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11 CITY OF TIGARD , ELECTRICAL PERMIT
PERMIT #: ELC2007 -00499
COMMUNITY DEVELOPMENT DATE ISSUED: 7/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103AC -01503
SITE ADDRESS: 11195 SW FONNER ST ZONING: R -4 5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: DAVIS
Project Description: Service change and plugs in garage 8/30/07, ADDING AN ADDITIONAL FEEDER.
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: SIGNAUPANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 2 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:
DAVIS, ROBERT J HARVEY ROSE ELECTRIC SERVICES
11195 SW FONNER PO BOX 128
TIGARD, OR 97223 NORTH PLAINS, OR 97133
Phone: Contact #: FAX 503 - 648 - 8254
PRI 503 - 789 -3284
FEES
Description Date Amount Reg #: ELL 34 -130C
(ELPRMT] ELC Permit 7/19/2007 $113.55 LIC 43084
[TAX] 8% State Surcharge 7/19/2007 $9.08 SUP 2767S
[ELPRMT) ELC Permit 8/30/2007 $80.30
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $209.35
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 • - ATTENTION Oregon law requires you to follow rules adopted by the Oregon Utilit 6 ratification Center Those rules are set forth in
OAR 95 :01 -0010 throu• ,OA' ' = - 001 -0100 You may obtain copies of these rules or direct ques •ns to OUNC at 503 246.6699 or 1.800 332 2344
Iss ed By: /5/// / Permittee Signature: 62- 1
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.
CITY OF TIGARD ELECTRICAL PERMIT
'1 OF PERMIT #: ELC2007 -00499
' = F . COMMUNITY DEVELOPMENT DATE ISSUED: 7/19/2007
TIGARD- 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103AC -01503
SITE ADDRESS: 11195 SW FONNER ST ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: DAVIS
Project Description: Service change and plugs in garage.
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:
DAVIS, ROBERT J HARVEY ROSE ELECTRIC SERVICES
11195 SW FONNER PO BOX 128
TIGARD, OR 97223 NORTH PLAINS, OR 97133
Phone: Contact #: FAX 503 - 648 -8254
PRI 503 - 789 -3284
FEES
Description Date Amount Reg #: ELE 34 -130C
[ELPRMT] ELC Permit 7/19/2007 $113.55 LIC 43084
[TAX] 8% State Surcharge 7/19/2007 $9.08 SUP 2767S
Total $122.63 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 - 001 -00 ough 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.
Iss d By: M Permittee Signature: /z �-----
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: X 7 y7 �,� 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 OFFICES USE ONLY . 1 .
III g Plan Review
Received
City of Tigard
Date/By 7 l -( a 2 Permit No �l�.C.—�QQ7 -t0 7
. q - 13125 SW Hall Blvd , Tigard, OR 97223
Phone 503 639 4171 Fax 503 598 1960 Date /By Other Permit
Inspection Line 503 639.4175 Date Ready /By ® See Page 2 for
TIGARD Internet www tigard-or gov No tified /Method Supplemental finer � S
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit z sets of plans w /items checked below)
❑ New construction (- Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
v i. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
El A Addition of new motor load of ❑ "A ", "E ", "I - 2', "1 - ",
Job site address: j//,.5 100HP or inure occupancy
Job no.:
SW fi)H {��G S ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP:
7/ 0 Health -care facilities ❑ Supply voltage for more than
GI ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: / Project name: 06-0t ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145 iS 4
Ea add'I 500 sq ft or portion 33 40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ) 75 00 2
ft
��/ r Limited energy, multi- family 75 00 2
Ste/ U / r -( l i ; ku -r- - G /YIl 7 / /ct S I 4 ( 1- C/ residential (with above sq ft )
{ / / Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80 30 eo, 37 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name �� ) 401 amps to 600 amps 160 60 2
(J (/
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454 65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 599 amps 133 75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
ID APPLICANT ❑ CONTACT PERSON ' ` above service or feeder fee, 6 65 0! 2
each branch circuit
Business name: B Fee for branch circuits
Contact name: without service or feeder fee, 46 85 2
first branch circuit
Address: Each add] branch circuit 6 65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Phone: ( ) Fax: : ( ) Reconnect only 66 85 2
E -mail: Pump or irrigation circle 53 40 2
Z Sign or outline lighting 53 40 2
Business name: 7 - Signal circuit(s) or limited -
�G�F // t'G /I /G /G energy panel, alteration, or
Address: /� extension Describe Page 2 2
City /State /ZiP:A7 y / % 7-� r &/g q 7 / - 7 Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone: (S 7,...-- 2 �/
Fax: ( )
Investigation per hour (1 hr min) 62 50
CCB Lie.: y9 09 (/ Electrical Lie.: -/32 G Suprv. ic.a. 71 7 , Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: P g Q 2� " 1_� Subtotal l � 3 ,`> 5
a.
Plan review (25% of permit fee)
• Print name: n v c DC Date: 7 _../ GJ`....,-) 7 State surcharge (8% of permit fee) ct . 4 a A
Authorized signature: TOTAL PERMIT FEE lA , CD
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
I \Buildmg\Permns\ELC- PermtApp doc 05/23/06 440- 4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2' - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
O Burglar Alarm
0 Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding \Permits \ELC- PermntApp doc 03/23/06
ev
CITY OF TIGARD z
BUILDING DIVISION al /24 t-cf y PERMIT #: EL- C2007-00499
13125 SW Hall Blvd., Tigard, OR 97223 iym�� DATE ISSUED: 7/`191'2007
Phone: (503) 639 -4171 Y . i i 4lii ill
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 914/2007 TIME: 7.01AM PAGE: 20
SITE ADDRESS: 11195 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DAVIS
DESCRIPTION: Service change and plugs in garage. 8/30/07, ADDING AN ADDITIONAL. FEEDER.
OWNER: DAVIS, ROBERT J, PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503'719 -3211
Inspection Request Scheduled For: Date: 9/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 055070 -01 503-789-3284 N
Corrections /Comments /Instructions:
7..;
„P /
PASS PARTIAL APPROVAL CANCEL NO ACCESS
FAIL CALL OR INSPECTION ADDITIONAL FEES ASSESSED
4
Inspector: tit , Date: 9 D Phone #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION + t PERMIT #: ELC2007 -00499
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/19/2007
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 _IL
INSPECTION WORKSHEET FOR DATE: 8/7/2007 TIME: 7:03AM PAGE: 8
SITE ADDRESS: 11196 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DAVIS
DESCRIPTION: Service change and plugs in garage.
OWNER: DAVIS, ROBERT J, PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503 - 789 -3284
Inspection Request Scheduled For: Date: 8/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 053559 -02 503-789 -3284 N
Corrections /Comments /Instructions:
PaaN �� 61) ® (44:r\'
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(to PcLt4p.g 10 F\sIsart
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The electrical installation defects noted
on this report shall be corrected and
an inspection request made within 20
calendar days per 0AR 918 -271 -0030
'-' I I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: {W Q8 LC Date: q'1'01 Phone #: (503) 718- tififb
CITY OF TIGARD :,
BUILDING DIVISION PERMIT #: ELC2007 -00499
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7119/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 _�
INSPECTION WORKSHEET FOR DATE: 8/712007 TIME: 7:03AM PAGE: 9
SITE ADDRESS: 11195 SW FONNER ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: DAVIS
DESCRIPTION: Service change and plugs in garage.
OWNER: DAVIS, ROBERT J, PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503-789-3284
Inspection Request Scheduled For: Date: 8/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 053559 -01 503-789-3284 N
Corrections /Comments /Instructions:
\PASS PARTIAL APPROVAL I I CANCEL n NO ACCESS
I FAIL CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED
Inspector: Vr , 1 ® Date: g iS 1 • Q1 Phone #: (503) 718- 1-11146