Permit CITY OF TIGARD
ELECTRICAL PERMIT
° PERMIT #: ELC2008 00232
c j COMMUNITY DEVELOPMENT
D ATE ISSUED: 4/24/2008
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 112C B - 06900
SITE ADDRESS: 15425 SW 81ST AVE ZONING: R -
SUBDIVISION: ASHFORD OAKS NO. 2 LOT : 083 JURISDICTION: TIG
PROJECT: CAMBELL
Project Description: Installing (2) 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: SIGNAUPANEL:
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:
MARTA BURWELL WEBER ELECTRIC INC
15425 SW 81ST ST PO BOX 231154
TIGARD, OR 97224 TIGARD, OR 97281
Phone: 503 - 639 - 5332 Contact #: PRI 503 - 620 -1906
FAX 503 - 620 -6819
FEES
Description Date Amount Reg #: ELE 34 -442c
[ELPRMT] ELC Permit 4/24/2008 $53.50 LIC 44087
[TAX] 12% State Surchar 4/24/2008 $6.42 SUP 4028S
Total $59.92 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: _, 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.
Electrical Permit Application 1 dk , - r . - FOR OFFICE USE O NLY • - n 5 x r 1 -
c .-- ' V A ' CI of Ti and ceived / ; ;: U ( ) O 22
13125 SW Hall Blvd., Tigard, OR 97223 iq Plan Review /
I. rt 0 Phone: 503.639.4171 Fax: 503.598.1' . l . ,G
t� (✓j' 1 0 DateBy: Other Permit: w,,w a .�
t' A'R D; j �
Inspection Line: 503 ;t 4 Date Ready /By: _furls: 0 See Page 2 for
✓ Td _= tz ,. Internet: www.tigard- or.gov p \ ci o tified/Method: Supplemental Information
TYPE OF WORK ,r4 --
-- � ` ��r 1 .. P LAN REVIEW •
❑New construction Addition /alteration / l '11. ht�
��' Please check all that apply (submit 2 sets of plans w /items checked below):
����, ❑Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION . , - f exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Sand 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
❑ Emergency system. larger separately derived system.
• .. JOB SITE INFORMATION. AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - 2 ", 1 - 3 ",
/ S 4 2 S 100HP or more. occupancy.
Job no.: I Job site address: L 5 5r ft, - — ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: / E S cr ") ( ci ? 'Z 4 ❑ Health -care facilities. ❑ Supply voltage for more than
I ` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: r ve /1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE _ ._
Cross street/directions to job site: fie,/ t 3v, G- Description I Q 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
DESCRIPTION OF WORK . (with above sq. ft.) 75.00 2
l � Limited energy, multi - family
(� 2 G — be, ,Z ..---e,y,,./6_4_ residential (with above sq. 15.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
U r I rn ,v - 1 »\ 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: ( j , 3 - 5 33 24 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 599 amps 133.75 2
Branch circuits – new, alteration, or extension, er 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, t
first branch circuit 46.85 'iG`y 5 2
Address: Each add] branch circuit r 6.65 S 6,..; 2
Miscellaneous (service or feeder not included)
City /State /Z1P: 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
Signal circuit(s) or limited -
Business name:
GJ e 6 . , ►�C- - -- = K` energy panel, alteration, or
Address: FO I3, Z3 / ! 4 extension. Describe: Page 2 2
City /State /ZIP:A ` Q2 5` – 7 Z e i — / f ,-4 Each additional inspection over allowable in any of the above
5 Per inspection 62.50
Phone: (50 20 — i 9 U (0 I Fax ( J 6 2v — G 1 ? Investigation per hour (1 hr min) 62.50
CCB Lic.: ,e O g 7 I Electrical Lic.:34 _44 L L,Supry . Lic.:4013 s Industrial plant per hour 73.75
l ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 7 ,.�� Subtotal: S 3 _S C7
Print name: / / ( GUS tj e (J er- Date: .4 _ L. _0 Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: l
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information =
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY: T
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:
COMMERCIAL WORK ONLY:. .
Fee for each commercial $75.00
system
(SEE OAR 918 - 309 -0000)
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
TI Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 03/23/06
•
CITY OF TIGARD
BUILDING DIVISION .fr PERMIT #: ELC2008- 00232
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/24/2000
Phone: (503) 639 'LL
Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 6/3/2008 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 16/125 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 083 TYPE OF USE:
PROJECT NAME: CAMI3ELL
DESCRI PTION: Installing branch circuits.
OWNER: BURWELL , MARTA PHONE #: 503-639-5332
CONTRACTOR: WEBER ELECT INC PHONE #: 503-620-1906
Inspection Request Scheduled For: Date: &3/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 070645-01 503-209-2292
wfti4+1
Corrections/Comments/Instructions:
'TLJ 4...1 oh: 4-4
•
A V (
\it I- f-(144.21
0,64 11,0&6Q
x PASS I 1 PARTIAL APPROVAL 0 CANCEL 1 1 NO ACCESS
FAIL Li CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector:
Date: ( (0 Phone #: (503) 718- ddli6
CITY OF TIGARD
BUILDING DIVISION . , PERMIT #: El.C2008.0U232
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4124/2000
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639 -4175 s - !.'�i.
INSPECTION WORKSHEET FOR DATE: 4/25/2006 TIME: 7:01AiVi PAGE: 6
SITE ADDRESS: 16425 SW 81ST AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS NO. 2 LOT #: 083 TYPE OF USE:
PROJECT NAME: CAMI3ELL
DESCRIPTION: Installing (2) branch circuits.
OWNER: E;URWELl., MARTA PHONE #: 503
CONTRACTOR: WEBER ELECTRIC INC PHONE #: 503-620.1906
Inspection Request Scheduled For: Date: 4/25/2008 Pour Time:
Code # Inspection Description ( ' Con \ Contact # Message
120 E.Iectiicl rough -m 06692401 503- 20-2292 \ Y
Corrections /Comments /Instructions: ) 0 (WI 0 T
SCp'
)6LPASS I I PARTIAL APPROVAL ❑ CANCEL 1 1 NO ACCESS
I I FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: & Th 4' € Date: i V O Phone #: (503) 718 - 11-
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