Permit A�r �
ELECTRICAL PERMIT
CITY OF TIGA ® D PERMIT #: ELC2007 00184
COMMUNITY DEVELOPMENT
D ATE ISSUED: 3/27/2007
T G 13125 SW Hall Blvd., Tigard, 97223 503.639.4171
PARCEL: 2S103BB -00900
SITE ADDRESS: 12515 SW 124TH AVE ZONING: R -4.5
SUBDIVISION: BROOKWAY LOT : 009 JURISDICTION: TIG
PROJECT: HOLCOMB
Project Description: Feeder and 5 branch circuits.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 1 W /SERVICE OR FEEDER: 5 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
FREDERIC P. HOLCOMB OWNER
12515 SW 124TH AVE
TIGARD, OR 97223
Phone: 503 - 524 -8985 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 3/27/2007 $113.55
[TAX] 8% State Surcharge 3/27/2007 $9.08
Total $122.63 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 -nt •r. 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 OUN .t 51 .246.6699 or 1.800.33, 4.
Issued By: • /' � Permittee Signature: Ft4
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. ELECN: 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.
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11 Permit Application ft' V, +1 `'t ., , w w r FO OFFICE USE ONLY *,i4 �i i + r al " , q
a "� ,. u � fl _ ;^s , .,, :,_, . „1:/ M'.r i /LO s.�. )kie Sh O . r,i� n`l� 't a ■ i,1 ' , -o 4flinm'
' � ; ; : City of Tigard ` Date a /I� Permit No Lapb7 -- d0 /�`�
t , `` 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revi w
V P LI .li Phone: 503.639.4171 Fax: 503.59IM '.0 2 7 2007 Date/By: Other Permit:
Inspection Line: 503.639.4175 Date Read /B iu ris:
T I C�A�RD P Ready /By: ® See Page 2 for
N4 itIIat'IN.' !. Internet: www.tigard or.gov CITY OF •j ° -. 3AF D Notified/Method: Supplemental Information
TYPE 0 -GA i etx Gtwic7iO s� .
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
® 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,'
ID Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 2 ", "I - ",
Job no.: Job site address: j aj I S S.W. 12_4 L A .,'E N E 100HP or more. occupancy.
l.( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 'T 0 A2D • V Pc 9 ?223 ❑ 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: 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 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
`ge'L -AC EMEWT' OF Awwnr uOi W IR.Ii.16. Abbrnc .i DP residential (with above sq. ft.)
Services or feeders installation, alteration, and/or location
SUE: ANO L L. i NSTALLATiOiti 01= NEW Ci RGU iTS 200 amps or less 1 80.30 zw. 2
, Ig PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: PR.EbE 121 CK 17. O LC�M 6 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 12.j i5 S� 12_4 AV Iue- Over 1,000 amps or volts 454.65 2
Temporary City/State /ZIP: f 11 ) A 1, t u(. 9 2 23 relocation
or feeders installation, alteration, and/or
Phone: (SUS) 52 A -`5915S Fax: ( ) 200 amps or less 66.85 1
Owner installation: This ' al tion is being made e ' • ope that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, leas ent exch , cc rt i • / • RS ,• 7, 449, 670, and 701. _ 401 amps to 599 amps 133.75 2
27 /Lip O f Branch circuits — new, alteration, or extension, ter panel
Owner signat / i Date S�"7` l
A. Fee for branch circuits with I
❑ APPLICANT ❑, CONTACT _ :: PERSON;" _ above service or feeder fee,
each branch circuit 6.65 t3 a5 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 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
Signal circuit(s) or limited-
Business name: 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: 1/3 5 5
Print name: Date:. Plan review (25% of permit fee):
State surcharge (8% of permit fee): 9
Authorized signature: TOTAL PERMIT FEE: L .6,
This permit application expires if a permit is not obtained within 1 0
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC- Permit App. doc 05/23/06 440- 4615T(l l /05 /COM/VEB
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- 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
n Outdoor Landscape Lighting*
❑ Protective Signaling
❑ 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 PERMIT #: ELC2007-00184
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/27/2007
Phone: (503) 639 -4171 ('
Inspection Requests (24 Hrs.): (503) 639 -4175 "' .
INSPECTION WORKSHEET FOR DATE: 8/24/2007 TIME: 7:OOAM PAGE: 54
SITE ADDRESS: 12515 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 009 TYPE OF USE:
PROJECT NAME: HOLCOMB
DESCRIPTION: Feeder and 5 branch circuits.
OWNER: HOLCOMB, FREDERIC PHONE #: 503. 5248985
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/24/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
130 Ceiling cover 054595 -01 503 -524 -8985 N
Corrections /Comments/ Instructions:
•
► ' SS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Date: J, E--- v.- Phone #: (503) 718-
CIT ■ OFTIGARD
{
BUILDING DIVISION PERMIT #: ELC2007 -00184
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/2712007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175 t'�_�i
INSPECTION WORKSHEET FOR DATE: 7/31/2007 TIME: 7:07AM PAGE: 29
SITE ADDRESS: 12515 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 009 TYPE OF USE:
PROJECT NAME: HOLCOMB
DESCRIPTION: Feeder and 5 branch circuits.
OWNER: HOLCOMB, FREDERIC PHONE #: 503.524-9985
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/31/2007 Pour Time:
1
Code # Inspection Description 1 C rm' #� Contact # Message
125 Wall cover 053091 -01 503 - 5248985 N
Corrections /Comments /Instructions:
j- LAN/el 3 LA/ALL ZmtaIL
\sl•ke(461
X PASS 1 PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL 1 1 CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: CY QV LL Date: 441111/1 Phone #: (503) 718- L
CITY OF TIGARD .
BUILDING DIVISION - PERMIT #: ELC2007 -001B4
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/27/2007
Phone: (503) 639 -4171 4 u' I
Inspection Requests (24 Hrs.): (503)'639 -4175 ,,..
INSPECTION WORKSHEET FOR DATE: 4/612007 TIME: 7:04AM PAGE: 55
SITE ADDRESS: 12615 SW 124TH AVE CLASS OF WORK:
SUBDIVISION: BROOKWAY LOT #: 009 TYPE OF USE:
PROJECT NAME: HOLCOMB
DESCRIPTION: Feeder and 5 branch circuits.
OWNER: HOLCOMB, FREDERIC PHONE #: 503 -524 -8085
CONTRACTOR: OWNER 6C �` 1).\-' PHONE #:
Inspection Request Scheduled For: Date: 4/6/2007 Pour Time:
Code # Inspection. Description Confirm # Contact # • Message
108 Electric:al final 046067 -02 503- 620 -5643 h!
Corrections /Comments /Instructions: •
•
11:12p
PASS ❑ PARTIAL APPROVAL - ❑ CANCEL NO ACCESS
L,FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED .
Inspector: ' N VZ Le Date: L 6 0 Phone #: (503) 718 -1 -1M)