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Permit C ITY OF TIGARD ELECTRICAL PERMIT ; PERMIT #: ELC2005 -00334 ����, DEVELOPMENT SERVICES DATE ISSUED: 5/19/2005 ' - 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S102DB - 08200 SITE ADDRESS: 09148 SW HILL ST ZONING: R - 4.5 SUBDIVISION: CHELSEA HILL NO.2 LOT : 059 JURISDICTION: TIG Project Description: (2) branch circuits, A/C & WP. 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: FISHBACK, RONALD SOHLER ELECTRICAL CONSTRUCTION 9148 SW HILL ST 41131 SW BURGARSKY RD TIGARD, OR 97223 GASTON, OR 97119 Phone: 503 475 - 2964 Phone: 971 - 832 - 0807 FEES Reg #: LIC 158285 ELE 34 -667C Description Date Amount SUP 594S [ELPRMT] ELC Permit 5/19/2005 $53.50 [TAX] 8% State Surcharge 5/19/2005 $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. 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: Permittee Signature: J . 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. • II. ECPillirr) • ;lectrical Permit Application n FO USE ONLY :fly of Tigard HAY 1 8 10 > r i +CT t✓ -- p�it+o.:6�.1./7eaj4��Jy Blvd. Ti rd, OR eview 97223 0 5 P lan R Oelaer 1125 one : 503.639.4171 Fax: 503.598. SW Hall ga tone1'9Ct0 ^ I Il s Da i m Rc I g1 See Page 2 for spection Line: 503.639.4175 - - ^ -- Date RendYBY torelrm:000 BUIL -yr� 14 1.1 Nonriecvm thud: IerrneL' WtiVR'.C7.11 grid. or. us - _ _ -- S .... _- ELAP.I •REVIEW Supplemental TYPE' :OX . ..'a .0 .. • Please check all that apply: ] New construction V Addition/alteration/replacement DS� over 225 amps, comtri 1 ['Hazardous location ] Demolition ❑ Other: OService over 320 amps - rating OBuildng over 10,000 sq. ft. CAT OF' CON ;. ` , - of 1- and 2- family dwellings 4 or more new residential ❑System over 600 volts nominal units in one structure and 2- family dwelling ❑ Commercial/industrial 0 Accessory building ['Building over three stones ['Feeders, 400 amps or mon Master builder ❑ Oth er ['Occupant load over 99 persons ❑Manufactured structures or ] Multi-family ❑ - _.. DEgressilight RV park JOB SITE 'INFOR11L1T1O1�T Al 1D 'LOCATION - )b no.: I Job site address: ' 7 1 4 $ 5 (/i/ j i. L ST ❑Hcalth•care facility ['Other= Ot['Other= Submit 2 sets of plans with any of the above. Icy/State/ZIP: T rt -7 � 3 The above are not applicable to temporary construction service. �S� 0 I Cl - . ••- : , - <:: .3• _:- ' +: = a .: .SCHEDULE.• :: • .. ;uite/bldg.lapt. no.: I Project name: ____ e: � Pena:ption Qtr. I Fm I Total I -- New residential single- or multi - family dwelling unit. :trots street/directions to job site: Includes attached garage. 1,000 sq. it. or less 145.15 4 iuhdivision: (Lot no.: Ea. add'l 500 sq. R or portion 33.40 I Limited energy, residential 75.00 2 fax map /parcel no.: _ energy, non - residential 7 5. 00 2 DESC =OF .WORD .:.' . . -... - Each manufactured or modular dwelling, service and/or feeder 90.90 2 • A C HIV 12 P L 1/ C Services or feeders installation, alteration, and/or relocatio 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 p1ZOPERTY • OWNER D TEt�7 - 401 amps to 600 amps 160.60 2 Vane: 1` d AI ( S H g !7' C.- K 601 arts to 1.000 armps 240.60 2 F O 1,000 arms or volts 454.65 2 4ddress: l q ( S Vhf H L L Reconnect only 66.85 2 ZityJState/ZIP: y i G,Prz 0 / n - 3 Temporary services or feeders installation, alteration, and/or relocation Phone: (5 t 3) R Y — 58 e 1 c� 1 Fax: ( ) 200 amps or less 66.85 I Owner installation: This installation is being made on property that 1 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 A F for bru n ch circuits with ^� APPJ TCAN r • �: ." , f . . ONT?iC@L '. service or feeder fee, each • ' C .:.......... T ." . PER$O- ` 6.65 2 S o I, t k.,e F - 1 >< c• l N 5 4 = branch circuit Business name: p _c, B. Fee for branch circuits Contact name: -t Cr. 1 CQ,� without service or feeder fee, l 46.85 t. /(o 3 r 2 1 n e / each branch circuit Address: e_� (i 3 ( S e,-"-' e ,i eV a,'. Jr-- - ¢/ Each arld'l branch circuit i 6.65 (c 14 < 2 City /State/ZIP: (...,--r-:. S - IN ? 0 rz ' Miscellaneous (service or feeder not included) 9 7 /1 - Pump or irrigation circle 53.40 ' 2 Phone: 97 (5 c/ 2 si or outline lighting 53.40 2 E- mail: Signal circuits) or limited- energy panel, alteration, or 2 • CO]VTR OR ' :.% : ' extension. Describe: Page 2 Business name: c L �� C�. l G7"r t c,o, I Co ,,, S f Each additional inspection over allowable in any of the above Address: Per inspection I 62.50 City/State/ZIP: per hour (1 In min) 62.50 tY : es Industrial plant per hour 73.75 Phone: ( ) I Fax: ( ) . • . RL CTRICA.L.' . t ERMIT-:FEES`• . CCB Lie.: Electrical Lic., L a 7C1 Supry: Lie.: Subtotal 5-5 e S`j / Plan review (25% of permit fee) Suprv. Electrician signature, required:/ - �i � _ a. • i State surcharge (8% of permit fee) p Print name: n r) 7 . t IJ rO . r q l / e c s Date: TOTAL PERMIT FEE g �� 7 Authorized signature: / /tom /t/1 l Yi T h i s appllea ion expires if a permit Is not obtained within 180 11 llll days alter it rut bcea accepted as complete 1 Date: • Fee methodology set by Tri -County Building Industry Service Board Print name: �t> i� / /v� 1 S Iti I A/Yg I •- Number of inspections per permit allowed. em-4a c.,. nv.•,.rf..n : ,Buindin¢U'ern.iiz,CLC PenniaAOn doe 2✓O'! • z - d BLOT - S B 6 - E O S . i a T L1oS aor dBE : EO SO B T Fe w CITY OF TIGARD ' BUILDING DIVISION PERMIT #: ELC200S -00334 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/19/2005 Phone: (503) 639 -4171 /sumo, t 4 � Inspection Requests (24 Hrs.): (503) 639 -4175 -�±i '-,J... INSPECTION WORKSHEET FOR DATE: 6/23/2005 TIME: 7:10AM PAGE: 101 SITE ADDRESS: 09148 SW HILL ST CLASS OF WORK: SUBDIVISION: CHELSEA HILL NO.2 LOT #: 059 TYPE OF USE: PROJECT NAME: FISHBACK DESCRIPTION: (2) branch circuits, A/C & WP. OWNER: FISHBACK, RONALD, PHONE #: 503- 475 -2964 CONTRACTOR: SOHLER ELECTRICAL CONSTRUCTION PHONE #: 971 - 832 - 0807 Inspection Request Scheduled For: Date: 6/23/2005 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 009844 -01 503- 684 -5889 N Corrections /Comments /Instructions: 0/ 5 4 A - ss ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: 4LAIA Date: C 2 - 3 - © 1 Phone #: (503) 718-