Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00479
DEVELOPMENT SERVICES DATE ISSUED: 8/25/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1 S135CA -90150
SITE ADDRESS: 11150 SW GREENBURG RD 150 ZONING: R -12
SUBDIVISION: ASH CREEK PARK CONDO LOT : JURISDICTION: TIG
Project Description: Repair damage from auto accident.
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:
JEAN MONDRAGON KELSO ELECTRIC INC
545 SE 3RD
HILLSBORO, OR 97123
Phone: Contact #: FAX 503 - 648 -2075
pRI 503 -648 -6360
FEES
Description Date Amount Reg #: ELE 34 -433c
[ELPRMT] ELC Permit 8/25/2006 $53.50 LIC 116254
[TAX] 8% State Surcharge 8/25/2006 $4.28 SUP 4270s
Total $57,78 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: 1 Q Permittee Signature:
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.
AUG -25 -2006 09: 45A FROM: KELSOELECTRIC 503 -648 -8211 TO: 5035981960 P.1
Electfi ical Permit Application FOR OFFICE USE ONLY
City of Tigard RECE !i ED o� ve yg / QZ�D(o 4�}
Permit N. A4904„......-00,1111q 13125 SW Hall Blvd., Tigard, OR 97223 1
Phone 503 639.4171 Fax 503.598.1960 AUG 2
5 �o01• r.n e(, ,A. I I k e1B the Other I cnnd' I
Inspection Line: 503 639.4175 _ . D '` Date Ready/0y: Junes ® See Page 2 fur
w.
Internet wwci.tigard.or.us CITY OF TIIGA- / Notified/Method. 'l Supplemental Iii form alien •
TYPi �A V ' I9}. h r It';6;`jj a•;•^ .. . . ..
�•„ �.!,. 1 �.�x . , � ? +�if.F?,��tl� lt� � # %lw'�Y.'v"', ,�.r ,, PLAN REVIEW r
butt construction j�''Addition/alteration replacement Please check all that apply:
❑Service over 225 amps, comm'1 ❑! lazardous location
❑ Demolition ❑ Other: ❑Service over 320 amps - rating 013uildng over IO,OUO st1 it
�'•- of I- and 2 - family dwellings 4 or more nett residenu.ii
CATEGORY:OF.CONSTRUCTION . ' :.:. � • „• , .`• . t �l,
❑ 1- and 2- family dwelling ❑ CornmerciaU ❑System over 600 volts nominal units in one structure
industrial 0 building
❑Quilding over three stories feeders, 400 amps or more '
❑ ”' p
%'lulti- family ❑ Master builder ❑ Other: ❑Occupant load over 99 persons OManufaciured structures or ■
JOB SITE • INFORMATION ".AND • LOCATION: ; .: fs." "' y?=��'?'..: •�' v RV park
�, � ❑Egr ess/lightingp1an
Job no.: Job site address: = ❑Healt2 -car of ['Other. 150 t k) ��.. _ (.. _
• � Submit 2 sets of plans with any o U,c above.
Cii\!State/ZIP: 7%6A 2p The above are not applicable to temporary consinucnon sett 'Le
i5g1WatagOiAli 4i vaFEE +• SCHEDULE. •
Suitt: bldg iapt no.: Project name: Description I Qty. I Fee. Taal 1
Cross street/directions to job site: New residential single- or multi- family dwelling unit. I
Includes attached garage. - i
/ate ( Y 80frODO,L( //1)/ 1,000 sq. ft, or less 145 I a
ubdivision: Lot no.: Ea. add'I 500 sq• fl. or portion 33.40 I
Limited energy, residential 75,00 '
1 a map parcel no.: Limilcd energy, non - residential 75 00
-. DESCRIPTION .O#r ° WORKl s "': " `;;'i !' ": tY`;'q d Each manufactured or modular
dwelling, service and/or feeder 90.90 ' I
6 t>-2 ro/ t"!*4 7?--' 94 j, /.� - n�. dr, Al Services or feeders installation, alteration, and /or relocation
it M I? e°2-450A,) 200 amps or less 80.30 2
❑ PROPERTY OWNER .1:: , X: +:v` irk? 4 0 T NANT.'"-:''.'';'''. ? `: , 201 amps to400 amps 106.85 ;
• 401 amps to 600 amps 160.60 - I
Name: 601 amps to 1,000 amps 240 60 _ l 2 7
Address: Over 1,000 amps or volts 454 65 I 2
Reconnect only 66 85 ' -
Cit■IStatelZ1P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66 85 1 I
. Owner installation: This installation is being made on property that I own which is not ' 201 amps to 400 amps 100 30 ` ,
intended for sale lease, rent, or exchange, according to ORS 447, 449, 670, and 701. qOl amps to 600 amps 133 75
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
)t W_}% "' ,, A. Fee for branch circuits with - ,
❑ APPLI CANT ., 0( <' itt ,� 1. ..'' "r'c.y.❑ �CUNTAGT.:P.ERSONI ? r ek
service or feeder fcc, each 65 -
, Business name: branch circuit - -_
Q. Fee for branch circuits
Contact name: • without service or feeder fee,
/ 46 s5 ea -
Address.
each brunch circuit _
Each add'l branch circuit / 6 65 �.
I Citt /State••ZIP: Miscellaneous (service or feeder not included) _
�- - Pump or irrigation circle 5 3 4O
Phone:t ) Fax: : ( ) -
Sign or outline lighting 53 40 _
E-mail: Signal circuit(s) or limited-
.: r f.r.o k a.y •,�;:,,.,, • ,,,y energy pan el, alteration, or
i CONTRACTOR K i . ,
extension. Describe; Page 2 I Business name: 61 1 / #) :.- 0 l
Address: KELSO ELECTRIC 1 '' p � Each additional inspection over allowable in any of the shot e
t Per inspection 62 50I 1
. C•uy Sta tei7.1P: „ l \ 545 SE 3rd St 4) \ investigation per hour (I hr nun) 62.50
` p�, F(~; Industrial plant per hour 73 75 I I
Phone I ) (503 glli.63 :0 r p , -x6ii ,,, f.: ELECTRICAL'PERNIIT FEES
CCI3 Lic.: if a5q Electrical Lic.3y.4/,3'3 Suprv. Lic.: 2 45 Subtotal 5350
' Plan review (25% of permit fcc)
Suprv. Electrician signature, required: �� _
Prim: name: .� Date: �' State surcharge (8% of permit Ice) 'Yr 28 _
'� .1.4(41 Ir t * I_ - � T OTAL PERMIT FF.E 7$'
Authorized signature: � l��. This permit application expires if permit is nut obtained mithin isv .
— ..- ` r ' days after it has been accepted as cum ptete
Print name: �_ _ Date: • Fee methodology set by Tn- County Building ttidustr ,Service ttoa.d
r� . " Number of ins. coons pct permit allowed
■ h..,a.a a•Ye.-miuJLC 4enm,AS0 dx 12.03 440461 !tY02/COM/WEB
•
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2006-00479
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/25/2006
Phone: (503) 639-4171 t
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 8/29/2006 TIME: 7:01AM PAGE: 1
SITE ADDRESS: 11150 SW GREENBURG RD 150 CLASS OF WORK:
SUBDIVISION: ASH CREEK PARK CONDO LOT #: TYPE OF USE:
PROJECT NAME: ASH CREEK CONDOS
DESCRIPTION: Repair damage from auto accident.
OWNER: MONDRAGON, JEAN PHONE #:
CONTRACTOR: KELSO ELECTRIC INC PHONE #: 503-648.6360
Inspection Request Scheduled For: Date: 8/29/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 035747-01 503-6413-6360
%
Corrections/Comments/Instructions: ri gal -III 3
w F
p.
PARTI1 " — *VAL EI CANCEL I NO ACCESS
Nu CALL FOR INSPECTION EI ADDITIONAL FEES ASSESSED
Inspector: Date: ■ I 4. Phone #: (503) 718- 144
' I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006.00479
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 0 /°)2OQ6
Phone: (503) 639 -4171 utl�il
Inspection Requests (24 Hrs.): (503) 639 -4175 ...
INSPECTION WORKSHEET FOR DATE: 102006 TIME: 7 :02AM PAGE: 70
SITE ADDRESS: 11150 SW GREENBURG RD 160 CLASS OF WORK:
SUBDIVISION: ASH CREEK PARK CONDO LOT #: TYPE OF USE:
PROJECT NAME: ASH CREEK CONDOS
DESCRIPTION: Repair damage from auto accident. •
OWNER: MONDRACON, JEAN PHONE #:
CONTRACTOR: KELSO ELECTRIC INC PHONE #: 503- 618-83G0
Inspection Request Scheduled For: Date: 10/4/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 037618 - 01 503 Y
Corrections /Comments / Instructions:
•
I
ASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
❑ FAIL El CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date] ® —V - e- Phone #: (503) 718-