Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00897
DEVELOPMENT SERVICES DATE ISSUED: 11/15/2005
41" - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 28111 DD - 15300
SITE ADDRESS: 08743 SW HAMLET ST ZONING: R -
SUBDIVISION: MILLMONT PARK LOT : 030 JURISDICTION: TIG
Project Description: Panel change, install new circuit for a /c.
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: 1 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:
DALE BLUE - OWNER
8743 SW HAMLET ST
TIGARD, OR 97224
Phone: 503 - 598 -8934 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 11/15/200' $86.95
[TAX] 8% State Surcharge 11/15/200` $6.96 REQUIRED ITEMS AND REPORTS
Total $93.91
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 f. ore than :0 da ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are -t forth in OAR 9 .01 -0) : rough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 -24. 6699 or 1-800-3320344.
Issue. By: � ' Lae ! Permittee • ure: j._1 //;
OWNER INSTALLATION ONLY
The installation is being made on pr. •erty I own which is not in.ended for sale, lease, or rent.
OWNER'S SIGNATURE: 4111111W... / /4(9 '� DATE: /1 /5 O
/!
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.
•
Nov 14 05 01:07p 503 -598 -8934 p.2
. ,t Dale
Electrical;Permit Apphca on .- , FOR OFFICE: USE ONLY
S.
City of Tigard 7 q 4 2005 Received
Date/B : it � i / _�__
Permit _ ,tom Qa
g , e NO v 1 _ii! A r/ 6
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1p6,0, r "" " I" • Date/B : other Permit:
Inspection Line: 503.639.4175 �..� �Jr J ' Date Ready /By: 0 See Page 2 for
'''' Interdt.! www.ci_tigard.or.us B IJ r - ,... F �IG " Notiliedilvlethod: MI Supplemental information
�, I / 1 � E OF WI/CIS-10N PLAN REVIEW
❑ New construction IClAddition /alteration/replaeement Please check all that apply:
❑ Demolition El Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. it.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
Mas builder Other ❑Building over three stories ❑Feeders, 400 amps or more
❑ l�lulti -famil
• y ❑ ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
❑Health -care facility ❑sec
Job no.: Job site address: /7113 51„) 4p 14 s -�- .
Submit 2 sets of plans with any of the above.
City / State/ZIP: — 0 . m A 1 Q 9 )c)-LA y The above are not applicable to temporary construction service.
Suite/bldg. /apt no.: Project name: FEE* SCHEDULE 1--e1 1 1 Description I Qty. I Fm 1 Total I°
Cross street/directions to job site: I l `� �l f� S E e µk New residential single- or multi- family dwelling unit.
111 Includes attached garage.
1 " SA - 0 HO K f , L co Ye F C 1j d- 1,000 sq. ft. or less 145.15 4
Subdivision: y ,t,i : , ( im 6 �- ct K Lot no.: 3C) Ea. add'l 500 sq. ft, or portion 33.40 1
t� 1 Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
ill { I J ' A,, i dwelling, service feeder 90.90 2
�rS�al 0.1 i�K Ft 10 �i S{ L� T t 4/ I �� r L~� .N l Services or feeders installation, alteration, and/or relocation
Cl 201) amps or less I 80.30 F0,30 2
Wlq� - 1r - YtS�( /Vet- �,��+irT" d'vr .�� ilgNi 20
PROPERTY OWNER l 0 TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: AV& 1 wt._ 601 amps to 1,000 amps 240.60 2
Address: S( - 7tt 3 5 k, I, � Over 1,000 amps or volts 454.65 2
U ` Reconnect only 66.85 2
City /State/ZIP: -- f e,,A f relocation 0 9 �� y Temporary services or feeders installation, alteration, and/or
Phone: Fax: f
(� 3 � (y �) 3 4 ( ) 200 amps or less 66.85 • 1
Owner installation: Thi in llation is berg made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, r exch • p ; ording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: ./*--' ` 1 _Date: jtfi or Branch circuits - new, alteration, or extension, per panel
yt APPLICANT I ❑ CONTACE PERSON A. Fee for branch circuits with i
service or feeder fee, each
Business name: branch circuit 6.65 t 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
`` __ each branch circuit 46 2
Address: !Are- S C.!�Q Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax :: ( )
r Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
(��� energy panel, alteration, or
D
extension. Describe: Page 2 2
Business name: .
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/ State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES"
CCB Lie.: Electrical Lie.: Suprv. Lie.: Subtotal • r
I i
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit flee) (,
Print name: Date: 1 3 , 9 /
TOTAL PERMIT FEE
Authorized signature: This permit application expires if a permit is not obtained within 1811
days after it has been accepted as complete
Print name: Date: Fee methodology set by Tri-County Building Industry Service Booed
** Number of inspections per permit al lowed.
li\ BuildinePcrmits %. ELC-PermitApp .doc 12103 440- 4615TO0K21COM/WEB
CITY �~�����U��J�����
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BUILDING DIVISION
~�~,,~~~~""~=° ~°.°"~°"~~"~ PEAK8|T#: ELC2005-00897
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/16/2005
Phone: (503) 639-4171 4,4fivoi
Inspection Requests (24 Hrs.): 0503 639'4175 .4.11k ^tJ�
INSPECTION WORKSHEET FOR DATE: 11/18/2006 TIME: '7:17AM PAGE: 19
SITE ADDRESS: 08743 SW HAMLET ST CLASS OF WORK:
SUBDIVISION: MILLMONT PARK LOT #: 080 TYPE OF USE:
PROJECT NAME: BLUE
DESCRIPTION: Panel ohmn0m, install new circuit for a/c.
OWNER: BLUE, DALE PHONE #: 603-658'8934
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/18/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
116 Electrical service 021886-01 503-698-8934
Corrections/Comments/Instructions:
\
/- -\
\^~~~^ ~
� PASS | I PARTIAL � CANCEL � NO ACCESS
.+' . . � ��
I | FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Al.-17U Date� / ° Phone#' (6O3)718'
� ' ' ' . '
- - 1
CITY OF TIGARD
BUILDING. DIVISION
A . PERMIT #: ELC2005-00897
‘-\
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/15/2005
Phone: (503) 639-4171 .44,411
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/18/2005 N, TIME: 7:17AM PAGE: 18
•
SITE ADDRESS: 08743 SW HAMLET ST CLASS OF WORK:
SUBDIVISION: MILLMONT PARK LOT #: 030 TYPE OF USE:
PROJECT NAME: BLUE
DESCRIPTION: Panel change, install new circuit for a/c.
f .)
OWNER: BLUE, DALE
PHONE #: 503-598
CONTRACTOR: OWNER ( 0 0 (4 )4 la 1. 77 3 # 1
Inspection Request Scheduled For: Date: 11/18/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Electrical final 021886-02 503-598-8934
Corrections/Comments/ nstructions:
V) t C.,cloYkikkk-No GmAN D
•
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1
uu\ 0 rzk7..L
PASS 1 PARTIAL APPROVAL CANCEL El NO ACCESS
I 1 FAIL El CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: ----- Date: //// Phone #: (503) 718-