Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #. ELC2005 -00467
�� 4 DEVELOPMENT SERVICES DATE ISSUED 6/30/2005
13125 SW Hall Blvd., Tigard, OR 97223 503- 639 -4171 PARCEL. 2S104CC - 05400
SITE ADDRESS 13581 SW ESSEX DR ZONING: R -7
SUBDIVISION: HILLSHIRE ESTATES NO 3 LOT: 162 JURISDICTION: TIG
Project Description 2 branch circuits, AC and furnace
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: SVC /FDR > = 225 AMPS CLASS AREA/SPEC OCC
Owner: Contractor:
PURDY, KELLEY B + WEST SIDE ELECTRIC CO INC
CARROLL, LISA 1834 SE 8TH AVE
13581 SW ESSEX DR PORTLAND, OR 97214
TIGARD, OR 97223
Phone: 503- 524 -7553 Phone: 503 - 231 -1548
FEES Reg #: LIC 13306
SUP 4654S
Description Date Amount ELE 26 - 135c
[ELPRMT] ELC Permit 6/30/2005 $53 50
[TAX] 8% State Surcharge 6/30/2005 $4 28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Speaalty 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 -8011 332 -2344 �
Issued By: A __ , AL ri3 - , _ Permittee Signature: iris % ,_/ /_ _ ,/e
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.
Electjeal Permit Application p ® FOROFFIcti USE ONLY
✓ Tigard of Tiey �
and tl/� -Y v Imo D.toi d 2j / fir) /0. -j) ne.2 94 — 9 5%
- f Pernal No.
13125 SW Hall Blvd , Tigard, OR 97229 rew
Pion Review
Phone 503.639 4171 Pax: 503.598 19�OJ 29 20 05 4 + .'t' . ' . 0` Da Other Permit
Inspection Line: 503.639.4175 „ ,� Due Icead / - -
Internet www Ci,tigard.of.us Nodtlod/Method. n � • ' See mtn. i for
l ( -\ Snnnl<.l tnrnr .snit,.
•
TYPE WO)•lClnhl PLAN REVIEW
❑ New construction 'Addi lion /alteranon/replacement Please check all that apply
❑ Dentobtion ❑ Other, ❑Service owe 225 amps, comm'I ['Hazardous location
DService over 320 'ones rating ['Rink over 10.000 sq. ft,
-�-�- CATEGORY OF CONSTRUCTION of 1- and 2- fannly dwellings 4 or more new residential
IC - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 05ysmm over 600 volts nominal units in one structure
Q Multi - family ❑ Master builder El Other ['Building over three stories ❑Feeders. 400 amps or more
❑Occopant load over 99 persons ❑Manulaclured stnicturcs Or
JOB SITE INFORMATION AND LOCATION ❑F..gress/lighting plan 12V park
Job no. Job site address. v / ❑Health - pre facility Dottier
_ �(15S �� I S f /' JJ r . Submit 2 sets of plans with any of the above.
City /State/ZIP, ( r 6) u L`' The above are not applicable to temporary construction set vice
Suite/bldg./apt. no.. ` -. tolcct- nal -Ile_P r FEE* SCHEDULE [ Ay tom' /� W`{A r ueern ® Fee �Tma - - � �—
Cross street /directions to job site (Ta t lb 1 New residential single - or multi - family dwelling unit.
-- — •"^ lactudea attached garage,
+ _ 1,000 sq. n. or less 145,15 4
Subdivision: Lot no . Ea. add"' 500 sq, R. or portion 33.40 1
Limited energy. residential _ _ 75 00 2
map/parcel ap/parcel no.. _ Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
t � . dwelling, service and /or feeder 90.90 2 _
W ,) . '^t A C k e. "-la C Services or feeders installation, alteration, and/or relocation
200 amps or less 80 Jo 2
41 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.86 2
�yn L d` 401 amps to 600 amps 1 60.60 2
Name; Si isaA-0 \xi( r/,' I i . ; cc' ( / z' ( /` 'c r 601 amps to 1,000 amps - -- 240.60 _ 2
Address: S ,,,:l."...9 A Over 1,000 amps or volts 454 65 2 -
City /State/ZIP: _ Reconnect only 66.85 2
Temporary services nr feeder. installation, alteration, and/or
relocation _
Phone ( . ii ) c2 (4„, 75 3 _ [Fax:( ) 200 amps or less _ 66 85 t
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 ro ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature. _ _ _ Date: _ -. Bra c ircuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ 'CONTACT PERSON ' A, lice for branch circuits with
service or feeder fee, each fi 65 2
Business name' branch circuit _
B. Fee for branch circuits -
Contact name without sery ec or (cede, fee, I 46x5 ''''// 'hr 2
Address' - -- - each hrench circuit `110
Fad, add') branch circuit Y ! 665 6,415," 2
City /State /ZIP: Miecellaueous (service or feeder not included) _
—• Pump or irrigation circle 53.40 2
Phone: ( ) Fax: . ( )
Sign or outline lighting 53 40 2
E - mail Signal circutt(s) or limited-
CONTRACTOR energy panel, alteraton. Or
extension. Describe Page 2 2
Business name; WEST SIDE ELECTRIC Co •
Address; 1834 SE gTn AVE Each additional Inspection ov allowable in any of the abov
- - -•- - Per inspection 62.50
City/State/ZIP. PORTLAND, OR, 97214 investigation per bnur(i hr mm) 62.50 T _
Phone (503) 231 - 1548 Fax: (503) 736 -0677 Industrial plant per hour 73 75
_ ELECTRICAL PERMIT FEES
CCB Lie,: 13306 Electrical L• 26 - 135C Supry 7 Lie :Lf44 f S Subtotal 4 .--- 4 : , i 0
Supry T�
Electrician signature, required, I ( 2,t �� Plan review (25% of permit fee)
1 C y
?nit x ti
t name Lc r�Lc,k I p 1., n ✓ 1! J 1 ., Date. 67, 7 / State surcharge f8% of permit fee) H. 2,y�
t �-tCi TOTAL PERMIT FEE ' 1 3
Authonzcd signature: p ' Tins permit application expires if a permit Is not obtained - d w 180
Print name day.' after a hat been accepted n complete
Date • Pea methodology set by Tn Cowry Building Industry Semen Board
•• Number oftnspectiora per pornet allowed.
.t6 thannaVermaruiLC.Pem,anpp doe I Lea 440-16i57( ie/02/COh{wCa 1 1 / / te r
2 'd LL90- 9EL1E051 •03 ot-4aoal3 ept9 asapl e90:L0 50 B3 unr
CITY OF TIGARD : ,
BUILDING DIVISION • PERMIT # ELC2005 -00467
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED. 6/3012005
Phone. (503) 639 -4171 , w 1 p''����
Inspection Requests (24 Hrs) (503) 639 -4175 i4 °.
INSPECTION WORKSHEET FOR DATE: 7/13/2005 TIME: 7:10AM PAGE 93
SITE ADDRESS. 13681 SW ESSEX DR CLASS OF WORK
SUBDIVISION HILLSHIRE ESTATES NO 3 LOT # 162 TYPE OF USE
PROJECT NAME. PURDY
DESCRIPTION 2 branch circuits, AC and furnace
OWNER PURDY, KELLEY B +, PHONE #. 503 - 5247553
CONTRACTOR. WEST SIDE ELECTRIC CO INC PHONE #: 503 - 231 -1548
Inspection Request Scheduled For V ` I Date: 7/13/2005 Pour Time.
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 011111 -01 503-572 -0201 N
Corrections /Comments /Instructions:
.---
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
7 --1 3 ' D5 -- Inspector f Date: Phone #: (503) 718-