Permit A. .
CITY OF TIGARD ELECTRICAL PERMIT
Il
PERMIT #: ELC2007-00257
COMMUNITY DEVELOPMENT DATE ISSUED: 4/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103BA -00116
SITE ADDRESS: 11705 SW ANN ST ZONING: R - 4.5
SUBDIVISION: LERON HEIGHTS LOT : 016 JURISDICTION: TIG
PROJECT: ERWERT
Project Description: 15 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: 14 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:
ERWERT, ROBERT E TRUSTEE OWNER
11705 SW ANN ST
TIGARD, OR 97223
Phone: 503 - 590 -5966 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/20/2007 $139.95
[TAX] 8% State Surcharge 4/20/2007 $11.20
Total $151.15 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 • - at 503.246.6699 or 1.800.332.2344.
Issued By: Alkf / , A / Permittee Signature: : / _ `41
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.
b T 'f, s 'WIZ t i o Y n ' .,
Electrical Permit Application h n +
FOOIE S.kiPhL 4 • _ a 4 '� _ _ l . � ..i' ` R ., "r FF ., � C h u e�4r "' 1 4 - r s, "' .. " a
City of Tigard pErEl Date y 0 7 Permit No.EL _ 007 e, ' " 13125 SW Hall Blvd., Tiga, k 'q Plan Review /
•.:, ®,f'" Phone: 503.639.4171 Fax: 503.598.1960 Date/By Other Permit:
• t Inspection Line: 503.639.4175 Date Ready/By: 1uris: ® See Page 2 for
T4G'AK Internet: www.tigard - or.gov APR Z 0 LUU Notified/Method: Supplemental Information
: . :.. E � O • PLAN REVIEW
�i e pi p{
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Additi a
�' „! V 1 9 q B�
El Demolition ❑ Othe , ❑ Service or feeder 400 amps or more El Building over three stories.
where the available fault current ❑ Marinas and boatyards.
- - ' r CATEGORY OF CON
ONSTRUCTION - ' exceeds 10,000 amps at 150 volts or 0 Floating buildings.
,/ 1 -and 2-family dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I y g ❑ 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.
❑ Addition of new motor load of ❑ "A ", `T ", "1 -2 ", "1 -3 ",
/ /� 100HP or more. occupancy.
Job no.: Job site address:
! /�0 c - .... /..ii ,9t✓N 5-9 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ri /^ /17 I o f ��' 3 -- / > L 13 Health-care facilities. ❑ Supply voltage for more than
[ 9 / � i ` c I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. tlo.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to ob site:
J Description I Qty. 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: �,
: Limited energy, residential 75.00 2
, - :..- ' ...:.::;.: i;.. D TION'OF
. : ; . - ESCRIP . ,WORK :. ..:.,.. - _.:'; •: ; • . , : • , . _>:. ,::` :.' : (with above sq. ft)
H Limited energy, multi- family
/t ./P--kA (I ' / C H C l / ' 0 I �5 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
. .. , :PROPERTY" -OWNER. `..' -- . , . . 0, TENANT 201 amps to 400 amps 106.85 2
Name: la ,6, fe ( 2 cc) �2 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: / / / 7 0 s , t� , f9IVN i . % Over 1,000 amps or volts 454.65 2
City/State /ZIP: 77 92 1 / 02 �� x 3 _0 i � L}-- Temporary services or feeders installation, alteration, and /or
/ relocation
Phone: (i l CtO - -g16,e Fax: ( ) 200 amps or less 66.85 1
Owner installation: "' 's installation is being made on • operty that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, 1.1 / , or -,, h. • = - . c• ding to RS 447, 449, 670, • d 01. 401 amps to 599 amps 133.75 • 2
Owner signature: i • Date: 7 — alteration, or extension, per p
Branch circuits new, alterati n o n er nel a
A. Fee for branch circuits with
❑ ' APPL y. ". " : ; : ` 4. '. :: : ' , 4 ;{ , ::❑-: CONTACT PERSON. " ::. 'r' ". above service or feeder fee,.
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee r
Contact name: first branch circuit / 46.85 �6 a 2
Address: Each add'l branch circuit ! 6.65 9,3,/a 2
Miscellaneous (service or feeder no included)
City/State/ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) 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: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable In any of the above
Phone: ( ) Fax: Per inspection 62.50
( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lie.: . Industrial plant per hour 73.75
ELECTRICAL PERMIT. FEES ' s - •
Suprv. Electrician signature, required: Subtotal: / 3c C/
Print name: Am I Plan review (25% of permit fee):
i. - Date: , State surcharge (8% of permit fee): ,J, 2j7
Authorized signature: 7 �; , , TOTAL PERMIT FEE: /5/ • /
This permit application expires if a permit is not obtained within 180
Print name:
06 7 E'. A-� � i Date: �/ 0/07 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440-4615 T(I I/05/C OM/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*
El Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
El 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
El Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
El HVAC
El Instrumentation •
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
p Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
•
I:\ Euildin0ennits \ELC- PermitApp.doc 03/23/06
CITY* OFTIGA■■D
BUILDING DIVISION PERMIT #: ELC2007 -00257
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/20/2007
Phone: (503) 639 -4171 :alit
Inspection Requests (24 Hrs.): (503) 639 -4175 ... .
INSPECTION WORKSHEET FOR DATE: 4/26/2007 TIME: 7:00A14M PAGE: 70
SITE ADDRESS: 11705 SW ANN ST CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS - LOT #: 016 TYPE OF USE:
PROJECT NAME: ERWERT
DESCRIPTION: 15 branch circuits. •
OWNER: ERWERT, ROBERT E TRUSTEE, PHONE #: 503690-6966
CONTRACTOR: OWNER ■ W 114 006 PHONE #:
i
Inspection Request Scheduled For: Date: 4/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
+99- "Mtritel-tioalie 047155 -01 503. 590.5966 , _ -Y
J 20 (Lo .)°ilk -' ►N
Corrections /Comments /Instructions:
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\ -..\-, , ,„,; - _, • L fl CANCEL ❑ NO ACCESS
❑ FA ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: , N r)(34= Date: 2 T) Phone #: (503) 718- 1-1b