Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2007
DATE ISSUED: 11/9/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 CA -13700
SITE ADDRESS: 09685 SW SATTLER ST ZONING: R - 3.5
SUBDIVISION: DARMEL LOT : 012 JURISDICTION: TIG
PROJECT: FURLOTT
Project Description: Installation of service panel.
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: 2 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
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Owner: Contractor:
ROD FURLOTT WEST SIDE ELECTRIC CO INC
9685 SW SATTLER ST 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: 503 - 624 -9439 Contact #: FAX 503 - 736 -0677
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 11/9/2007 $160.60 LIC 13306
[TAX] 8% State Surcharge 11/9/2007 $12.85 SUP 4654S
Total $173.45 REQUIRED ITEMS AND REPORTS
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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: DA/ fP/°G/ C4-70
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: /2A) /9 /e6 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.
Nov 09 07 07:58a WEST SIDE ELECTRIC COMPAN (503)231 -9987 p.2
'EIectr cal Permit A > )lication FOR OFFICE USE ONLY
' City of Tigard f EIVED Received 7 ,e117
, � 9 0 Date/By: I 5• 'ern" [�
it No 7 — 0
..- .q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
•. Phone: 503.639.4171 Fax 503.59 I G Date/By: Other : ?emtil:y ,fr�O0 --- /�
TIGARD Inspection Line: 503.639.4175 Nub �t 2007 Date Ready /By: Juris ® See Page2 for �Kt�/ 77
Internet: www.tigani- or.gov rAio
Notifled'Mnhud: 7 7 Supplemental Information
I L Y VI ISION PLAN REVIEW ❑ New coction Addi cement Please check all that apply (submit Z sots of plans **terns checked below):
❑ Service or feeder 400 amps or mom Q Building over Lhrec stories.
❑ Demolition ❑ Other: where the available fault currau Ei Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or D ;luting buildings.
less to ound, or exceeds 14,000
' 1- and 2 family dwelling ID Commercialiindustrial ❑ Accessory building g 1 ['Commercial-use
buildngs se agrict rural
gimps for all oil= instal aliens. buildings.
. ❑ Multi- tatn'ly ❑ Master builder ❑ Other: ❑Fire pump. ❑ :nstallatiunof 5KVAor
J OB SLTE INFORMATION AND LOCATION l ❑ Emergency system. larger separately derived system,
O Addition of new motor load of ❑ "A', E ", : - "c " I.3 ",
: lob no.. -IA lob site acdress: c] t7 1u0HP ormore. occupancy.
L :1 7w 5 ✓ t • ❑ Six or more residential units. ❑ Recreational vehicle parks_
�.
City /S tate/Z IP: f 7 � ' .Health -care facilities.
❑ Hazardous laca:ioru. ❑ Supply voltage for more than
(tOO volts nominal.
Suite.'bldg.!apt. no.: i Project name: re�a tit i t G ❑ Service or feeder 600 amps or mote.
i FEE SCHEDULE
Cross streetidirections to job site: Dcaelption
Qty. I Fee. I Total I •
New residential single— or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 ay. ft. or portion ' 33.40 1
Tax map/parcel no.: Limited energy, residential '
DESCRII''f1ON OF WORK i ( with a bove s q. ft) 75.00 2
Limited energy, multi- family 75.Oti 2
@ OnP.\ C- L151,�be, 4 �r.(o PCtt.�. residential(withalovesq.ft.) -
�I I Services or feeders Installation alteration, and/or relocation
200 amps or less 80.30 4,0,4 Q 2
V PROPERTY OWNER ❑ TENANT 1 201 amps to 400 amps 106.85 _ 2
Name: ¢ r k
401 amps to 600 amps 160.60 2
\r)
r d 6� O 601 amps to 1,000 amps 240.60 2 •
Address: 1 , rA `A 1 o Over 1,000 amps or volts 454.65 ' 2 l
Ciry!State,"ZIP: ? "'L— Temporary services or feeders installation, alteration, and/or
relocation
Phone: (i3.7.2 6 ?LI -.3 - ; [3 Fax: ( ) 200 amps or less 66.85 i
Owner installation: This installation is being made on property that I own which is not 20 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. Fce for blanch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
6.65 I 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, •
Contact name: first branch circuit 46.85
Address: Each add'l branch circuit I I 6.65 I 2
Misccllaoeous (service or feeder not included)
City/SuLeJZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: gienngewestsideelecrric.culn Pump or irrigation circle I 53.40 2
CONTRACTOR Sign or outline lighting ' 53.40 2
Signal circuit(s) or limited -
Business name: West Side Electric Co., Inc. energy panel, alteration, or
Address: 1834 SE 8th Ave. extension. Describe: i Page 2 2
CityiStateiZlP: Portland, OR 97214 Each additional inspection over allowable in any of the above
Per inspectior. 62.50
Phone: (503) 231 -1548 Fax: (503) 736 Investigation per hour (I hr min) 62.50
CCB Lic.: 13306 E.eetrieal Lic.: 26 - 135C Suprv. Lie.: 46545 / Industrial plant per hour 73.75
d'�� f ELECTRIC . FEES
Suprv. Electrician signature, require. � � .4J PERM . Subtotal: IT I b Oc �n
I/ S f � Plan review (25% of permit Re): Print name: Randall Robeit Date: / - - --
State surcharge (8% of permit fee); i Z .g S
Authorized signature: TOTAL PERMIT FEE: )'-'Z . , 4 S l
This permit application expires ifa permit is nor obtained within 190
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
..•Oust :ercuutratELC- PY :e.tApp..clu: (.1.121 441.461 Sr( I IICi,COM/WE0
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CITY OF TIGARD
BUILDING DIVISION - - PERMIT #: ELC2007-00760
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/9/2007
Phone: (503) 639 -4171 ��" I ,�
Inspection Requests (24 Hrs.): (503) 639 -4175 1 I L ' -
INSPECTION WORKSHEET FOR DATE: 4/312008 TIME: 7:02AM PAGE: 46
SITE ADDRESS: 09685 SW SATTL.ER ST CLASS OF WORK:
SUBDIVISION: DARMEL LOT #: 012 TYPE OF USE:
PROJECT NAME: FURLOTT
DESCRIPTION: Installation of service panel.
OWNER: FURLOTT, ROD PHONE #: 503 -G24 -3439
CONTRACTOR: WEST SIDE ELECTRIC CO INC PHONE #: 503 -231 -1548
Inspection Request Scheduled For: Date: 4/3/2008 Pour Time:
Code : pec i • : - - i •tion C Contact # Message
193 EIectiical final 067816-01 503. 231 -1548 N
z-
Corrections /Comments /Instructions:
,r\
V 4.
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: t �� Date: Al- 01 Phone #: (503) 718- iM