Permit •
CITY OF TIGARD _ ELECTRICAL PERMIT
° q PERMIT #: ELC2007 - 00503
0 . COMMUNITY DEVELOPMENT
DATE ISSUED: 7/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S133DA
SITE ADDRESS: 12960 SW HAWK'S BEARD ST ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT : 092 JURISDICTION: TIG
PROJECT: KOPPLIEN
Project Description: (2) branch circuits for range and microwave.
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: 1 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:
KOPPLIEN, KAREN J WEST SIDE ELECTRIC CO INC
12960 SW HAWKS BEARD ST 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: FAX 503 - 736 -0677
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 7/20/2007 $53.50 LIC 13306
[TAX] 8% State Surcharge 7/20/2007 $4.28 SUP 46545
Total $57.78 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.
Issue. = y: '// Permittee Signature: SeR__ f /c/,j../4-(j
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.
•
It .. - - -- -. .. . ' ".". . FOR OFFICE USE ONLY •
71 City of Tigard V p I '+ " "° � �p O SW c
a 1 �-�- , ri / Permit (, L ' Z;5 . } - G0sp3
IJ125 SW lull BI R I•IS„ Itevtew -
" Phone: 503.699.41 71 Fox: S03 .598 1 Q6U
t)arr /Ov: _ ouxr Parrnit:
TIGARD Inspection Line: 503.639.4175 n il 20 2007 I "arc G Ro y /U3' r "' 6.-1 ® Page 2 for
-� Indeed: www-tigerd- or.gpv Nanal/Mcrhnn; _ Supplement J Information
P LAN REVIEW
TYPE ' � K ok ill AJ, _..
-
• 0 Ncw construction Addi tam Il r•ml � T ., Please check all that apply (submit j rx;s of plans H
a w /ir�my ,ecked below);
Q Demolition plh j � Al V <J J J E V S �� j ': ❑ Service or header 400 amps or more ❑ itni lain!:ONLY chile stork -4.
where U;c available fault current ❑ Marmot and boatyards.
CATEGORY OF - CONSTRUCTION •� I exceeds 10.000 amps at ISO vnlra or ❑ ]looting hn q
iWip.
1. and 2- family dwelling ❑ Commercial/industrial ACCCSSOf uildin lessiu mund,nrexceeds 14.001 ❑C'ontmeminl- use agriculturnl
y E amps for all other installations. buildintp.
Q Multi-family .... ❑ Master builder ❑ Other; ! 0 I:,rn I"• "•t'. 0 installation of 75 KVA or
JOE SITE INFORMATION AND LOCATION 0r 'Ae r acllcy system. larger xpmamly derived system.
" 0 Addition ()New minor load of 0 "A•' ••C" "1.2 - . "1 - 3".
Job no.: I Job si address 4 W t - la (34,40..0 t{ $ Z L �2q Haney.
❑ Six or more residential units. ❑ Recreational vehicle parks.
�( ��yL
City /Stone /Z P: " (3 ` ` 7 .. - 0 Supply voltage then
for more 4n
, , .-L- ❑ Ilazanlnus locations. 600 volts nominal.
Su ✓t-
ite /bldgJapt. no.: Project name: ,A/ - 4 . 4 r 6, ❑H ealth - cure fi:44;cs. 00 am re.
p,: or mo 0. �P tLE�it/ ❑ S or feeder •
Cross strcet/direclions to job site: I FEE SC1IN:[)l
•
... n..rriprinr, _ tv. _M►e. 'coda
- - -- New residential single- or multi family dwelling unit.
_ Includes attached garage.
Subdivision: Lot' no.: 1,000 sq. R. nr Icss 145.15 4
Tax map/parcel no.: - j - • --- Ga. Eiden 500 sq. . 11. or portion 33.40 I
. _
DF,SCItIY'I'iUN OF WORK .i - ' ' - I.imiled energy. residential - f5.00 2
(with above sq. IQ _
- CZ ) Gr - nn - i Limited energy, multi - family 75.00 2
• ✓ • t ti .r _ 4 Me c ,. -.,r_ r idential (with shove sq. f.) _
Sar vices nr feeders Inctnl atipn, alteration, and /or rdneutlen
_ 200 amps or less _ 80.30 __ 2
PROPERTY OWNER
Igt
I ^ Y ❑ TENANT _ 201 amps to 400 omps T 106.85 y 2
Name: t7Af•/ e.-A) . IQ, B L . ho -- -- _ 401 amps t o 600 amps ^ i6o , 60 ,
601 amp to LOW amps 240,60 2
Adds ',s: -` ^ ^ 'w 0 __.... Over 1,000 amps or volts 454.65 ' ' 2
City/Scat e/71 "^"" Temporary services yr feeders Installation, alteration, and /or
rclocatlnn_ __
Phone: ($, j)) lid $ -36 2-L f- lax: ( ) _ 200 amps or less -- 66.85 I
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 599 amps 133.75 2
Owner Signature: Branch circuits - new, alteration pr cstension,,per
Date: - j�, pea for branch circuits with
❑ APPLICANT r_ 0 CONTACT PERSO above servi or feeder AT.
•. each branch circuit 6.65 2
Business name: •
.. Y 13. Pee for branch circuits
y
Contact name: without service or feeder fee, I 46.85 4G -SS 2
- • firer hunch rirtalil _ Y
Address _ Each add9 branch circuit ( 6.65 6.6s 2
•"- -' -- _ Miserllaneens service or feeder not included)
City/Sw1dZlP: F.ach manuhctmrcJ ur modular �_..
crvice and/or feeder 90.90 2
Phone: ( ) - - I Pax:: ( ... ... ) Rc dwelling, s _ -
• _ cnnnrct nl
only 66.ft5 2
lenng «w ..---- C Cstsldccicctric.com -. Pump or irrigation circle 3
_ 5.
E -mail: 40 2
CONTRACTOR _ _ _ Sir ur outline lighting 2
• Business name: West Side Electric Co., Inc. : Signal circuits) or limited- '
- _ energy panel. alteration, or
Addre .v 1634 ■ SE 8th Ave. ' extension. Describe: Page 2 2
-
City /Stnte/7_IP: Portland, OR 97214 ` M:aeh additional inspection over allowable in any of the above
j , Par inspection 62.50
Phone: (51/3) 231-1538 _ -_ Fax (503) 730 -0677 - -- - - . �.
Investityation per hour (1 hr min) 62.50
C CLi Lic.: 13306 Flcctrictll Lie.: 26.1350 Sttprv. Lie.: 4654S Industrial plant per hour 73.75
-77Y- - - ELECTRICAL PERMIT FEES
Suprv. Electrician signahur., required: • 4 fr EN Subtotal:
.._. ��
Print name: Randall Roberts Date: r� /2_6107 Plan review (25% of permit fee):
- ( Suite surcharge (8% of pemut fee): (.4 'L8
Authorized Sivttlurc: TOTAL. PERMIT FEE: s , Z
Print name: p Thb, p ermit opplicution rapirca if u permit Is not obtained within 180
_ _ dnra unto- It has been accepted DI complete.
•
• Number of inspections allowco per permit.
t!tlaldinoreimi s\I:L(' PermiuApa.doe 05123'06 440.46151111 /0.S/COM/WL•Il
2 .01 LL90 -9EL 1EDS) '03 otJ .oai3 apis %sari eLi? :OT LO 02 ins