Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 COMMUNITY DEVELOPMENT Permit#: ELC2013 00663
T(G A.R D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 11/04/2013
Parcel: 2S 101 AC00800
Jurisdiction: Tigard
Site address: 7148 SW GONZAGA ST
Project: The Adrienne Subdivision: BEVELAND NO.2 Lot: 14
Project Description: 200 amp temporary service.
Contractor: ADK ELECTRIC, INC. Owner: ROGERS, ROY R
9000 NE 90TH STREET 13690 SW TWELVE OAKS CT
VANCOUVER,WA 98662 TIGARD,OR 97224
PHONE: 360-546-5155 PHONE:
FAX: 360-576-6975
FEES
Quantity Description Date Amount
1 ea Temp Services or Feeders- 11/04/2013 $59.36
Specifics: 200 amps or less
1 ea 12%State Surcharge- 11/04/2013 $7.12
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $66.48
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 through OAR 952-001-0090. You ma •• •• • .•e rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: L_� _ Permittee Signature. pry
��► 7P
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' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available Inspection date.
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. 1. 2013 10: 31AM 1 t;l< t,l J li l No, 5003 P. 3
Electrical Permit Applicati ,CEIVED
City of Tigard Received
tY Date/13 . .11 � .. .
13I25 SW Halt Blvd..Tigard,OR 91,1p,�/ Plan Review �U
Phone: 503.718.2439 Fax: 503.598:111960 4 2013 bete/B :
Other Permit. ' • _�_
Inspection Line 503.639.4175 Date Ready/By 66 Sex Page 2 for
Internet: www.tigard-or.gov CITY OF T : ; No O�Method' Supplemental Information
n t y Ipar+u l I,e e ‘.:';':.1.;7.-- FLAN REV1EW -
,,., 1 a ►
❑New construction ®Addition/alteration/replacement Please check an that apply(submit 2 sets of plans w/items checked below);
❑Service or feeder 400 amps or more ❑Building over three stories.
0 Demolition ❑Other: where the available fault current ❑Marinas and boatyards
,
,v'�ll 7:7..` , '" 1 ' r `' f3 i
��l exceeds 10,000 amps at 150 volts or ❑Floating buildings.
lees to ground,or exceeds 14,000 ❑Commercial-use agricultural
❑ 1-and 2-family dwelling ®Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi family ❑Master builder ❑Other: ['Fire pump. ❑Installation of 150 KVA or
iJB,,111ki t t+° ❑Emergency system. larger separately derived system.
ga rt.wt t/e....ar, 30 `,.SYCE,._. , ..'' •'.'L. ❑Addition of oew motor load of 0"A",`E","1-2" "1-3".
100111'or more. occupancy.
< Job no.:M3053 Job site address:7148 SW Gonzaga Street ❑Six or more residential facilities. mts. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97223
❑Health care facrties. ❑Supply voltage for more than
`j
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.; Project name:The Adrienne ['Service or feeder 600 amps or more
Cross street/directions to job site: netertkloa Otr. ■ Ter Total •
New residential single-or multi-family dwelling unit.
Includes attached garage. _
k Subdivision: I Lot no.: 1,000 sq.ft.or less 168.54 4
Fa add'l 500 sq.R.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
.,. 1 x 75,00 2
,, .,r++ ;. . 1pESCRtPTION OF WOONIMIMIIIIIIMI (with above sq,ft,)
Limited energy,multi-family 75.00 2
200 amp temorary service residential{with above sq.ft.)
Renewable nergy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
'4 S + , y Fr 200 amps or less 100.70 2
.* 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
C Address: 601 amps ro 1,000 amps 301.04 2
Ci !State/ZIP: Over 1,000 amps or volts f 552.26 2
tY Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 1 59.36 59.36 1
t Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08
Intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 70I. 401 amps to 599 amps 168 54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per panel
Nt r r r A.Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name:ADK Electric,Inc. each branch circuit
B,Fee for branch circuits without
Contact name:Kaylee Simonson service or feeder fee,first 56,18 2
branch circuit
Address:9000 NE 90th Street Each add'/branch circuit 7.42 2
City/State/ZIP:Vancouver,WA 98662 Miscellaneous(service or feeder not included)
Each manufactured or modular 67,84 2
Phone:(360)546-5155 I Fax: :(360)576-6975 dwelling,service and/or feeder
. Reconnect only 67.84 2
E-mail:kayleesgadkelectricinc.com Pump or irrigation circle 67.84 2
. .. - '= Sign or outline lighting 67.84 2
Business name:ADK Electric,Inc. Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address;9000 NE 90th Street Each additional inspection over allowable in any of the above
Additional inspection(1 hr min) 66.25/hr i
City/State/ZIP:Vancouver,WA 98662 Investigation(1 hr min) 6625/hr
Phone:(360)546-5155 Fax (360)576-6975 Industrial plant(1 hr min) 78.18/hr
Inspections for which no fee is 90.00/hr
CCB Lic.: 148882 Electrical Lic.: 37-934 Suprv.Lie,: 4853s specifically listed OS hr min)
I I #0/ £L p ' ,d t,t •� ?':�L r' ,,;
Suprr.Electrician sig : e,required: i ), / Subtotal: 59.36
Print name: Alan Kangas Date: 11/1/13 Plan review(25%of permit fee): 0.00
State surcharge(l2%of permit ibe): 7,l2
Authorized signature: , ). — TOTAL PERMIT FEE: 66.48
This permit application expires if a permit is not obtained within 180
Print name: Alan Kang Date: 11!1!13 days after it has been accepted as complete.
' Number of inspections allowed per permit,
I:11luildinglPermitclfLC PermitApp E,LRfP. doo Rev 05/2112011 440-4415T(iifosicoMiW$B
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7148 SW GONZAGA ST, TIGARD, OR, 97223
Commercial - Electrical
110 Temporary electrical servi
2013-11-07 (null)
ELC2013-00663
PASS
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
7148 SW GONZAGA ST, TIGARD, OR, 97223
Commercial - Electrical
199 Electrical final
PASS - No C of O
ELC2013-00663
Jeff Grove
Violation Summary:
Inspector Contractor