei CANCEL 0 NO ACCESS
,
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: i - 7- 0 (9 Phone #: (503) 718-7-11-141*