Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00986
DEVELOPMENT SERVICES DATE ISSUED: 12/30/2005
411111 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 102AB - 03600
SITE ADDRESS: 112255 -SW MAIN ST ZONING: CBD
SUBDIVISION: / 2 2-3_5 LOT : JURISDICTION: TIG
Project Description: 4 branch c ir c uits for compliance repairs.
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: 3 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:
JOHNSON, WARREN W + BETTY TRS AN GOLD STAR ELECTRIC
JOHNSON, REES C + MARYANNE G 51627SW 5TH
3112 SW SANTA MONICA ST SCAPPOOSE, OR 97056
PORTLAND, OR 97201
Phone: Contact #: PRI 503 - 274 -4653
503 . 03 _ Oa,
FEES
Description Date Amount Reg #: ELE 5 -55C
[ELPRMT] ELC Permit 12/30/200' $66.80 LIC 151939
[TAX] 8% State Surcharge 12/30/200' $5.34 SUP 33055
Total $72.14 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations co ntained 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 AR 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 00-33 2344.
Issued By: el .c am i 1.dJ Permiftee 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.
Dec 29 05 01:02p GOLD STAR ELEC 5035434025 p.6.
` Electrical Permit Apt , I V E D FOR OFFICE USE ONLY
City of Tigard I'� � ......4 !.r D - Permit No.. i �Oe, og,
13125 SW Hall Blvd, Tigard, OR 97223 Plan �N,,
Phone: 503.639.4171 Fat: 503.598.1960 2 9 �00 _ �''sr j •' >�t4/eY Other Perm
it:
Inspection Line: 503.639.4175 D E C v k1. •_ f � � Date Ready/By: lam El See Pago2 far
Internet `ww.c•tiga"d.or.us CITY OF TIGARD Notified/Method �0 I Supplemental
Miii_all'I■Vi3MISION PLAN REVIEW
❑ New construction 3 Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other ❑ Service over 225 amps, comm'l ❑ Hazardous location
❑
CATEGORY 01? CONSTRUCTION of !- Service
nd 2- family dwellings g ❑ 4 Buildng over or more new residential
❑ 1 - and 2- family dwelling (yl Commercial/industrial ❑ Accessory building 0 System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other ❑Building over three stories CI Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufachlred structures or
JOB SITE INFORMATION AND LOCATION ❑ Egress/lighting plan RV park'
Job noid9 i -- Job site address: /; 5 , S t <) 411(4;7 : Jam'
['Health facility ❑ Other:
Submit 2 sets of plans with any of the above.
City /State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: r/I� yn� ti FEZ* SCHEDULE G' S/ /3-, J h o e Sr G %Y?..- pesalinam I Qty. I Fee 1 Total {
Cross street/directions to job site: New residential single- or multi- family dwelling milt.
o Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea add'l 500 sq. ft. or portion 33.40 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
/ dwelling, service and/or feeder 90.90 2
( X-
' '1 / / / ;t aas p` "�� Services or feeders installation, alteration, and/or relocation
/ /) L'J PROPERTY ' /qt._ S'/)/e:-7/1< 200
TENANT 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
n is being lat
Owner installation: This installation ade on 200 amps or less 66.85 1
lease, bent, to exchange, g property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, ange, according to ORS 447, 449, 670, and 701. 401 antra to 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ' ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
- r -. _.. - B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 • f/ 2
first branch circuit /f
Address: Each add'l branch circuit j 6.65 / 2
City /State/ZIP: Miscellaneous (service or feeder not included) 1. '
Phone: ( ) I Fax : ( ) Pump or irrigation circle 53 2
E - mail: Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 66,0 ,,.. 5y . /4 ';: i - / 6: 7 , •
Address: rO fe' L 7 %-) A/ 3/� Each additional inspection over allowable In any of the above
Y
Per inspection : 62.50
City /State/ZIP: ,s /2) c / ck 9 Investigation per hour (1 hr min) 6230
Phone: ( 3) a'7 (/ . • I Fax: ( ^- -, / , ._ [ �r� Industrial plant per hour 73.75
�'[ ELECTRICAL PERMIT FEES'
if- CCB Lic.: / /7 _ Y �l.J31� I Electrical Lic� upr
Suprv. Lic.:51)c�� to �, /V ' Subtotal
Suprv. Electrician signature, required: � ,� R ,C Plan review (25% of permit fee) ��'� t( l
--� - State surcharge (8% of permit fee) 5,3v
Print name: 7 /. /,` r , , S ` D ate: /) �. /.
l � TOTAL PERMIT FEE /7d / ki
1r C
Authorized signature..{ / ' -
2 1C /2, Thts permit application expires If a permit b not obtained wttbth 180
\ / I /) 9j`„/ d after it has been accepted as complete
Print name: ` E
fj > ` J / ,�/� C / il Date: /' �` -. Fee methodology set by - Tri_Comity Building Industry Service Board
-ta
Electrical Permits Completed a/o 1/31/06, 12297 SW Main St., Tigard
Permit Address Scope
EL 2005 -00858 12297 SW Main St. Service upgrade, meter relocations,
installation of meter mains.
ELC2005 -00983 12265 SW Main St. 6 branch circuits and compliance repairs.
ELC2005 -00984 12271 SW Main St. 6 branch circuits and compliance repairs.
ELC2005 -00985 12259 SW Main St. 5 branch circuits and compliance repairs.
ELC2005 -00986 12255 SW Main St. 4 branch circuits and compliance repairs.
. ELC2005 -00987 12285 SW Main St. 2 branch circuits and compliance repairs.
ELC2005 -00988 12289 SW Main St. 2 branch circuits and compliance repairs.
ELC2005 -00989 12297 SW Main St. 6 branch circuits and compliance repairs.
All complete through final inspection approval.
CITY OF TIGARD .
BUILDING DIVISION r ` PERMIT #: El-C2005- 009136
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/30/2005
Phone: (503) 639 -4171 ao
Inspection Requests (24 Hrs.): (503) 639 - 4175 —
INSPECTION WORKSHEET FOR DATE: 1/30/2006 TIME: 7 :01AM PAGE: 34
SITE ADDRESS: - 1.2.2 - 4E W MAINS CLASS OF WORK:
SUBDIVISION: /a 53 LOT #: TYPE OF USE:
PROJECT NAME: ESP PROPERTIES /S E STORE
DESCRIPTION: 4 branch circuits for com lance repairs.
OWNER: JOHNSON, WARREN W + TRS AN, PHONE #:
CONTRACTOR: GOLD STAR ELECTRIC PHONE #: 503-2744653
Inspection Request Scheduled For: te: 1/30/2006 Pour Time:
Code # Inspection Description Con irm # Contact # Message
199 Electrical final 025` -04 971 - 219 -2810 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N643 (.,W" Date: 1 -3D-46 Phone #: (503) 718- 2.44