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Permit r CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2005 -00571 4p , DEVELOPMENT SERVICES DATE ISSUED: 8/9/2005 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 25111 DA - 14700 SITE ADDRESS: 15410 SW EMPIRE TERR ZONING: R - SUBDIVISION: APPLEWOOD PARK NO. 3 LOT : 140 JURISDICTION: TIG Project Description: 200amp service changeout w/5 branch circuits. 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: 5 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: RANDY MCALISTER DELSTAR ELECTRIC INC 15410 SW EMPIRE TERR. PO BOX 1371 TIGARD, OR 97224 TUALATIN, OR 97062 Phone: 503 - 684 -8848 Phone: 692 -3219 FEES Reg #: LIC 63667 SUP 3214S Description Date Amount ELE 34 - 214C , [ELPRMT] ELC Permit 8/9/2005 $113.55 [TAX] 8% State Surcharge 8/9/2005 $9.08 REQUIRED ITEMS AND REPORTS Total $122.63 • 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 issua' , or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Not .ti. Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these r . - . i qtr stio G at 503 - 246 -6699 or 1 -8!3- 332 -._ -4. ``, Issued B _ __ -� Permittee Signature: �—,: "4 rf �a • 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 ! FOR OFFICE USE ONLY City of Tigard C � Date/B O d 00J ZJ Permit No./ L�,9S *0097/ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie . Phone: 503.639.4171 Fax: 503.598.1960; k. 9 � /&rJ ';HI Y N,, s'F � Date/By: Other Permit: Inspection Line: 503.639.4175 P,:� ; 0 9 2005 _Al_ / ,'I II Date Ready/By: lin ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental information erWE Ware' PLAN REVIEW ❑ New construction LIKa1dtfitiSgalierlatiori /re'placement 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., CATEGORY OF CONSTRUCTION of 1 -and 2- family dwellings 4 or more new residential q 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure El Multi - family ❑ Master builder ❑ Other: ❑Building over three stories 0 Feeders, 400 amps or more DOccupant load over 99 persons ❑Manufactured structures or JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park Job no.: Job site address: f ❑Health -care facility ❑Other: J O L�+ 1=ri1p1 (2.67d2 R r Submit 2 sets of plans with any of the above. • City/State /ZIP: ( 14 /2 -77 '2. 2- 1 The above are not applicable to temporary construction service. / C/ 0 FEE* SCHEDULE Suite/bldg. /apt. no.: Project name: Description I Qty. I Fee. I Total I ` 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'( 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no.: Limited energy, non - residential 75.00 2 DESCRIPTION OF WORK Each manufactured or modular (.��1JLsil dwelling, service and/or feeder 90.90 2 l� FL L 04-c_ AiEk / 91 ) 3 S eigetJ /! 1 Services or feeders installation, alteration, and /or relocation 200 amps or less I 80.30 2 201 amps to 400 amps 106.85 2 ❑PROPERTY OWNER ❑TENANT ' 401 amps to 600 amps 160.60 2 Name: ` IA„).,.-( 1 C ALL 601 amps to 1,000 amps 240.60 2 Address: (s4Io S � E►�-kel 2E � [E _Il Over 1,000 amps or volts 454.65 2 Reconnect only 66.85 2 City /State /ZIP: —r - t / C7 Temporary services or feeders installation, alteration, and /or Phone: ( 1,0 , gc6,4c4 Fax: ( ) 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, 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 ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with • service branch circuit t der fee, each Business name: 1` �f._ �,�. ._ J 6.65 33 D6 2 B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'( branch circuit 6.65 2 City /State /ZIP: Miscellaneous (service or feeder not included) Phone: Pump or irrigation circle 53.40 2 ( ) Fax::( ) Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited- CONTRACTOR energy panel, alteration, or extension. Describe: Page 2 2 Business name: e� ,_g-ly. -,2 Er!-E /hie- • � Z 3 - � Each additional inspection over allowable in any of the above Address: ��, �� Per inspection 62.50 City /State/ZIP: / ©,e_ 07,67 7 - Investigation per hour (1 hr min) 62.50 Fax: ( X63) Z Industrial plant per hour 73.75 Phone: (�3) 68 .,/.. a V b' � — �3/ ELECTRICAL PERMIT FEES* CCB Lie.: Electrical S �3Ce6� Y 2 3 il A.: +'32/ Subtotal / / 3 . SS Suprv. Electrician signature, required: Val.. • Plan review (25% of permit fee) • I /) `• State surcharge (8% of permit fee) g. O g Print name: , � Y / tq '` C f � u 5 . _ Date: 0/2 '( TOTAL PERMIT FEE /< 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 per permit allowed. i:\ Building \Permits\ELC- PermitApp.doc 12/03 440-4615T(10 /02/COM/WEB - . Electrical Permit Application - City of Tigard 7, Page 2 - Supplemental Information • LIMITED ENERGY PERMIT FEES: RESIDISITIAE VVORiC-ONLY: . . • 7i • Fee for all residential systems combined.. ..... $75.00 Check Type of Work Involved: El Audio and Stereo Systems* CI Burglar Alarm , • El Garage Door Opener* D Heating, Ventilation and Air Conditioning System* O Vacuum Systems* O Other: . COMMERCIAL WORK ONLY: Fee for each commercial system $75.00' • (SEE OAR 918-260-260) Check Type of Work Involved: • • • ; • Audio and Stereo Systems LI Boiler Controls , CI Clock Systems 0 Data Telecommunication Installation O Fire Alarm Installation , ...1 • HVAC CI I nstrumentation O Intercom and Paging Systems O Landscape Irrigation Control* O Medical • ; 3 CI Nurse Calls O Outdoor Landscape Lighting* ••• • • . , 0 Protective Signaling CI Other • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i:\BuildingWerrnits\ELC-PennitApp.doc 04/03 CITY OF TIGARD BUILDING DIVISION ". PERMIT #: ELC2005 -00571 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8t9/2005 Phone: (503) 639 -4171 Alit■ �,�i Inspection Requests (24 Hrs.): (503) 639 -4175 W INSPECTION WORKSHEET FOR DATE: W10/2005 TIME: 7 :05AM PAGE: 8 SITE ADDRESS: 15410 SW EMPIRE TERR CLASS OF WORK: SUBDIVISION: APPLEWOOD PARK NO. 3 LOT #: 140 TYPE OF USE: PROJECT NAME: MCALISTER DESCRIPTION: 200amp service changeout w/5 branch circuits. OWNER: MCALISTER, RANDY PHONE #: 503 6t�4 -81348 CONTRACTOR: DELSTAR ELECTRIC INC PHONE #: 692 -3219 Inspection Request Scheduled For: Date: 8 /10/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 013273 -01 503- 720 -3901 N Corrections /Comments /Instructions: DE(PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED • Inspector: /4 Date: Phone #: (503) 718 -