Permit CITY OF TIGARD ELECTRICAL PERMIT
" PERMIT #: ELC2009 -00066
COMMUNITY DEVELOPMENT DATE ISSUED: 2/19/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103DA -05491
SITE ADDRESS: 13425 SW 107TH AVE ZONING: R - 3.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: MERRITT
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:
KAREN MERRITT WEBER ELECTRIC INC
13425 SW 107TH AVE PO BOX 231154
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Contact #: PRI 503 - 620 -1906
FAX 503 - 620 -6819
FEES
Description Date Amount Reg #: ELE 34 -442c
[ELPRMT] ELC Permit 2/19/2009 $73.45 LIC 44087
[TAX] 12% State Surchar 2/19/2009 $8.81 SUP 4028S
Total $82.26 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: tsi au rkQ Permittee Signature: `746Z —✓
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 FOR OFFICE I SE O\L1
Received ` . permit No.:
City of Tigard Date /By: c' ' lq - o 9 F ilo 2C A • crock,
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
I Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I t i A tt t) Inspection Line: 503.639.4175 Date Ready/By: tuns. t ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: 'T IC 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.
t � , � ' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
s�`�- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Mu lti- family ❑ Master builder ❑ Other: El 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 ",
Job no.: Job site address: n 100HP or more. pmcY•
3 2 S S� / 7 t ii �. ❑ Six or more residential units. ❑ Recreational vehicle parks.
Cl /State✓ZTP' �7-- ❑ Health -care facilities. ❑ Supply voltage for more than
t c 5 �� 2_,2:m ❑ 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: . e r / o ' t $ e G, s 7 Description i Qty. I Fee. 1 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'l 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
n_ . _. C /1'C _ v al' residential (with above sq. t)
r Services or feeders installation, alteration, and/or relocation
IC i7G/..-�+'r / 6 i .ti T � �� 200 amps or less 80.30 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
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: ( ) 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 l ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: service or feeder fix,
first branch circuit l 46.85 g b
Address: Each add'l branch circuit 41 6.65 / :
Miscellaneous (service or feeder not included) 9 1, . (Q
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-
energy panel, alteration, or
Address: po ,'2 d 2_ 3 / � 5--� extension. Describe: Page 2 2
City/State/ZIP: / - Z / _ / / 9 _Each additional inspection over allowable in any of the above
5 Gti Per inspection 62.50
Phone: (503 6 2_ .D - / 70/, i Fax: ( 50 3) (p 20- (s B 19 Investigation per hour (1 hr min) 62.50
CCB Lic.: .1 4 g 7 Electrical Lic.: 3,q � 4 Suprv. Lic.: 40Is Industrial plant per hour 73.75
4 ELECTRICAL PERMIT FEES "7 3.L45
Suprv. Electrician signature, required: 7 - 2,7 f�� Subtotal:
! Plan review (25% of permit fee):
Print name: �/I/1 e Die 2 - 19 -O 7 State surcharge (12% of permit fee): 8.s t
Authorized signature: / TOTAL PERMIT FEE: 6Z .2 (p
I Date: This permit application expires if a permit is not obtained within 180
Print name: days after it has been accepted as complete.
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2009.000 ;6
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/19/20()3
Phone: (503) 639 -4171 jib
Inspection Requests (24 Hrs.): (503) 639 -4175 °: _..
INSPECTION WORKSHEET FOR DATE: 2/23 /2009 TIME: 7 :00AM PAGE: 7
SITE ADDRESS: 1:125 SW 10771 -1 AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: MEizrz 'r'r
DESCRIPTION: (5) branch circuits
OWNER: MERRITT, KAREN PHONE #:
CONTRACTOR: WL:t3ER ELECTRIC INC _ VY\/4 , PHONE #: ?:03-620.190G
Inspection Request Scheduled For: Date: 2123!2009 Pour Time:
• • - Description Confirm- Contact # Message
►q� • . .L
Electrical rough -in 080744 -01 , 503 -•815- 7380 Y
Corrections /Comments /Instructions:
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0 P■ (pect6s) FAN 80x Ic L, K • , N\17
. v.ri l .); 04:‘ R-00m,
z NIA_ PAN L 6 cizsW3 moil" g>- ; Ng`iALL:00 COA-
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5.11•10, tq°v• Cr. Nbi3 LE 1.27
74, PASS ❑ PARTIAL APPROVAL ❑ CANCEL (1 NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G .--- ' me Date: 2- 'pi Phone #: (503) 718- I L