Permit CITY OF TIGARD ( ELECTRICAL PERMIT
PERMIT #: ELC2008 -00037
COMMUNITY DEVELOPMENT DATE ISSUED: 1/18/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 BA -10800
SITE ADDRESS: 09543 SW ELROSE ST ZONING: R -4.5
SUBDIVISION:, LAUTT'S TERRACE LOT : 002 JURISDICTION: TIG
PROJECT: HUMPHREY
Project Description: (2) branch circuits for computer outlets
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 HMI 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: SVC /FDR >= 225 AMPS: CLASS AREA /SPEC OCC:
Owner: Contractor:
HUMPHREY, THAD WEST SIDE ELECTRIC CO INC
9543 SW ELROSE ST. 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 736 -0677
PRI 503 - 231 -1548
FEES •
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 1/18/2008 $53.50 LIC 13306
[TAX] 12% State Surchar 1/18/2008 $6.42 SUP 4654S
Total $59.92 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: j � i Permittee Signature: /j 72
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 Applieati¢. _ \
rOli OrFICE USiC'ONLY
s_ Cii , of Tia. -trd 11 _
i ,et N L� U� Received
Uate /B I (I/0 Pent[ No L.
13125 SW Flail Blvd., Tigard, OR 97223 E 1 y (.K.� 7
a... Phone: 503.639.4171 Fax: 503598.1960 Plan Review
,` �� ,Date/By: Other Permit:
F,'r;:,',,:;.:s '' Inspection Line: 503.639.4175 c �� sf
i IG� RD ���� V ® � � Ql ®1 ` Uate Ready/By: 1uris: 11 See Page 2 far
.i .v..,: ; .,:?:.'i., inlet www.tigard- or.gov ,�G •T Nontied/Method:
i`� Supplemental Information
—
.. , TYPE OF WO 1. :.:.. :.., PLAN REYJEW
❑ New construction \ Additiolr /alteration/replacement Please check all that apply (submit 2 sets of plans wlitems checked below):
❑ Demolition ❑ Service or feeder 400 amps or store ❑ building over three stories.
Other: where the available fault CUITCRI
❑ Marinas and boatyards.
1 -
CATEGORY OF. CONSTRUCTION '' ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
s g .
I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building •
Multi ID Master builder less to grswtd, or exceeds 14,000 ❑Commercial -use agricultural
amps for all other installations. buildings,
El Other: Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION: ❑Gmngen system. huger sepmatelyderived system .
-� �y ❑ Addition of ne new of ❑'•A" "E" "1.2" - 1-3",
Job no.: -J ) 1 / 1-..J t-'1 Job site address: 5 Li S L f ( • 10011P or more. occupancy.
tJ I L i( ,/� % /l ❑ Six or more residential units, ❑ Recreational vehicle parks.
City/State/ZIP: r ,),,,,_1 L ❑ Heultlrcare duilities. ❑ Supply voltage for inure than
` ( t ❑ Hazardous locations. 600 volts nominal.
N
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Vot 6 �C / 4 Llf'
Cross street/directions to job site: FEE SCHEDULE.
Description ( qty. I rec. J Total L • •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
fax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Limited energy, residential
' . DESCRIPTION OF WORK '..'.'''. (with above sq. ft.) 75.00 2
J Limited energy, multi - fancily
(Z.) ( / C L i t --1 C, 17? (� / L C c 1 r ' r Q' 1 75.00 2
r a �.�, ( residential (with ab ove sq. ft.)
Services or feeders installation, alteration, and /or relocation
•
200 amps or less 80.30 2
PROPERTY .OWNER • .: :❑' 1TNAN'r, 201 amps to 400 amps 106.85 2
Name: .'` ! 401 amps to 600 amps 160.60 I 2
Address:
v l 601 amps to 1,000 amps 240.60 2
l , _ .t/\-' Over 1,000 amps or volts 454.65 2
City /State /ZIP: :-‘ Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ((o ! �1 („ 3 9 _ Q 2 . 5 Fax: ( ) 200 amps or less 66.85 I 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 599 amps 133.75 2 :
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
— "'— — — - A. Fee for branch circuits with
. ' . 0. APPLICANT CONT:T' • IC.PERSON - above se rvice or feeder fee,
Q ... 6.65 2
cadit branch circuit
Business name: WEST SIDE ELECTRIC CO- B. Fee for branch circuits
Contact name: GLENN GROSSMAN without service or feeder fee, j 46.35 / l6 6'S 2
first branch circuit f
Address: 1834 SE 8TH A.VE., , Each add'i branch circuit ( 6.65 r r, • C7 2
• _ Miscellaneous (service or feeder not included)
City /State /ZIP: PORTLAND, OR 97214 Each manufactured or modular
dwelling, service and/or feeder 9090 2
Phone: (503) 231 -1548 Fax: : (503) 736 -0677 Reconnect only 66.85
E - mail: GLENNG @WESTSID.EELECl'RIC.COM Pump or irrigation circle 53.40 2
. :. ; CONTRACTOR • t -
t . • • ., Sign or outline lighting 53.40 • 2
Business name: WEST SIDE ELECTRIC CO. Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1834 SE 8 111 AVE. extension. Describe: Page 2 2
City /State /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in any ol'the above
Per inspection 62.50
Phone: (503) 231 -1548 Fax: (503)' 736 -0677 Investigation per hour (1 hr mitt) 62.50
CCB Lie,: 13306 1 Electrical Lie.: 26 -135c ( Suprv. Lie.: 4654S Industrial plant per hour 73.75
. : ELECTRICAL .PERMIT FEES • S uprv. Electrician signature, required:� 0 /L � (it- Subtotal: 7 �
3
Print name: RANDALL ROBERTS Date: ' ( 3 /�t <� Plan review (25% of permit Ice). -
6- y.2.. Scats surcharge (12% of permit fee): I y r ` Cp
Authorized signature: F E E : ' , . _ t ]`
Print name:
This permit application expires if a permit is not obtained witttit ISO
Date: days after it has been accepted as complete,
Number of inspections allowed per permit.
lA iiuilding \Pennits \GLC•PennitApp.doe 05/ ?3i06 ; 440 4615T(11,05 COM/WHs l p•
L9661£Z£OS
7l Z 8006 I- I0 4S:6 I £Z
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BUILDING DIVISION DIVISION ' �' PERMIT F���.�O 7 �
�� 4k 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1H1812000
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175 �8�N� II.
INSPECTION WORKSHEET FOR DATE: 1/25/2008 TIME: 7:00AM PAGE: 14
. SITE ADDRESS: 0Sf43E2WELR0GEST CLASS OF WORK:
SUBDIVISION: LMi/TT13TERFlACE LOT #: 002 TYPE OF USE:
PROJECT NAME: MUNIPMREY
DESCRIPTION: (2) branch circuits for computer outlets
OWNER: PHONE #:
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 503-231-1640
Inspection Request Scheduled For: [)ate: 1/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
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199 [i|eci/iue|final 063965-01 503-231'1648 ~^ V
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�� PASS | | PARTIAL APPROVAL El CANCEL pi NO ACCESS
0 FAIL f CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
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Inspector: «`* ��'u�^� Date: r �~V -w » Phone #: (503) 718- 24%