Permit CITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2005 -00756
" Z � �� 1 . . DEVELOPMENT SERVICES DATE ISSUED: 10/7/2005
i t 11. 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2 S 104 AA -00 300
SITE ADDRESS: 12665 SW 127TH AVE ZONING: R -4.5
SUBDIVISION: BELLWOOD LOT : 052 JURISDICTION: TIG
Project Description: Branch circuits, furnace and AC.
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:
CROMWELL, SAMUELT PHIL'S ELECTRIC
MARGARET A 6600 SE CHARLES ST
12665 SW 127TH MILWAUKIE, OR 97222
TIGARD, OR 97223
Phone: 503 - 590 -3209 Phone: 659 -0303
FEES Reg #: LIC 46126
ELE 3 -217C
Description Date Amount SUP 3201 S
[ELPRMT] ELC Permit 10/7/2005 $53.50
[TAX] 8% State Surcharge 10/7/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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 wort< 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 ques'ons to OUNC at
503 - 246 -6699 or 1 -80: -332- 4.
Issued By: 1 ��„�� Permittee Signature d
l
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.
Electrical Permit Application -, �' n" .,;�a , ;1 ./r' I. OR iii I I i' i ' Iv t
City of Tigard ECEIV t• Vii Dat (� /D6 86 Permit No C �j� �J�
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ( N
Phone: 503.639.4171 Fax: 503 .598.1960 '! '� =y} I' ^ ., Dale/BY Olher Permit:
Inspection Line: 503.639.4175 (' _ r ' 1
p
OCT O ' '1� � D ate ReadyBy: 1u %: El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
TYPE gyp TIGARD PLAN R EW ' .
RAMC DIVISIOPJ
El New construction a Addition/ alteratton/replacement Please check all that apply:
❑Demolition ❑Other: ❑ Service over 225 amps, comm'I ['Hazardous location
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
g 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE • INFORMATION AND LOCATION . ❑Egress/lighting RV park
❑Health-care facility ['Other:
Job no.: Job site address: t d � 2 � ,5 /R7 I Submit 2 sets of plans with aqy of the above.
City /State/ZIP: 7 , 2 �1 0,,, The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I *'
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
. Includes attached garage.
/4) 4—Z.- Rd Cs 4" 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK - Each manufactured or modular
dwelling, service and/or feeder 90.90 2
7 / i c - ' - ,1 - - — /PVC C /!L lii,t5 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
401 amps to 600 amps 160.60 2
Name: 601 amps to 1,000 amps 240.60 2 •
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( )
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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
- ❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
Contact name: 13. Fee for branch circuits
without service or feeder fee,
each branch circuit t 46.85 2
Address:
Each add'I branch circuit / 6.65 _ 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) 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: P /�/ 5 £L e A-9 e
Address: Each additional inspection over allowable in any of the above
llr /C) 5 C6 / 4( de /Py Per inspection 62.50
City/ State/ZIP: or 144,4. fe-/4 ,e Cr M.) Investigation per hour (1 hr min) 62.50
Phone: ( ) ` I f Fax: ( ) Industrial plant per hour 73.75
`` �� �� ELECTRICAL PERMIT FEES* -
CB Lic. 4 6 /z4„, Electrical Lic.: 3 7 c Suprv. Lic.: 3, ?0 ,/9 5 Subtotal 3.50
qlqk Electrician signature, required: p,/ /l / Q � Plan review (25% of permit fee)
'u f C� ""' y State surcharge (8% of permit fee) L a, i(
Print name: Ar L L AJele dC,r, Ai N Date: m / 4 / � _ TOTAL PERMIT FEE �1 7 g
Authorized signature: /m This permit application expires if a permit is not obtained within 180
� • ' '� "�` �' days after it has been accepted as complete
Print name: 7,k/ 4.%I,2P��, 4 ,� Date: , ,,e / /, „,,x,-- • Fee methodology set by Tri- County Building Industry Service Board
•Number of inspections per permit allowed.
i:\ Building \Permits\ELC- Permi*App.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL, WORK ONLY: 7
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
LCOMMERCIAL WORK ONLY .
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical •
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pemuts\ELC- PermitApp.doc 04/03
CITY OF TIGARD --a
BUILDING DIVISION PERMIT #: ELC200S -00756
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/7/2005
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 may.
INSPECTION WORKSHEET FOR DATE: 10/10/2065 TIME: 7:04AM PAGE: 90
SITE ADDRESS: 12666 SW 127TH AVE CLASS OF WORK:
SUBDIVISION: BELLWOOD LOT #: 062 TYPE OF USE:
PROJECT NAME: CROMWELL
DESCRIPTION: Branch circuit.;: furnace and AC.
OWNER: CROMWELL, SAMUEL T, PHONE #: 503 -590 -3209
CONTRACTOR: PHIL'S ELECTRIC PHONE #: 659.0303
Inspection Request Scheduled For: Date: 10/10/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 017852 -01 503 -803 -7074 N
Corrections /Comments /Instructions:
/4' /‘ ()A/ IT it /N zg. v 14 ,4-,< S
V PASS 'ART IAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I 1 FAIL ' ALL FOR INSPECTION _ ADDITIONAL FEES ASSESSED
Inspector: Date: / '! • 67 Phone #: (503) 718-