Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00063
COMMUNITY DEVELOPMENT
DATE ISSUED: 2/5/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 BA -09600
SITE ADDRESS: 09535 SW BROOKLYN LN ZONING: R -4.5
SUBDIVISION: SHANNON MEADOWS LOT : 001 JURISDICTION: TIG
PROJECT: WHITEMAN
Project Description: repair home run
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/ FOR: 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: 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:
WHITEMAN, RICHARD A
14380 SW 97TH AVE
TIGARD, OR 97224
Phone: Contact #:
FEES
Description Date Amount Reg #:
1ELPRMT] ELC Permit 2/5/2008 $46.85
[TAX] 12% State Surchar 2/5/2008 $5.62
Total $52.47 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: �` ii= 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 .., : -z, , , ? FO FILE USE ONLY ' ` a
°, ' City of Tigard Date /B : or 5 J, Permit No.: 0 _ 4 O _— - .l0
F q 13125 SW Hall Blvd., Tigard, OR 97223
x Plan Review
v 9 Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit:
"■/ " t Eris: Inspection Line: 503.639,4175 Date Ready /By: ® See Page 2 for
aICA K D,
H>w. „=. Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE - OF WORK PLAN REVIEW
❑ New construction 14 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.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
J1 - 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, El A of system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: 100HP or more. occupancy.
' S 3 5 Sal ra ���L, L� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: / C ,t 1 - e) g - try 2 2 ❑ Health -care facilities. ❑ Supply voltage for more than
/ / ❑ 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: S r.,, " 7L Description 1 Qty. 1 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
DESCRIPTION OF WORK . (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Repa' " Pe is--e_ ket.4.-, residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
Al PROPERTY OWNER. ❑ TENANT . . 201 amps to 400 amps 106.85 2
Name: K- l Z k a ✓ 1,) tr -J-C i,i, 4 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: CI S 3 C ' vc o K / l/ _ % p Over 1,000 amps or volts 454.65 2
City/State /ZIP: 7 �,t L / d if et 22 2 3 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( .1 73 -6 se ' Fax: ( ) 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 599 amps 133.75 2
D Branch circuits — new, alteration, or extension, per panel
j-----1.-- _ � _
Owner signature:
Date: 2 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, D 46.85 7LP . 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: 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
Business name: (:)/.,00 Signal panel, or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: � , 8'
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): Jo 9.
Authorized signature: TOTAL PERMIT FEE: 54_ t 4 7
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.
I:\ Building \PermitslELC- PermitApp.doc 05/23/06 440- 4615T(II/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
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- 309 -0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
E 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
BUILDINb DIVISION PERMIT #: ��
L-'l, C2008 -00066
3
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 2/6/2008
Phone: (503) 639 -4171
A Ni ( il'
Inspection Requests (24 Hrs.): (503) 639 -4175 d.114 112.
INSPECTION WORKSHEET FOR DATE: 1/16/2009 TIME: 7: 02Ati A PAGE: 3
SITE ADDRESS: 09536 SW BROOKLYN LN CLASS OF WORK:
SUBDIVISION: SHANNON MFAIDOV'+ LOT #: 001 TYPE OF USE:
PROJECT NAME: Willi "EMAN
DESCRIPTION: repair home run
OWNER: WiI i RICHARD A, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 1 /15f O09 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electhical final 079742 971 - 3440603 N
Corrections /Comments /Instructions:
i _
• I
C 37 ,X .... PAS _ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ^` Y y L_L Date: I - J Phone #: (503) 718 - '- 1 1 '6
CITY OF TIGARD
1 1
BUILDING DIVISION , 4, PERMIT #: ELC2008-000B
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/5/2008
Phone: (503) 639-4171 iittt
Inspection Requests (24 Hrs.): (503) 639-4175 _. --.
INSPECTION WORKSHEET FOR DATE: 1714/2009 TIME: 7 PAGE: 11
SITE ADDRESS: 09636 SW BROOKLYN LW CLASS OF WORK:
SUBDIVISION: SHANNON MEADOWS LOT #: OM TYPE OF USE:
PROJECT NAME: t*IITEMAI4
DESCRIPTION: repaii home run
OWNER: WHITEMAN, RICHARD A, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 111412009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 079698-01 971-344-0606 Y
Corrections/Comments/Instructions: g‘c-klifsikb
6 20 NW? • trv Q Z-t1-.4.c.› wiTK
Cr v4) OE
0 PASS 0 PARTIAL APPROVAL 0 CANCEL I I NO ACCESS
N AIL III CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G' N66LE Date: I - 1 1 4 , 7 Phone #: (503) 718- __________
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