Permit CITY-,OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00456
?, ' . ° ,:. COMMUNITY DEVELOPMENT DATE ISSUED: 8/7/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133CA -04100
SITE ADDRESS: 11496 SW LOMAX TERR ZONING: R -25
SUBDIVISION: GABRIEL WOODS LOT : 020 JURISDICTION: TIG
PROJECT: BRAY
Project Description: Installing (1) branch circuit for NC unit.
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: 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:
MARY ELLEN BRAY OREGON INTEGRATED CONTRACTING
11496 LOMAX TERRACE 6720 S. KNIGHTS BRIDGE
TIGARD, OR 97223 CANBY, OR 97013
Phone: 503 - 705 -9112 Contact #: PRI 503 - 880 -8649
FAX 503 - 761 -3833
FEES
Description Date Amount Reg #: ELE 3 -534C
[ELPRMT] ELC Permit 8/7/2008 $46.85 LIC 158482
[TAX] 12% State Surchar 8/7/2008 $5.62 SUP 38535
Total $52.47 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 throu• • •AR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC)t 503.246.6699 or 1.800.332.2344.
Issued B Aigt' Permittee Signature: le�
4 .....,
/....--•...41' OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or n€ t.
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.
Electrical Permit Application rt li r, r r i i r: l s t: t, 1.1 -.- -
� Received
C
Air
ity of Tigard � Deem . 1/ Permit No.:
�� o
• 13125 SW Hall Blvd., Tigard, OR 972 Plan Review -
C Phone: 503.639.4171 Fax: 503.59 ^1, e/By: Other Permit:
�- G RD w Inspection Line: 503.639.4175 I ! Mite Ready/By: kris: 65 See Page 2 for
IA
Internet ww.tigard - or.gov � �� d kV 3 - s . otifed/Method: 7T6 I Supplemental Information
TYPE OF WORK ( ( ■ PLAN REVIEW
❑ New construction ® Addition/alte1Btion/ Please check all that apply (submit 2 sets of plans w /items checked below):
` ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other 1 where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRU TION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less 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 15 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ". "1 -3 ",
loollP or more. occupancy.
Job no.: I Job site address: 11496 Lomax Terrace
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health-care facilities. ❑ 600 Supply voltage nominal. more than
❑ Hazardous locations.
Suite/bldg. /apt. no.: I Project name: ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I 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 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
AC Circuit
Limited residential Y' multi-family
) 75.00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2 • Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I owri which is not 201 amps to 400 amps 10030 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. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 1 4 2
fast branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: OIC Electric Signal circuit(s) or limited -
energy panel, alteration, or
Address: 6720 S Knights Bridge Rd extension. Describe: Page 2 2
•
City/State/ZIP: Canby, OR 97013 Each additional inspection over allowable in an of the above
Per inspection 62.50
Phone: (503) 8808649 I Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: 158482 Electrical Lic.: 3 -534c I Suprv. Lic.: 3853s Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, re ui ....---- Subtotal: 616.515
Print name: Steve L Morris Date: 8 - 1 - 2008 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 576,
Authorized sig nature : TOTAL PERMIT FEE: )^� , K
Print name: Jason Bo I Date: 8-1 -2008 7� permit application expires if a permit is not obtained within t
- ^ days after it has been accepted as complete.
r .
CITY OF TIGARD - ao
BUILDING DIVISION PERMIT #: E1.C2008 -00456
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED 8/7/2008
Phone: (503) 639 -4171 ill +
Inspection Requests (24 Hrs.): (503) 639 -4175 . .
INSPECTION WORKSHEET FOR DATE: 8/8J2008 TIME: 7:00AM PAGE: 14
SITE ADDRESS: 11496 SW LOMAX TERR CLASS OF WORK:
SUBDIVISION: GABRIEL WOODS LOT #: 020 TYPE OF USE:
PROJECT NAME: BRAY
DESCRIPTION: Installing (1) branch circuit for NC unit.
OWNER: BRAY, MARY ELLEN PHONE #: 503 - 7059112
CONTRACTOR: OREGON INTEGRATED CONTRACTING PHONE #: 503880 -8649
Inspection Request Scheduled For: Date: 8/8/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073967 -01 503-880.8649 N
Corrections /Comments /Instructions:
71 "lcn., Ts-o #V 11
if
O r d — I I P ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL /1111 CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: er/ /D6 Phone #: (503) 718 - 7.---e
r . l
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 -00456
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/7/2008
Phone: (503) 639 -4171 yI�lI
Inspection Requests (24 Hrs.): (503) 639 -4175 ..„,� _..
INSPECTION WORKSHEET FOR DATE: 8!8/2008 TIME: - 1:00AM PAGE: 13
SITE ADDRESS: 11496 SW LOMAX TERR CLASS OF WORK:
SUBDIVISION: GABRIEL WOODS LOT #: 020 TYPE OF USE:
PROJECT NAME: BRAY
DESCRIPTION: Installing (1) branch circuit for NC unit.
OWNER: BRAY, MARY ELLEN PHONE #: 503705 -9112
CONTRACTOR: OREGON INTEGRATED CONTRACTING PHONE #: 5038848649 • Inspection Request Scheduled For: Date: 618/2008 Pour Time:
Code # Inspection Description Confirm # • Contact # Message
145 A/C or heating unit circuit 073967 -02 503.880 -8649 N
Corrections /Comments /Instructions:
Ad
ti z r 41; O .4 P, RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
II FAIL ''' (CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: e z dg Phone #: (503) 718- ____W