Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 00461
1
-::1 COMMUNITY DEVELOPMENT
D ATE ISSUED: 8/8/2008
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 102AB -00912
SITE ADDRESS: 12125 SW 92ND AVE ZONING: R -7
SUBDIVISION: KIMBERLY ADDITION LOT : 012 JURISDICTION: TIG
PROJECT: LAWSON
Project Description: Installing (1) low voltage stereo and stat system and (3) 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: 1
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: 2 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:
RICK LAWSON OWNER
12125 SW 92ND AVE
TIGARD, OR 97223
Phone: 503 - 968 -9048 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 8/8/2008 $135.15
[TAX] 12% State Surchar 8/8/2008 $16.22
Total $151.37 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 • may o• •. - • •: of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: ,,..-2 � /` Permittee Si • • . — � "� 1_
OWNER INSTALLATION • •
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 a�; % Y .r `3FOR OFFICE�U ONLY x � - sue'= , '
,, may, k .4 ' 4-- v.
is sue: 37�t f�{t k , % ;�3YC4+�� + .s!1�Eaa!"S «� s 7
QQ ,,� l .. Recei G c
r ' Y C of Tigard Ali s Date/By: Sf A �a �f P ermit No.' r / C ) J O i l
• ' ° 13125 SW Hall Blvd., Tigard, O ' 3 �o! Plan Review / rLC I `/
0 Phone: 503.639.4171 Fax: s t ' •.:' Other Permit:
0 DateBy:
il+l C A ' p Inspection Line: 503.639.417 e ` J �' �� C � Date Ready /By: turis: 0 See Page 2 for
:'- Internet: www.tigard- or.gov pw �® Notified/Method: 7 Supplemental Information
TYPE OF WO � ,�� e � � ` ® PLAN REVIEW
❑ New constructio ❑ Addition /alte Al A eB e, Please check all that apply (submit 2 sets of plans w /items checked below):
� f,`�9� ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: tP`p53 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 A
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
Job no.: Job site address: / �/ f� IOOHP or more. occupancy.
1 / 2_ / 2 � ,/, 4.,,. ( 724 ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 77 c / ?/2'L OR 2 Z 3 4Uf, ❑ 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'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
' DESCRIPTION` OF WORK (with above sq. ft.)
/ Limited energy, multi - family 75.00 2
Sy v'1 (3/ >rL�� e -,�, ) residential (with above sq. ft.) -
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ 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 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or - . i . nge, according to ORS 447, 449, 670, a d 7 1. 401 amps to 599 amps 133.75 2
Q Branch circuits - new, alteration, or extension, per panel
Owner signature . gate: 0
V A. Fee for branch circuits with
i • ' PLIC • ' - ❑ CONTACT P ON •' above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, ( 46.85 %'& i ' 2
first branch circuit
Address: Each add'I branch circuit a- 6.65 /3. 30 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:
0 et, /CJ f `< energy panel, alteration, or .-----
Address: extension. Describe: l 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: ( 3S, 1 5-
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): RD
Authorized signature 5 TOTAL PERMIT FEE: (37
This permit application expires if a permit is not obtained within 180
Print name: / G 6050/1 Date: g O g' days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: \Building+Permits\ELC- PermitApp.doc 0523/06 440- 4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
r- RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLYc ,. : - ___1
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
❑ Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n I • nstrumentation
❑ Intercom and Paging Systems
n L • andscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ 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
• Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
1 will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property 1 own, a residence that I reside in or a residence that I will
reside in. If I hire subcontractors, 1 will hire only subcontractors licensed with the Construction
Contractors Board. If 1 change my mind and hire a general contractor, I will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Property Owners about Construction
Responsibilities contained on these two pages and I hereby certify that the information checked and
completed above is correct and accurate.
Ric L- At-
Print name of permit applicant ignatur rmit ap licant
'/g
Date
Permit #: t- L'eok —cr- `{ Co
This form is supplied to building • _
/0 SW - ° 1.
permit offices by the Oregon Or _ l . Address:
Construction Contractors Board F: .,,..
as required by ORS 701.055 (6) /
•
Issued by: • / ' Date:
878 ./or
This copy to issuing permit office
i
CITY OF TIGARD
BUILDING DIVISION A-.." PERMIT #: EL 02008.001( 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 818/2008
Phone: (503) 639 - 4171 f i A.
Inspection Requests (24 Hrs.): (503) 639 -4175 °7 11
INSPECTION WORKSHEET FOR DATE: 8/11/2008 TIME: 7:01AM PAGE: 3
SITE ADDRESS: 12125 SW 92ND AVE CLASS OF WORK
SUBDIVISION: KIMBERLY ADDITION LOT #: 012 TYPE OF USE:
PROJECT NAME: LAWSON
DESCRIPTION: Installing (1) low voltage stereo and scat system and (3) branch circuits.
OWNER: LAWSON, RICK PHONE #: X503-968 -90418
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date 8/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
135 Low voltage 074025-02 503 -968 -9048 N
Corrections /Comments /Instructions:
1
■
`, 'ASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECT! 4 ❑ ADDITIONAL FEES ASSESSED
0
Inspector: 6 -1 0% w — AI Date: %.11. oft Phone #: (503) 718- 1
I
CITY OF TIGARD
BUILDING DIVISION A- ..■ PERMIT #: ELC200i3-00461
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/8/2008
Phone: (503) 639-4171 hxypithati tr.,
Inspection Requests (24 Hrs.): (503) 639-4175 A.61:
INSPECTION WORKSHEET FOR DATE: 8111/2008 TIME: 7:01AM PAGE: 4
SITE ADDRESS: CLASS OF WORK:
12125 SW 92ND AVE
SUBDIVISION: LOT #: TYPE OF USE:
KIMBERLY ADDITION 012
PROJECT NAME: LAWSON
DESCRIPTION: Insianing (1) low voltage stereo and slat system and (3) branch clic:Las.
OWNER: PHONE # 503968_90,18
LAWSON, RICK
CONTRACTOR: PHONE #:
OWNER
Inspection Request Scheduled For: Date: 8/11/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 074025-01 503-968-9048 N
Corrections/Comments/Instructions:
PASS 0 PARTIAL APPROVAL 0 CANCEL El NO ACCESS
7 AIL El CALL FOR INSPEC • v 0 ADDITIONAL FEES ASSESSED
0
41/
Inspector: Cr 006 1.-12 f Date: e t 'It ' Phone #: (503) 718-1
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