Permit `' ' - j ELECTRICAL PERMIT
,' �� .,. . CITY OF TIGARD
'' COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PERMIT #: ELC2007 - 00710
DATE ISSUED: 10/17/2007
:TIG AR D
PARCEL: 1S133DA-05500
SITE ADDRESS: 12880 SW GLACIER LILY CIR ZONING: R -7
SUBDIVISION: AMART SUMMERLAKE LOT : 077 JURISDICTION: TIG
PROJECT: LUTZ
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:
LUTZ, ARTHUR A + CAROL ANN LIGHTHOUSE ELECTRIC LLC
12880 SW GLACIER LILY CIRCLE 27750 SW 95TH AVE # 109
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 330 - 0654 Contact #: PRI 503- 582 -9600
FAX 503 - 582 -8484
FEES
Description Date Amount Reg #: ELE 3 -562C
IELPRMTI ELC Permit 10/17/200' $73.45 LIC 154897
[TAX] 8% State Surcharge 10/17/200' $5.88 SUP 3051S
Total $79.33 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 throe•,;• •AR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
ife
Issued By: ', . / /,,.._.; m �/ Permittee Signature: o p'
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.
19=17/2007 10:53 5035828484 PAGE 01/01
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�° City of Tigard
, Receives
t" ,, ; Pem+itNo �
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13125 SW Hall Blvd Tigard �� .e Plan Rcvicw
t p >. ! OR 9 .72" r Other Permit!
.� Phone: 503.639.4171 Fa03� 9 60 DalolBy:
i t I Line: 503.639. � o • ,i ' • pato Ready /By: .wrh,r m See Page 2 for
T rC n l , r s 7 } t' Q� Nnl.lfied /Method: Su pp l emen t a l I
Internet: www.tigtu'd- or•g0.
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Please check all that ripply (submit/ sots of plans w /items checked below):
❑ 1v�'lt+ ¢ot s1:1�e n 2] Addition/a.ltr.- ration /replaceltie�tg
r� f n : ' p` 0 Service or feeder 400 amps or more ❑ Building over three stories.
%�� . 011 . ❑ Ol:her: D , S d — a where the available fault current ID Marinas and boatyard.
'. I{ j ; '^ a : s . . L. l {11e i' 1' . 1 ': iV' 1 '.” ,:: Y n ` i , .', lift ; I 1, 1'ira'IE i 1 !i exceeds 10.000 amps at 150 volts or El Floating buil(linw,
�( .atoll(''” I €�Ilir l�, l,l�li ill lrei ; ,, >I :6, 1 ;” I,� €i pi , Il. �,'4 1��, lI 1 I I� I� I I €ii;i ii
' lass to ground, or exceeds 14,000 Q Commercial -Use ngriellltlml
® 1- and 2- family dwelling ❑ CorOtWa Industrial El Accessory building amps for illl other inninllnt:iorcl, huildings.
❑Multi- family ❑ Master builder El Other: 0 Fac pump. ❑ installation of75KVAor
+ s '.1 I i i li U�' I f r y r : r } "e y � j, }� :i4iN( 1 11 {i 'f Iii i') r i' ;∎i ( {t ,; ¢ p El Emergency system !MITT separately derived system. Ili r i,V . li,k 1, l{!'tt , il{ 1!r illu , ilN
, li�, ,! �A� 1 I ) t l l !?4 ',> 1 3 }��� . Nil rl,f )I S {FI r'). i {,: 11, if i{ Ad dition of now motor load of el
r11,91r jl.ili�¢r�14,111) i4 -) ( +d -cc ( z a< S A.. w p,,,bra,,,A•I', ,..rd,��,n4 „ y :ip. .p ,,qp T i , rv,rah, 11 11 ~ 1 1 1 ' 1 0,1:I 1 ,id, ;I), ,�„I0 ' i i ❑ ❑
Job no.: 7164 Job site address: 12880 SW GLACIER LILY CIRCLE u) Orrr or mare, occupancy,
❑ Six or more residential units, ❑ Recreational vehicle parks.
City /State/ZTP: TIGARD, OREGON ❑ Honith -caro facilities. ❑ Supply voltage for more than
. ❑ Hazardous locations. 600 volt nominal.
Suitc/bidg. /apt, no.: I .Project name: ❑ Service or feeder 600 amps or amts.
{ S 6 ,I I{ )f {y 5 `i S yyFFff iyt' ii 1' yy r y� S} �(�> fy � J I Il> { F l I'IE
Iii fl,slii:iNtli ff [(11U III S¢llliii { AZ: I 1} 0 ir! 4Ei 1f�322 (`r+yl�ci3 #rr! 1 ?illy ∎% /1 q it
Cross street /directions to job trite: naserpi tam 1 Qty Fee. I Toms I •
' New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 ,000 sq• R. or less 145.15 4
. . Ea. add' 1 500 sq, 11. or portion 33,40 1
Tax map/parcel no.:
Limited energy, residential
S 7S, 0
.'� „�,:.1 j . r .r { ., Il . }, ,} .1, }.1.1 u.j %.I,r, }...r ill cit�� ,i} r � , II� { gtr p;,f;' } �`T If j {� {11(i }'i "115 Ci e tl
i,l'i ;1(1 §;11 ~,I {1si�';fiEl� t�tl � {(li {S ?; hilt {ISlii��iAgt00#' ! I „I �S:{i� ,lil� € 1 1�fI�iC�rlli� 3;i(liti;;�(4i fl,f�l1i1; #ES #i ( with above act ft.)
Limited energy, multi - family 75.00 2
KiTCHEN REMODEL residential (with above gy, I1.)
Services or feeders Installation, alteration, and /or relocation
_ 200 amps or leas 80.30 2
`i 2 I 6 it 1 , I . '9141.`q
d1'i ; rt I t i i i FO r 1'r {. y {'
3i fI 1 , { i i '�i tli 1 1 l>�S hill Y i ,IC h f r 1 �I I l I II'rS' ; 'I on l 3 ? �il� # `I 1 ' I` 1 # I seIII ,l I i S� 11 201 amps to 400 amps , 106.85 2 •
/ f 401 amps to 600 amps 100.60 2 • N. [�I' (/1� q���A / / /Li. 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; (ldy) 2, _ a 1., 5 I Fax: ( ) 200 amps or less 66.85 l
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100 2 _
intended for sale, icasc, rent, or exchange, according to ORS 447, 449, 6'70, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new alteration, or extension "er "and
Owner signature: __ �y � y , , y Date: y;y y��� A. Fee for branch circuits with
y ': P ” i�ti{ ' "j 1 ;1' �y;�' r`, i i tf ;f> }IIiI'iSI!S } '''(fl', (i ; )) I i �ijtl11 ;�1' Y ' ii :UU/1�Ii 9J' 4f ,l i })l t {{ * ti(F l{I l l{, Ii�I'j} above service or feeder 'fee,
6.65 2
��;��i: it "Il }! S 311 I lG ;li1 , r +Il ; #;j I,.S ? I s 1 11�!?Ili,r �' �� I I " �l
(( ILL ,ti l lr, �' Il fill ..,, ,,,,,,,i h,,,;,,,«,,;,, .: :,•,,,a, j +i „c.
� � V I �� A each branch circuit
13usinest3 name: B. Fcc for branch circuits
without service or feeder l'ee, 1 46.85 4(1 2
Contact name: first branch circuit
Address: Each add'I branch circuit 4 6,65 26,60 2
Miscellaneous (service or feeder not included)
City /State /Z1P: Each manufactured or modular I 90.90 2
dwelling, scrvicc and /or feeder
Phone: ( ) - I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
as :, . -,:,,, :�� ' '{ I , y ,: -p . ; :,.,:,� a .,:� l . .. ...... .. ..... 1 �,,, �,i, ; ; ;, ; , '! 4'''I %'(y'h ^' ;' ;sS ;d,N¢yr ;,tl ;`�f „$'4i r,' ;i I}c,T ; i Sign or outline righting 53.40 2
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I ai,la:. .11}511 f'q ; - }1.1y i; t 4fV/: ,; II- /;�Wr {ri,'�1:k ;�,lu.ahnl �`., {iE� „ ?lIC�1.J�. �rII, ., i: :iS.. „I!r�isi�il: i },6.
Business name: LIGHTHOUSE. ELECTRIC LLC Signal circuit(s) el er to. limited-
energy panel, alteration, or
Address: 27750 SW 95` AVE, SUITE 109 extension, Describe: Page 2 2
City /State/ZiP: WILSONVILLE, OREGON 97070 Ench additional inspection over allowa In nnv_of the nbovc
Per inspection 62.50
Phone: (503) 582.9600 I Fax: (503) 582.8484 Investigation per how' (1 hr min) 62.50
CCI3 L.ic,: 154897 I Electric, •.: 3-562C uprv. Lic.: 30515 Industrial plant herhour 73.75
F” TYu` ijG #'1ICid:`I'E1VI.1I? ;;.'.,,,,
Suprv, Electrician signature, required ' L>/ /r/ I ' I +� Subtotal: 73.45
— Plan review (25% of permit fee):
Print name: RANDY KILL , Date: 10.17
State surcharge (8% or permit lee); 5.88
Authorized signature: TOTAL PERMIT FEE: 79.33
- -- This 0011111 :111pIiettii(n ex Hirt”, if a permit is not ohtnincrl within 1811
Print flume: Date, clays after' it has heen accepted :1x complete.
—
' Number nl' inspections allowed per permit.
{:'. I1uiidin4.I'0rmit:a.fl1.('.PcnniiApp.dnc 05 -.I ft 94114(.I5'r(I lal.'( C)M•WEK
•
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: CLC2007.00710
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/17 /2Q07
Phone: (503) 639-4171 ;dI
Inspection Requests (24 Hrs.): (503) 639 -4175 �I
..-__
INSPECTION WORKSHEET FOR DATE: 10/19/2007 TIME: 7:01AM PAGE: 40
SITE ADDRESS: 12880 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: AMART SUNMMERLAKE LOT #: 077 TYPE OF USE:
PROJECT NAME: LUTZ
DESCRIPTION: 5 branch circuits.
OWNER: LUTZ, ARTHUR A + CAROL ANN, PHONE #: 543.330.0654
CONTRACTOR: LIGHTHOUSE ELECTRIC LLC PHONE #: 503. 583 -96Q0
Inspection Request Scheduled For: Date: 10/19/2007 Pour Time:
Code # Inspection Description Co ' # Contact # Message
120 Electiical rough -in •7934 -02 503-582-9600 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL fl NO ACCESS
❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: , (Kt (3 L' Date: 10111,(0 Phone #: (503) 718- .6t1419
CITY OF TIGARD
BUILDING DIVISION PERMIT #: L 2007 0 710
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 10/11/2007
Phone: (503) 639-4171 'I ;
Inspection Requests (24 Hrs.): (503) 639 -4175 1 �..
INSPECTION WORKSHEET FOR DATE: 10/19/2007 TIME: 7 :01Am PAGE: 41
SITE ADDRESS: 12880 SW GLACIER LILY CIR CLASS OF WORK:
SUBDIVISION: AMAUT SUMMI F <LAKE LOT #: 077 TYPE OF USE:
PROJECT NAME: LUTZ
DESCRIPTION: f=, branch circuits,
OWNER: LUTZ, ARTHUR A + CAROL ANN, PHONE #: 503.330-0654
CONTRACTOR: LIGHTHOUSE ELECTRIC LLC PHONE #: 503.582 -9600
Inspection Request Scheduled For: Date: - iQ/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical seivice '7 1 503582 -9600 N
Corrections /Comments/ Instructions:
NO 5 V\(k, Vez-vAil
•
1 1 PASS ❑ PARTIAL APPROVAL XCANCEL n NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: CM ---- ■ 1 CSG1 LE- Date: Vr) (q Phone #: (503) 718 - l'I.1%
\ 1 1.401011
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