Permit � CITY OF TIGARD ELECTRICAL PERMIT
Oa PERMIT #: ELC2007 - 00461
COMMUNITY DEVELOPMENT
� DATE ISSUED: 7/6/2007
T' [ p 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 DA -06900
SITE ADDRESS: 15320 SW EMPIRE TERR ZONING: R -
SUBDIVISION: APPLEWOOD PARK NO. 2 LOT : 064 JURISDICTION: TIG
PROJECT: MEAD
Project Description: 2 branch circuits. AC and outlet.
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:
RONALD &SHARON MEAD OREGON INTEGRATED CONTRACTING
15320 SW EMPIRE TERR 6720 S. KNIGHTS BRIDGE
TIGARD, OR 97224 CANBY, OR 97013
Phone: Contact #: PRI 503- 880 -8649
FEES
Description Date Amount Reg #: ELE 3 -534C
[ELPRMT] ELC Permit 7/6/2007 $53.50 LIC 150266
[TAX] 8% State Surcharge 7/6/2007 $4.28 SUP 3853S
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.
Issued By: i f Permittee Signature
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:
Cali 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 FOR OFFICE USE ONLY
City of Tigard JUL b 2007 Received--1 y CO p Permit Ng f /� j VVi f
lig ° 13125 SW Hall Blvd., Ti e • C 97A3, r Plan Revie 1 7
.: Phone: 503.639.4171 I3.•9&1 0 I. IU AiLfi— Date/By: Other Permit:
Inspection Line: 503.. • � �. q Date Ready/By: Juris: El See Page 2 for
TI GARD Internet: www.tigar•j . i _ : )I `/ A , V 1 • S _ _ ` Notified/Method: T Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement 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: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION 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 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor Toad of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 15320 sw Empire Terrace Six 1001-IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: tigard Oregon ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 QTY. 1 Fee. 1 Total 1 •
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
AC CKTS Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ 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: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT ❑ 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 y/ . it.- 0 2
first branch circuit tp
Address: Each add'I branch circuit 1 6.65 6.1 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) 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 / (I /D 9 / � • Each additional inspection over allowable in any of the above
Phone: (503) 880 -8649 Fax: ( ) r e , 0 7 Per inspection 62.50
/ / Investigation per hour (1 hr min) 62.50
CCB Lic.: 158482 Electrical Lic.: 3 -534c / Suprv. Lic.: 3853s Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: "" - Subtotal: 5 0
Print name: Steve L Morris Date: 7-6 -07 Plan review (25% of permit fee):
State surcharge (8% of permit fee): L/. 2_ O
Authorized signature. /� / - TOTAL PERMIT FEE: 5 '?. 7
/ / This permit application expires if a permit is not obtained within 180
Print name: Jason Bo h Date: 7-6 -07 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(11 /05 /COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00461
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/6/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR L DATE: 7112/2007 TIME: 7:04AM PAGE: 00
SITE ADDRESS: 15320 SW EMPIRE TERR CLASS OF WORK:
SUBDIVISION: APPLEVVOOD PARK NO. 2 LOT #: 064 TYPE OF USE:
PROJECT NAME: MF.AD
DESCRIPTION: 2 branch circuits. AC and outlet.
OWNER: MEAD, RONALD & SHARON PHONE #:
CONTRACTOR: OREGON INTEGRATED CONTRACTING PHONE #: 503 -800 -8649
•
Inspection Request Scheduled For: Date: 7/1212007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 051746 -01 503-233-1779 Y
Corrections /Comments /Instructions: AM
Q40 s7 ;c t ►`p 10 '0No 1,
PASS n PARTIAL APPROVAL n CANCEL 1 NO ACCESS
I FAIL 1 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V c ( Date: 1 ' Z- 'T) Phone #: (503) 718-14%