Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2009 -00078
COMMUNITY DEVELOPMENT DATE ISSUED: 2/25/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S104AA -90031
SITE ADDRESS: 12666 SW KAREN ST 3 ZONING: R -12
SUBDIVISION: BELLWOOD TERRACE CONDOMINIUMS LOT : 003 JURISDICTION: TIG
PROJECT: BELLWOOD
Project Description: Install (2) branch circuits.
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:
BELLWOOD TERRACE LLC FIRST ELECTRIC CO
12666 SW KAREN ST 19093 S BEAVERCREEK RD #305
TIGARD, OR 97223 OREGON CITY, OR 97045
Phone: Contact #: PRI 503 - 632 -8373
FAX 503 - 632 -7989
FEES
Description Date Amount Reg #: ELE 14 -519C
IELPRMT] ELC Permit 2/25/2009 $53.50 LIC 147966
[TAX] 12% State Surchar 2/25/2009 $6.42 SUP 4496S
Total $59.92 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: q.(10,1,1cL 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. 639.41.75_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.
`r,. Feb 24 09 03:59p Mark Lengele CE1VcL 5 036327989 p.2 `�• lv+ lkct�rical Permit An Q lication Fem p1..11 c 1: l 5 r c»l:, e
.
City of Tigard FEB 2 4 2009 nab Q . ay .cc �� Permit No.�IC ?009_ •00
13125 SW Halt Blvd.. Tigard. OR 97223 Plan Review Oilier Permit
IInsppectieLied5 03.6344 5
7503 �.19�+I1Y OFTiGARD D li �y, B E 5tPada2far
ItltZrtfct_ vrww,ti gr •� p f v flp �Y� B y� U II LDING DIVISION Natifwd/Method: jc 1� Soppier= Wlarerraa w
-•' •.O . A" _ ':•:*''' ' TYPE. Otr. "tIK ..: - - •:E.:. r .. *-'.. r4 ';'. '� _ O * w*
0 New cOnctruction 0 Addition/alteration/replacement r Plrssc war e all 0 r apply (suhlnir 2 arts of plays Wilms clacked bdow): i
O Service or fouler 400 nowt or oo0m D Building ever trout series.
❑ Demolition ❑ Other:
where 1hr available Gilt current ❑Marinas and hnahyards,
:.:: -:;- " -C:•:•;;•;.' ::::_ :i':= "i .CA�i ICIr - .OF'• CONSTRUCTION. • - - . - r : •_ -i , . rscem41 10.0(10 Armin 10 15g volts a 0 Ftoatisg buildiaKt.
dwelling lera to froemd-or exceeds 14.000 0Com.ne.ciel -ose agricultural 2- and 2•fami
lY g [] Commercial /industrial ❑ Accessory building amps 1br alt elver imaltarions. building!.
X lulti•famity /� cp A ❑ a aFM�a uilder a sterb n0 cAi1 OOtthye� - Other OThrt p. EiltwallauoneflS KVA oc
_. �; ^':i.' = `.• •• ./ll i $tFOR1td+FTIt31Q Al!iD i.oW1 � ' 'In r 8;� m. 1.1rry GCpprP dCz c4 DyQSCIn.
1.
^ - ❑ Addition of raw w motor lead or
Job no . r)ob site uces i%T� 1 o0tipm more memory. onty.
� r li) ' y (wry ! t . S D Six Or mom veaodenrial mfrs. Q Rccreetiah n.1 v parsec
�� "> ❑ Heahhcre facilities. ❑ SSupply voltage sc fa mace thin
Ci IStatel7`1F 1 l �L add ("4,1?,.. �f ?� 7/, ❑ hlaznrdoulRocatiaas b00veltennminnl.
Suite/bldg./apt no.: Pox feet name; t ( C] service or Fcrar. Roo amps a rm..
• :.:: ± - '4_ ' <.FEE/ SCREDII[.E: :`t•'•'• -
Cross Street/drections to job site: ' nen � oqr. 1 Sec I Toy .
r vyea I •
New reo*datial single- or malts - family dwelling unit
Iodides attached garage,
Subdivision: 1 Lot no.: 1.000 sq. ft. or less l 145,15 4
Tax map/parcel ao.: Ea. add'i 500 sq. ft. orportion 33,40 1 • ��p _ Limited energy,_ residential 75,00 2
'
DE ON OF WOkX .'� - '.. _ (was vbovepq. 6.)
11 Limited energy. multi - family
f �j � : 1 it .. ,`e\(0.( [ C C e‘ ci cc S 0,4 1 residential(lobabove 7S 00 2
/� Scrib e, or ieeder s inseatlatioa and/or_ relocation
4'ti• (.)J- 200 amps m lcgg 80.30 2
;_ •.: E.I 'IROi'E*TY OWNER' `. ` D TLENAiw'P -: ' : • Y , 201 smps to 400 amps 106.85 2
I Names 401 amps to 600 amps 3 60.60 2
601 amps to 1.000 amps 240.60 2
• Address: Over 1,0170 amps or volts 454.65 , 2
airy /StateJZIP: Te services or reddens i abdi. ton, xltaoriton. and/or
Phone: ( ) I Fax: ( ) 200 amps or toss 66.85 1
Owner ilaat altarlinnc This installation is being made on property that I own cahich is not 201 amps to 400 'm+ps 100.]0 2
irrvended for sale• (case, rent, or.exch ange, according to ORS 447.449, 670, and 701. 401 amps ro 599 amps 133.75 , 2
Qwnef signature: Dates Brandt dreuifa- new, altaratloly oar esteedos, per -panel
a. Fee for branch circuits with
1 -' . C ) Ai'PUdillil'-• ONTACT wasp"; ' aove servc
bi e oT f eeder fee,
:. +
' ,.= �:: '' ` ❑ C 6.65 2
Btr4it ees na : me melt (ranch circuit _
• B, Fee for branch circuits
r Contact name: without service a feeder Re, , 46.85 L / 1 5
fiat branch circuit f } cy� 2
Address: Each add'l branch arcuit 1 / 645 V c '..% 2
City/State/ZIP: _ Miscellaneous (service or feeder root included)
Each manufactured or modular 90.90 2
damping, service anoLos feeder
Phone:
( ) PBX:: ( ) Rerottnoxtonly 66.85 2
E -mail: Pump or irrigation elude 53.40 2 •
• . . .. _ ' - coNI'RAcrog 7 : - - - - Sign or outline lighting 53.40 2
LCiness turtle: Signal circuit(%) or limited-
Bt / 9 `4. l L (L- ` --4 QA.C✓ ej3 \r\ PNL`- T energy panel, alteration. a
Address: ('S C) R C.7,}: `-1 ` Lr =tension. Dacribc Page 2 2
City/StateaR): i.›>n C ( - V<,•{: Each nddi itmal inspection overallean bk iso aoQof the above
Phone. (5 ) e. 3 L 1 3 tut: ( S�3) 6,••� l 7 i � r o I I t on 62.50 .
Investigation per holm (1 M m9n) 62.50
CCB Lis.:J�
0 [4. (Electrical Lie,: f C L S ' d Suprv. Lic.:i'±4 l �° Industrial plant per ho 73.75
= ELECTRICAL' FEEJ� Il'P. FEES • : • .• .. .
Suprv. Electrician signature. taquircd � �,N Qi { h,(l _ _ .7� .0 Subtotal: S f -C
Ri i t Mane: `, ��`Is LA El.r2X D 2 � y c 7� Plan revica (2596 of permit fee):
ll � State surchrge (12% of permit fm):
Authorized sigaatu . - + TOTAL. PERMIT FEE: S" 7 i o '-
p / - Ilia rimer appiiaMm aspires ire petvnitia not dbtolaed wittern up Print name :' c ) ,, C,Ic- Date. + «�( y! al
dater is sub bum aeerped as rameplets
tUto tissarenii0SLGPem ir
ifA�p.loe ` , ' z vilss 410. t0M/
46131t11I W08 ••1 '11t[nlllf crimsoned= allowed 9R merit.