Permit k s= 3 CITY OF F TIGARD ELECTRICAL PERMIT
M , . Y PERMIT #: ELC2007 -00833
COMMUNITY DEVELOPMENT
DATE ISSUED: 12/12/2007
, l ' i ARQ; 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DC - 00900
SITE ADDRESS: 13935 SW 72ND AVE ZONING: I -
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: CICERONE
Project Description: (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:
PAUL CICERONE HARVEY ROSE ELECTRIC SERVICES
15993 SW KREICK PL PO BOX 128
TIGARD, OR 97224 NORTH PLAINS, OR 97133
Phone: 503 - 407 -5630 Contact #: FAX 503 - 648 - 8254
PRI 503 - 789 -3284
FEES
Description Date Amount Reg #: ELE 34 -130C
IELI'RMT1 ELCPermit 12/12/200' $53.50 LIC 43084
ITAX I 8% State Surcharge 12/12/200' $4.28 SUP 2767S
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 .. 3. - . - •rdance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more an 180 days. A TION: • -.on law requires you to follow rules adopted by the Oregon Utility Notific tion Center. Those rules are set forth in
OA' 952- 001 -0010 through O • ■ : 2 -00 -0100. You may obtain copies of these rules or direct questions to NC at 503.246.6699 or 1.800.332.2344.
I-sued By: 1 ! 'A Permittee Signature: j --- S�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or ren .
OWNER'S SIGNATURE: DATE:
• ONTRACTOR INSTALLATION ONLY
Ipmp
i
SIGNATURE OF SUPR. ELEC'N: --.0.9:1" _S? % � 11�_ 1 ' DATE: � - d �
i !l
LICENSE NO: 3
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 l+i- FOR OFFICE1US ONLY . -:?'4i744.:1-• .k i '
,tit i _ ,—/q
°" 0 City of Tigard Date /B ' (/ nt / .111' Permit No (�(/p
?•' q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
4 0 Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready /By: luris: 0 See Page 2 for
XT r :y „ f Internet: wv♦tiv.tigard -ocgov
1I G ASK D) Notified/Method: I q 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
p 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. A
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
) ' q 2 m d 1 ' IOO or more. occupancy.
Job no.: Job site address:
t �� � i t {rl v ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: — a ❑ Health -care facilities. ❑ Supply voltage for more than
I 1 Gt .71 ❑ 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 Cry. I 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 75.00 2
. DESCRIPTION OF WORK (with above sq. ft.)
/ Limited energy, multi - family 75.00 2
y
. V .�S' J
! _bo?r -5 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
1. e i t_7 , 601 amps to 1,000 amps 240.60 2
Address: t 5.1 3 (.A... 11-y2..? 1 L Over 1,000 amps or volts 454.65 2
City /State /ZIP: -1
I t c it Q I> �1 n — 9 72-2 � 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 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, per panel
Owner signature: - Date: 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, l /,Oc. 2
46.85 7
first branch circuit DD
Address: Each add'l branch circuit j 6.65 ( ,(s 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
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: � / Signal circuit(s) or limited -
/ /4,ve. •04.5-, fA., (l rd/ a energy panel, alteration, or
Address: Re extension. Describe: Page 2 2
/
�l
City/State/ZIP: Each additional inspection over allowable in any of the above
Ir� ���y� � r�, GJ 7� 3 3 Per inspection 62.50
Phone: (5- ) 7,q -3).. "/ Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: ( 7 y Electrical Lic.: - %-43 1 ‘.._ Suprv. Lic.d 7j7 5 Industrial plant per hour 73.75
L\ ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , 6_ Subtotal: r3 5--0 Plan review (25% of permit fee):
Print name tl
�! et \g OS E
fDate:1 10-07
State surcharge (8 %ofpennit fee): �s
Authorized signature: • TOTAL PERMIT FEE: 57 , 7g
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 pennit.
I:\Building \Permits \ELC- PermitApp.doc 05/23/06 440 -4615T(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - •Supplemental Information I. 1
LIMITED ENERGY PERMIT FEES:
?_ 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* ' •
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems* •
❑ Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system •
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n • Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
n Protective Signaling
n 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 TICaARD � 4e 14'
BUILDING DIVISION 7.1 PERMIT #: CLC2007 g;i833
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/12/2007
Phone: (503) 639 -4171 4111,41111‘
Inspection Requests (24 Hrs.): (503) 639 -4175 .�'.
INSPECTION WORKSHEET FOR DATE: 12/13/2007 TIME: 7 :00AM PAGE: 1.1
SITE ADDRESS: 13836 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CICERONE
DESCRIPTION: (2) branch circuits.
OWNER: CICERONE, PAUL PHONE #: 503-407-5630
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503789.3204
Inspection Request Scheduled For: Date: 12/13/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
139 Electrical final 061403.01 50:3-789- 328N
Corrections /Comments/ Instructions:
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(bM (A) tal 01 On (
Fre-
Tirr
I
❑ PASS ❑ PARTIAL APPROVAL r• CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ' Date: ( Phone (503) 718-
CITY i3 -' - ? L lc�0, ?- 0i-93 UIL®II\I ► IVISION L -
ice' P #: I' 1(:. 7 �� 6
13125 SW H, :II : vd., Tigard, OR 97223 •Y DATE ISSUED: 9" X1/2 7
Phone: (503; 63' -4171 A„
Inspection ' -sts (24 Hrs.): (503) 639 -4175 . "• °' s f.
INSPECTION WORKSHEET FOR DATE: 12160007 TIME: 7.06AM PAGE: z}f,
SITE ADDRESS: 13936 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CIr RONFE
DESCRIPTION: Reconnect only
OWNER: cV EP /
ONE, PAUL r PHONE #: 613
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Da e: - 16/t2007 Pour Time:
Code # Inspection Description --- Conf m # Contact # Message
116 Electrical sarvic: ° 060940-01 80a /107- 3630 N
Corrections /Comments /Instructions:
C Z a$ l 1 , : i 0 E c - - - c . - i e i s A[.. t.,5 A its► q6t1 T4;1 De, "ate
RavArt ft:
i tN si 0A- c 12ov0b 6L0b pht. 1:4: 25'0. '8J
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J �t � (4 toe x 1� ,t, � t
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.," , .1 BO 0 el i N e i AO %VW P4,- •
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
0 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CT 1 vbC3 Date: 114 ‘101 Phone #: (503) 718 - lietto. _