Permit CITY OF idTIOARD ELECTRICAL PERMIT •
PERMIT #: ELC2007 -00203
COMMUNITY DEVELOPMENT
DATE ISSUED: 4/5/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S111AB -00403
SITE ADDRESS: 09105 SW MOUNTAIN VIEW LN ZONING: R - 4.5
SUBDIVISION: • LOT : JURISDICTION: TIG
PROJECT: PETRIN
• Project Description: 6 br. circuits for kit. remodel.
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/ FOR: 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: 5 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:
PETRIN, JEROME ALED CARTON ELECTRIC INC
BARBARA ANN • PO BOX 860
9105 SW MTN VIEW LN AMITY, OR 97101
TIGARD, OR 97223
Phone: na Contact #: PRI 503 - 435 -1600
FAX 503 - 835 -0539
FEES
Description Date Amount Reg #: ELE 26 -120C
[ELPRMT] ELC Permit 4/5/2007 $80.10 LIC 159713
[TAX] 8% State Surcharge • 4/5/2007 $6.40 SUP 5075S
Total $86.50 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: � u.�� - Permittee Signature:
Xer
•
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.
`'3
Electrical Permit Application FOR OFFICE USE ONLY
Received 2� Electrical
Date /By: �� et �J Permit NA ' O�I.IJi ~ �
City of Ti and Planning Approv I Sign
Y g RECEIVED Pla nning Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 I p D - A)007 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 3- 98 -1 Post-Review Land Use
U �ir � Hr�.it � i 1' 1 �''� Date/By: Case No.:
Internet: www.ci.tigard.or.us CITYOFT�AR a ' e• �I Contact .113, ® See Page 2 for
24 -hour Inspection Request: BW&NOWISI Name /Method: Supplemental Information.
. TYPE OF WORK PLAN REVIEW (Plea se check all that apply)' .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
IN Addition/alteration /replacement ❑ Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square feet,
. • .CATEGORY OF . I & 2 family dwellings four or more residential units in •
N 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
' JOB SITE INFORMATION and'LOCATION Submit _ sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 91.OS S W 1400147%1 in Lhasa Ln- .... ` FEE * SCHEDULE - .. •
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
-Project Name: Description Qty Fee (ea.) Total 1
New residential - single or multi- family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
' Each additional 500 sq. ft. or portion thereof 33.40 I
Subdivision: I Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
:..
. { :.c4 ;:;y:, . 'DESCRIPTION OF'WORK • .. . service and/or feeder 90.90 2
;€-
W, Perri tc4–I Services or feeders - installation,
alteration or relocation:
• 200 amps or less 80.30 2
e, 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
ii c 601 amps to 1000 amps 240.60 2
�;PRUPER NER "M1s ,: = :TENANT ' 7: .
Over 1000 amps or volts 454.65 2
Name: ' - Ve. \ n Reconnect only 66.85 2
. Address: q 05 SW Nl ou A ; v Lr . Temporary services or feeders - installation,
alteration, or relocation:
City/State /Zip: t i cia -fc) / OK 91 as 200 amps or less 66.85 . 1
Phone: . Fax: 201 amps to 400 amps 100.30 2
. 401 to 600 amps 133.75 2
❑ APPLICANT .-'7. u °%:': iv _'
: , ' "° +i Di !CONTACT PERSON Branch circuits - new, alteration,or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/State /Zip: B. Fee for branch circuits without purchase of v
service or feeder fee, first branch circuit I 46.85 G D 2
Phone: I Fax: Each additional branch circuit .5- 6.65 a, a, 2
E -mail: Misc.(Service or feeder not included):
:,,._. i , ,. . ; - , - 4 '• ; ,a;,- „..., , - • Each pump or irrigation circle 53.40 2
CUNT�2ACTiOR`', Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: C a9l•TOPI E ' . RIC. alteration, or extension Page 2 2
_ Description:
Address: k p ( 2'c � ) ( 150 -
• . • Each additional inspection over the allowable in any of the above:
City /State /Zip_ ev i , 0 1. cr I 0 I �p Per inspection per hour (min. 1 hour) 62.50
Phone: 5o3 4 135 — / bUD Fax: ,5)3 835 — 053 7 Investigation fee:
CCB Lie. #: _ r:
othe
1517 / 3 L' . #: 3( lac) — _ Y4A � trElectrieal3Eertait .F.ees:O ,,,..,, .�.,
Supervising electrician n n . .. 9 _�
p g ( (---� Subtotal $ `d0 W. l U
Signature re wired: -- Plan Review (25% of Permit Fee) $
Print Name: Cvia �:- #: 5O755 State Surcharge (8% of Permit Fee) $ ,, p
TOTAL PERMIT FEE $ cf /p _ SU
Authorized
ei ____, or � J� / Notice: This permit application expires if a permit is not obtained within
Signature: �, Date: -/ 0 ? 180 days after it has been accepted as complete.
ekki CA, •Fee methodology set by Tri- County Building Industry Service Board.
n
(Please print name)
is \Dsts\Permit Forms\ElcPerrnitApp.doc 01/03
CITY OF TIGARD _
BUILDING DIVISION ' PERMIT #: ELC2007 -00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/5/2007
Phone: (503) 639 -4171 �r
Inspection Requests (24 Hrs.): (503) 639 -4175 I I�
INSPECTION WORKSHEET FOR DATE: 4/6/2007 TIME: 7:04AM PAGE: 15
SITE ADDRESS: 09105 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETRIN
DESCRIPTION: 6 br. circuits for kit. remodel. .
OWNER: PETRIN, JEROME ALED, - PHONE #: na
C ONTRACTOR: k3gi1�!'ttsh1 1171 e,.I11sT �OCJ PHONE #: 503 - 435 -1600
Inspection Request Scheduled For: Date: 4/6/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 046121 -01 503- 380 -6251 Y
Corrections /Comments /Instructions:
m., C Ou-T L. s--4 S Si &LL cc'M will--\
k....1 21 ,5ti
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C- 1"--- 1 tI Cel L Date: Phone #: (503) 718 - 141-0)
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/512007
Phone: (503) 639 -4171 A � III
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_..
INSPECTION WORKSHEET FOR DATE: 5/1812007 TIME: 7:02AM PAGE: 30
SITE ADDRESS: 09105 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: PETRIN
DESCRIPTION: 6 br. circuits for kit. remodel.
OWNER: PETRIN, JEROME ALED, PHONE #: na
CONTRACTOR: MIMI JERVISflan PHONE #: 503-435 -1600
Inspection Request Scheduled For: Date: 5/18/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 048629-01 503-380-6251 Y
Corrections/Comments/Instructions:
AM U■
1:4 PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ C , FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: Ti I 9 Phone #: (503) 718 -1