Permit r1: CITY ®� T��� ^ ELECTRICAL PERMIT
m . v TIGARD K
.. RMIT #: ELC2007 -00523
hi ' V ° PE COMMUNITY DEVELOPMENT
-, , DATE ISSUED: 7/30/2007
J.IGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 DD -14900
SITE ADDRESS: 15675 SW 87TH AVE ZONING: R -7
SUBDIVISION: MILLMONT PARK LOT : 026 JURISDICTION: TIG
PROJECT: PEREZ
Project Description: (3) branch circuits for furnace and a/c connections and service plug.
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: 2 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:
SERGIO PEREZ BOB'S ACTION ELECTRIC INC
15675 SW 87TH AVE. 2700 NE BURTON ROAD #A
TIGARD, OR 97224 VANCOUVER, WA 98662
Phone: 503 - 620 -2911 Contact #: PRI 360- 254 -7200
FAX 360- 254 -8219
FEES
Description Date Amount Reg #: ELE 37 -43IC
[ELPRMT] ELC Permit 7/30/2007 $60.15 LIC 53136
[TAX] 8% State Surcharge 7/30/2007 $4.81 SUP 4322S
Total $64.96 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: /L cif ��/ Permittee Signature: See *elirAhno
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.
Electr?ca1 Per g a tff FOR OFFICE USE ONLY
City of Tigard D �1 Received
I 0 Permit No.: E _ 2b - I II
13125 SW Hall Blvd., Tigard, OR - Plan Review
Phone: 503.639.4171 Fax: 50 5 . 60 I b, �� �� `I DateB : Other Permit: M 1)A., ' =A,
Inspection Line: 503.639.4175 . c 1 too � " e!f Date Ready /B H See Page 2 fo
t
Internet: www.ci.tigard.or.us ry 1ptG O��1t� NotiNotified/Method: , �' Supplemental Information
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TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other:
Service over 225 amps, comm'l ['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
1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
❑Building over three stories ['Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑ Other:
['Occupant load over 99 persons ['Manufactured structures or
- JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job si te address: ❑Health -care facility ['Other:
Job no.:
07 - 862 15675 SW 87th Ave., Submit 2 sets of plans with any of the above.
City /State /ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description Qty. Fee. Total
Cross street/directions to job site: New residential single -or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder _ 90.90 2
Furnace and A/C connections & service plug Services or feeders installation, alteration, and /or relocation
200 amps or Tess 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Sergio Perez 601 amps to 1,000 amps 240.60 2
Address: 15675 SW 87th Ave. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and /or
a relocation
Phone: ( 503 522 -7539 Fax: ( ) 200 amps or less 66.85 1
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
B. Fee for branch circuits
Contact name: without service or feeder fee, 1 46.85 46.85 2
each branch circuit
Address:
Each add'l branch circuit 2 6.65 1 3. 30 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: Bob's Action Electric
Address: tt tt Each additional inspection over allowable in any of the above
2700 NE Burton Rd. "A" Per inspection 62.50
City /State /ZIP: Vancouver, WA 98662 Investigation per hour (1 hr nun) 62.50
Phone: ( 360) 254 -7200 Fax: ( 36,0) 254 -8219 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 53136 Electrical Lic / :: 3 _ 1C Suprv. Lic.: 43225 Subtotal I 60.15
Suprv. Electrician signature, required: 4 Plan review (25% of permit fee)
State surcharge (8% of permit fee) 4.81
Print name: Kevin Broselle Date: /23/07
TOTAL PERMIT FEE 64.96
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: i Fee methodology set by Tri- County Building Industry Service Board
" Number of inspections per permit allowed.
i.\ Building \Pernvts\ELC- PermitApp. doc 12103 440- 4615T(10 /02 /COM/WEB
CITY OF TARD
.
BUILDING DIVISION PERMIT #: Et:C2007 -00523
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3012t)07
Phone: (503) 639 -4171 ' �+
Inspection Requests (24 Hrs.): (503) 639 -4175 �' tit
INSPECTION WORKSHEET FOR DATE: 10/1 /2007 TIME: 7:00AM PAGE: 39
SITE ADDRESS: 15676 S1N t37T'H AVE CLASS OF WORK:
SUBDIVISION: MIt LMONT PARK LOT #: 026 TYPE OF USE:
PROJECT NAME: PEREZ
DESCRIPTION: (3) branch circuits for furnace and a/c connections and service plug.
OWNER: PEREZ, SERGIO PHONE #: 50.3-620-2911
CONTRACTOR: 6013'S ACTION ELECTRIC INC PHONE #: 360-254 -7200
Inspection Request Scheduled For: Date: 10/1/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 056550-01 360-254-7200 Y
Corrections /Comments/ Instructions:
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Cy-- Qbe) L,i 1 1 O 0 A\--
L PASS ❑ PARTIAL APPROVAL n CANC n NO ACCESS
ON FAIL CALL FOR INSPECTION 1 1 ADDITIONAL FEES ASSESSED
Inspector: 4,U? Date: 1 o ( o Phone #: (503) 718-