Permit CITY OF TIGARD ELECTRICAL PERMIT
Tv PERMIT #: ELC2006 -10052
'~14: DEVELOPMENT SERVICES DATE ISSUED: 3/16/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S104DD -02700
SITE ADDRESS: 12859 SW RIDGEFIELD LN ZONING: R -4.5
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT : 024 JURISDICTION: TIG
Project Description: (5) branch circuits
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: 4 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:
MANDY MOCK OWNER
12859 SW RIDGEFIELD LN
TIGARD, OR 97224
•
Phone: 503 - 524 -3549 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/4/2006 $73.45
[TAX] 8% State Surcharge 4/4/2006 $5.88
Total $79.33 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: At _ . 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:
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.
Eiectri al Permit Applica F . r�� �° Ical� I Ic *r. t'�l t8 � ,� , : G - - $ a - .
City
.- f T Re
Tigard Dat ived eJBycg // 7 fr b erig Permit Ng aco b ' /005
13125 SW Hall Blvd., Tigard, OR 97223 MAR 16 Other P"it:
�'
N Plan Review
e
Phone: 503.639.4171 Fax: 503.598.1960 > P`i Date/By.
Inspection Line: 503.639.4175 If�a► Date Ready/By: I ® See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TI ' e. Notified/Method: Fl( Supplemental Information
BUILDIA1C DNISIOPI PLAN REVIEW
TYPE OF WORK
. ❑ New construction 14 Addition/alteration /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 ❑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 plan RV park
r9 ' g l e ^? /^/ L � ❑Health -care facility ❑Other:
�Q8j - f
Job no.: Job site address: /t/ !�f Submit 2 sets of plans with any of the above.
City / State/ZIP: T p r ago( 0/2 9.2.9 3 The above are not applicable to temporary construction service.
d �/ FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: .je Ht e0-t /1 Description 1 Qty. Ft?" I Total I ••
Cross street/directions to job site: N/rf/h h i /0 6 -/ P /C( ) 0 New residential single or multi - family dwelling unit.
P(404 /-/ /1 Includes attached garage.
/ Garde. 4-0 1,000 sq. ft. or less 145.15 4
Subdivi 'on: 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
Fin / ,/ dwelling, service and/or feeder 90.90 2
r/h /sit par h, e,of �/ /D �sPh[ 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: l�t?H0� /%( k 601 amps to 1,000 amps 240.60 2
Address: Pall 0 e/left P ( a ( (K Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State/ZIP: 7 O/� 0� 9 7% Temporary services or feeders installation, alteration, and/or
relocation
Phone: (,j03) - j - ,� y _ .3S Y ci Fax: (TO 3 ) 1'.2 if - 3.5-7 200 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 600 amps 133.75 2
Owner signature: Date: 3 /jcJ panel �p 6 Branch circuits —new, alteration, or extension, per p
1:1 APP I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
13. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 �6 $ 2
Address: • �,,/
Each add'I branch circuit / 6.65 2 _6 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: eJ ""
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/ State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: . Suprv. Lic.: Subtotal P1 3 . (4 S
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 5.8t
Print name: Date: r �
TOTAL PERMIT FEE 1 — 1 . 3 3
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pennits\ELC- PermitApp.doc 12/03 440.46IST(10 /02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
.�, __..__ _ __,.__. ._ - -__ - --
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El 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
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PennitApp.doc 04/03
CITY OF TIGARD f .
BUILDING DIVISION PERMIT #: EL C2006-10052
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/160006
Phone: (503) 639 -4171 '
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 9/20/2005 TIME: 7 :02AM PAGE: 60
SITE ADDRESS: 1 285!; SW RIDGEFIELD LN CLASS OF WORK:
SUBDIVISION: MOUNTAIN HIGHLANDS NO. 2 LOT #: 024 TYPE OF USE:
PROJECT NAME: MOCI<
DESCRIPTION: (5) branch circuits
OWNER: MOCK, MANDY PHONE #: 503.524 -3549
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: Rt28/2005 Pour Time:
Code : Inspection Description Confirm # Contact # Message
199 Electrical Tina! 037283 -01 503- 524 -3549 N
Corrections Comments /Instructions:
PASS ❑ PARTIAL APPROVAL n CANCEL NO ACCESS
❑ FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: t Date: 9 1 Phone #: (503) 718 - PK -
CITY OF TIGa4R® 1
BUILDING DIVISION PERMIT #: E.Lc200F;- 'Ioo.;2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3. /"iCJ:^.+00•
Phone: (503) 639 -4171 ° ',�o'r
Inspection Requests (24 Hrs.): (503) -4175. `'I ��'_
INSPECTION WORKSHEET FOR DATE: 4/27/2006 TIME: 7:04AM PAGE: 69
SITE ADDRESS: '1213;:.0 SW RIDGEFIELD IN CLASS OF WORK:
SUBDIVISION: MOUNTAIN I NO. 2 LOT #: 024 TYPE OF USE:
PROJECT NAME: MOCK
DESCRIPTION: (5) branch circuit:::
OWNER: MOCK, MANDY PHONE #: 503-524-3549
. CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/27/2003 Pour Time:
Code # Inspection Description Confirm # Contact # Message
•i ?r; Mit:c. impec ion PA., �f226 :01 503- 799.3675 N
�Gldsi o
it i •
v I' f J ' 6111 1 1 /l - ,1 i i i % _/ ■— I' '1 4 JiI
CRASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
j/
Inspector: Date: 11"- 7 P hone #: (503) L/
p VJ � ) 718 -