Permit 14 CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00625
DEVELOPMENT SERVICES DATE ISSUED: 8/25/2005
e• II'
- 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 111 AB -09000
SITE ADDRESS: 09365 SW VIEW TERR ZONING: R -4.5
SUBDIVISION: PENROSE TERRACE LOT : 035 JURISDICTION: TIG
Project Description: Change out 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: 1 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:
Owner: Contractor:
CHRIS & SU BELL TRI STAR ELECTIC INC
9365 SW VIEW TERR PO BOX 231175
TIGARD, OR 97224 TIGARD, OR 97281
Phone: Phone: 503 - 860 -5249
FEES Reg #: ELE 34 -620C
Description Date Amount LIC 153559
SUP 3832S
[ELPRMT] ELC Permit 8/25/2005 $80.30
[TAX] 8% State Surcharge 8/25/2005 $6.42 REQUIRED ITEMS AND REPORTS
Total $86.72
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: ' " 20.� , e . : Permittee Signature: _SA .L 9 ..
OWNER INSTALLATION ONLY f
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.
Rug 24 05 10:51a T Ii COEN I C 5035902302 P . 1
.M' ~�i l�
. Electr Permit Application 2 4 2005 rUR Orrl(1- t SI :ONI.)
City of Tigard CITY OF TIG' "D I W�� 1 I Permit No.: - • . � / ��Q '
13125 SW Hall Blvd., Tigard, OR 97223 BUILDING D ■, Plan Review Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 10 ; •,:_ i Date/B .
Inspection Line: 503.639.4175 1 _ '� �, Date Ready /By. See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
❑Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑ Other: ❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2- family dwellings 4 or more new residential
❑System over 600 volts nominal units in one structure
Er 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑Buildin over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other: DOccupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting RV park
❑Health -care facility ['Other:
Job no.: ej3 Job site address: 01 5(05 3„, `I
v I Q-lA- - Tex (-aC Submit 2 sets of plans with any of the above.
City / State/Z1P: i 1 T.....r8 I p� 91 2r 29
The above arc not applicable to temporary construction service.
-
FEE* SCHEDULE
Suite/bldg./apt. no.: Project name: Description 1 Qty. I Pcc• I mud 1 • '
Cross street/directions to job site: I.AC.— QprvaAci 93 gel- New residential single- or multi- family dwelling unit.
Includes attached garage.
1.000 sq. ft, or less 145.15 4
Subdivision: J Lot no.: Ea. add'I 500 sq. ft or portion 33.40 I
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
C ► '\ab 1G¢ Elm -• tcai Fan e'1 Services or feeders installation, alteration, and/or relocation
200 amps or less ) 80.30 8A 3c 2
201 amps to 400 amps 106.85 2
PROPERTY OWNER I ❑TENANT 401 amps to 600 amps 160.60 2
Name: ' 'V( 1S �- 601 am to 1,000 am s 240.60 2
L l - �t 1(�I�f . �� 1 Ps P
Address: Cj . (p r j �.N v 1 ci I e. —ac.�� Over 1,000 amps or volts 454.65 2
/t Reconnect only 66.85 2
City /State/ZIP: i cyjuraI OP, l' 2.1-4 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 6 6. 85 1
Owner installation: This installation is being made on property that I 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 600 amps _ 133.75 2
Owner signature: Date: . Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6 65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: D � �e_ti_t without service or feeder fee, 46.85 2
�.' each branch circuit
Address: _
Each add'I branch circuit 6.65 2
•
City /State/ZIP: Miscellaneous (service or feeder not included)
QQ Pump or irrigation circle 53.40 2
Phone: (eras) U(Q _,_g38 Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: rl -- 5\-- eA e cky -1 G 1 1 V'1 C- .
Each additional inspection over allowable in any of the above
Address: P Q . boy__ 2 3 , Per inspection 62.50
City /State/ZIP: ! , y a l O P. - 1 2.8 I Investigation per hour (1 hr min) 62.50
(50 8 Fax: (-- _ ` S9 0 .- 2 - 3r ` 7 Industrial plant per hour 73.75
Phone: 3 U j 1 lJ - ELECTRICAL PERMIT FEES*
CCB Lie.: I r'55 Electrical Lie.: 34 -tpwci Suprv. Lic.: 383l S Subtotal e0t30
Suprv. Electrician signature, required: 12�a�r( Plan review (25 %ofpermit fee)
1 A -. �, 1 — State surcharge (8% of permit fee) t.. 42
Print name: gLa and Me J ex Date: / Z 5/ 05
TOTAL PERMIT FEE eel Z
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tn County Building Industry Service Boast
• • Number of inspections per permit allowed.
,'Building\Permau ELC-PenniApp.doc 17/03 440 46157(10/07/COMAVEB
•
• C --OF TIGARD
BUILDING DIVISION PERMIT #: ELC2045 -04625
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/25/2445
Phone: (503) 639 -4171
Inspection• Requests (24 Hrs.): (503) 639 -4175 ^'IL
INSPECTION WORKSHEET FOR DATE: 9123! ?005 TIME: 7:07AM PAGE:
SITE ADDRESS: 09365 SW VIEW TERR
CLASS OF WORK:
SUBDIVISION: PENROSE TERRACE LOT #: 035 TYPE OF USE: •
PROJECT NAME: BELL
DESCRIPTION: Change out panel.
OWNER: BELL. CHRIS & SUZANNE PHONE #:
CONTRACTOR: TRI STAR ELECTIC INC PHONE #: 503.860 -5249
Inspection Request Scheduled For: Date: 9/23/2005 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
199 016452 -01 503-860-3838 Y
•
Corrections /Commen s s ructions:
iff)
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
. Inspector: Date: q/ ob Phone #: (503) 718- 2I41�