Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00091
COMMUNITY DEVELOPMENT DATE ISSUED: 2/20/2068
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S126bC-04800
SITE ADDRESS: 09495 SW LOCUST ST A ZONING: C - P
SUBDIVISION: LEHMANN ACRE TRACT LOT : 004 JURISDICTION: TIG
PROJECT: KLEIN DERMATOLOGY
Project Description: (3) 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: 2 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:
BAKER, JAMES + FIVE STAR ELECTRIC, INC.
9495 SW LOCUST ST. #G PO BOX 555
BAKER, DIANE R BANKS, OR 97106
TIGARD, OR 97223
Phone: NA Contact #: PRI 503 - 324 -0948
FAX 503 - 324 -0973
FEES
Description Date Amount Reg #: ELE 34 -665C
IELPRMTI ELC Permit 2/20/2008 $60.15 LIC 158231
(TAXI 8% State Surcharge 2/20/2008 $7.21 SUP 4622S
Total $67.36 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 Notif ation 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 • OU ( at 503.246..19 or 1.800.332.2344.
Issued By: 4 - `i ts / Permittee Signature: wow
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.
I
Electrical Permit Application OFFICE USE ONLY
City of Tigard !} EI DateB
Plan Review
ed O I Permit No ��,. d ��t�
° 13125 SW Hall Blvd., Ti ard, OR 72 y
II
g
I C : Phone: 503.639.4171 Fax: 503.598.1960rrg 2 ®2 ®0(� Date /By: Other Permit:
TI G A R D Inspection Line: 503.639.4175 `` CC Date Ready/By: Juris: ® See Page 2 for
Internet: www.tigard or.gov ;;'''���' �IG A R D Notified/Method: �( Supplemental Information
TYPE. OF W.O 1 (3 DIVISION • , . . PLAN REVIEW
111 New construction ❑ Addition/alte ti� replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
❑ 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.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 7 5 S � / O G( J T Six or or more. occupancy.
9 5 S ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Pcvere A/ 0 ORE y 7 Zz.3 ❑ Health -care facilities. ❑ voltage a more than
❑ Hazardous locations.
Suite /bldg. /apt. no.: 67-E- A Project name: ,p �M ❑ Servic or feeder 600 amps or more.
/P�/ ,/� A�o�G y IL° FEE SCHEDULE
Cross street/directions to job site: /' /e &Nw� / (DCJ A 17 Description I Qty. I Fee. I Total
v / New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:y,A 1,000 sq. ft. or less 145.15 4
� l Ea. add] 500 sq. ft. or portion 33.40 1
'7,
Tax map /parcel no.: I2/ Lt) S a3 b LOT '8e V P' 9'6J Limited energy, residential
/ D SCRIPTION OF WORK ' (with above sq. ft.) 75.00 2
E
Limited energy, multi - family 75.00 2
c .A/A// -r 1/I 'Ctr r »2s AND Std.)/ TG!5S ' residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
(kJ ® l/1 /J/1 ®p 200 amps or less 80.30 2
• ❑ PR PERTY OWNER , K 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: 6/ � �
/ ) C y 601 amps to 1,000 amps 240.60 2
Address: q 4 4 75 s k i . ) / p f r - Sr 6/EA Over 1,000 amps or volts 454.65 2
City/State /ZIP: /o/2rL,A/0' /v/e q 7 ? 2-3 Temporary services or feeders installation, alteration, and/or
7 relocation
Phone: (333) 2‘ Fax: (5 2 W-596 3 200 amps or less 66.85 1
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 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
(g APPLICANT ❑ CONTACT PERSON , . above service or feeder fee, 6.65 2
each branch circuit i
Business name: X a ,7 E t31. . 9�s d 4.,,, B. Fee for branch circuits
Contact name: � o (,)� 0icy wish bran crvi r or feeder fee, 46.85 / *3p
first branch circuit
Address: f 8ox / 9® Each add'l branch circuit 6.65 r3r
!O /� Miscellaneous (service or feeder not included)
City/State /ZIP: /1/ ,,40./ iD /,4 /NS U2 97/33 Each manufactured or modular 2
dwelling, service and /or feeder 90.90 2
Phone: (53) a 0 Fax: : ,c Reconnect only 66.85 2
E - mail: E T/fEpi . 50 /L.D 25 /OT/44 - 1L - . CA✓►t Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
• Signal circuit(s) or limited -
Business name: F _ 1 y ST ,4/L L 7 fC- T/2 /C_{/ L energy panel, alteration, or
Address: Po 3C X 2 8 extension. Describe: Page 2 2
City/State /ZIP: 8/1/0,<- O_ 9 7 / Ufo Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5b3 ) 22_ LI - 0 / 7 Fax: (56 3) 3 Z u 0 & 3 Investigation per hour (1 hr min) 62.50
CCB Lic.: /3 , Electrical Lic.:311— , ,5 Suprv. Lic.: ybZZ, Industrial plant per hour 73.75
i j, ELECTRICAL PERMIT FEES,
Suprv. Electrician sign /tit Electrical
Subtotal: !o , /
Print name: �- s Date: _/ 9 0C---/ Plan review (25% of permit fee):
State surcharge (12% of permit fee): 7
Authorized signature: TOTAL PERMIT FEE: 67 .3 ! //
o
This permit application expires if a permit is not obtained within 180
Print name: Date: 2 — /C9 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permiis\ELC- PermitApp.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 Al residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
r COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
• n HVAC .
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required -
for all other installations
I \Building\Permits\ELC- PermitApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELC2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2008
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 3/14/2008 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 0N19fi SW LOCUST ST A CLASS OF WORK: ,.
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: (3) branch circuits.
OWNER: BAKER, JAMES 4., . PHONE #: NA
CONTRACTOR: FIVE STAR ELECTRIC, INC. PHONE #: 50
Inspection Request Scheduled For: Date: 3/14/2008 Pour Time:
Code # Inspection Description —Confirm Contact # Message
\...
199 Electr in;:41 \ 66707-01 530-201-2996 Y
Corrections/Comments/Instructions:
-f 0 '. "3
•
j'1 PASS El PARTIAL APPROVAL 0 CANCEL H NO ACCESS
• ' L 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: Cr 1()43 LE"' , Date: 3 ,11- - (St Phone #: (503) 718- DA
. . . . . .. „ .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/20/2008
Phone: (503) 639-4171
is141,11
Inspection Requests (24 Hrs.): (503) 639-4175 _ J
INSPECTION WORKSHEET FOR DATE: 3/10/2008 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 09495 SW LOCUST ST A CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: (3) branch circuits.
OWNER: BAKER, JANIES +, PHONE #: NA
CONTRACTOR: FIVE STAR ELECTRIC, INC. PHONE #: 503-324-0948
Inspection Request Scheduled For: Date: 3/10/200a Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 066387-01 503-201-2996 Y
Corrections/Comments/Instructions:
•
0 C •
i e 11-
p • ;. ' :
ei4-1 e- a 6 el
- tr 4 co-v-z-r
n PASS <41=1TIAL APPROVAL n CANCEL . D NO ACCESS
111 FAIL CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
_
Inspector:
I t(2-1141.) Date:, 3 --i 0 - OP Phone #: (503) 718-
7
,
CITY OF TIGARD
vi
A
BUILDING DIVISION PERMIT #: ELC2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 20012008
Phone: (503) 639-4171 /MO\
Inspection Requests (24 Hrs.): (503) 639-4175 Ag--, -111. -
INSPECTION WORKSHEET FOR DATE: 2/2812008 TIME: 7:00AM PAGE: 6
SITE ADDRESS: 09496 SW LOCUST ST A CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: (3) branch circuits.
OWNER: BAKER, JAMES +, PHONE #: NA
CONTRACTOR: FIVE STAR ELECTRIC, INC, PHONE #: 503-324-0948
Inspection Request Scheduled For: Date: 20812008 Pour Time: .
Code # Inspection Description Contact # Message
( Go 6 n 6 1 8 i - r 3 7 02
12f Wall cover 503-210-1299 N
Corrections/Comments/Instructions:
\ _ /
1 El PARTIAL APPROVAL El CANCEL 0 NO ACCESS
fl FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: . 6 k-' Date: 2. t» 6 Phone #: (503) 718- Miikr
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CITY OF TIGARD
A
BUILDING DIVISION PERMIT #: ELG2008-00091
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2120/2008
Phone: (503) 639-4171 to lWokoltiO
Inspection Requests (24 Hrs.): (503) 639-4175 -
INSPECTION WORKSHEET FOR DATE: 2/28/2008 TIME: 7:00AM PAGE: 7
SITE ADDRESS: 00495 SW LOCUST Si A CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 004 TYPE OF USE:
PROJECT NAME: KLEIN DERMATOLOGY
DESCRIPTION: (3) branch circuits. .
OWNER: BAKER, JAMES 4., PHONE #: NA
CONTRACTOR: FIVE STAR ELECTRIC, INC. PHONE #: 503-324-0948
Inspection Request Scheduled For: Date: 2/28/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 065831-01 503.210-1299 N
Corrections/Comments/Instructions:
71' V46-1037
0 PASS fl PARTIAL APPROVAL C ------- Q CANCEI) El NO ACCESS
I I FAIL CALL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
Inspector: G 14661-Q Date: 2'7.10 (AI Phone #: (503) 718- 1.1M,