Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00483
COMMUNITY DEVELOPMENT DATE ISSUED: 8/21/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S133DC-14700
SITE ADDRESS: 13269 SW TAMERA LN ZONING: R -
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK LOT : 002 JURISDICTION: TIG
PROJECT: PEDERSON
Project Description: Installing (3) branch circuits for heat pump, furnace and GFI outlet.
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: SIGNAUPANEL:
MANF HM/ SVCI 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: SVCIFDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
RICHARD & FLORENCE PEDERSON WEST SIDE ELECTRIC CO INC
13269 SW TAMERA LANE 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 771 -7871 Contact #: FAX 503 - 231 -9987
PRI 503 - 231 -1548
FEES
Description Date Amount Reg #: ELE 26 -135c
[ELPRMT] ELC Permit 8/20/2008 $60.15 LIC 13306
[TAX] 12% State Surchar 8/20/2008 $7.22 SUP 4654S
Total $67.37 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. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
•
Issued By: Permittee Signature: �� r AP
i �
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.
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Permit Application ,t =, y , �t ", u
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i City of T D,tcn3y Pen „i1 No..
13125 SW } tall Blvd.. Tigard, OR 97223 Plan Review Y �. ` 2 ' . :. , Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I ` ''! "'' ' Inspection Line: 503.639.4175 AU 6 2 4 2 008
GARD; Date Ready/13y: �"'S. a sec Page 2 for
r:aaa:nr > ;a ;raa Internet: ,vww.tigard- or.gov Noti hcd/Method: / .0 Supplemental information
TYPE OF rvo
CITY OrTI('iARD New PLAN REVIEW
1 cw construction ddition /alter l g Please check all that apply (submit 2 sets of plans ��� /items checked helms.): �AIG DIVISION cement
❑ Service or feeder 400 amps or more ❑ 13uilding over three stories.
❑ Demolition El 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 El 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 ❑ " V "L "' "I _'',• "I 3"
: "±':
Job no.: Job site address: occupancy.
S �] Z � _ r !i'aa . ) ° + % j - Cr SG .J f � W -� J,,, . ❑ Sitox otu' or more.
or more residential units. 0 Recreational vehicle parks.
City /Stale /ZIP: ---r, � (.. - 7 ^ t ❑ Health -care facilities. ❑ Supply voltage for more Than
r,. 1 e- ■ -4 7 ❑ Hazardous locations. 600 volts nominal.
� _ S Suite /bldg. /apt. no.: 1 Project name_ ( ❑ Service or !ceder 600 amps or more.
c� Sr' 1 r / `� FEE SCHEDULE
Cross street/directions to job site: Description 1 Qts. I Fee. l Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. 0. or less 145.15 4
Ea. add'I 500 sq. 0. or portion 33.40 1
Tax trap /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
/ �
r---- Limited energy. multi - family 75.00
/�-Q c 2 S' 2 -- ` � "L4 r.i . !, L Le . 4 C� el F e- A ( 1,( * residential (with above sq. fl.)
Services or feeders installation, alteration, and /or relocation
-- 200 amps or less 80.30 2
l PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: `v1, (\-/L. ( C to 401 amps to 600 amps ! 60.60 2
t ? - Ci- 601 amps to 1,000 amps 240.60 2
Address: 1 T (-> G ( f C - r,t vi/ , 4 Lt Over 1,000 amps or volts 454.65 2
City /State /ZIP: ' r c_ „j - _ O/—� Z / -, Temporary services or feeders installation, alteration, and /or
r relocation
Phone: (50 >) S .?,/,._ 4 , L.) S Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 am ps 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
I _ I
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, tt (� C
Contact manic: t 46.85 (� !, 7
first branch circuit
Address: Each add'I branch circuit 7 6.65 t - 5. ) t? 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
90.90
Phone:
dwelling, service and /or feeder
( ) Fax:: ( )
Reconnect only 66.85 2
E - mail: GLENNG@WESTSIDEELECTRIC.COM Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: WEST SIDE ELECTRIC CO. Signal circuit(s) or limited-
energy panel, alteration, or
Address: 1834 SE 8111 AVE. extension. Describe: Page 2 2
City /Stale /ZIP: PORTLAND, OR 97214 Each additional inspection over allowable in anv of the above
Per inspection 62.50
Phone: (503) 231 -1548 Fax: (503) 231 - 9987 Investigation per hour (I hr min) 62.50
CCB Lic.: 13306 Electrical Lic.: 26 - 135C Suprv. Lic.: 4654S Industrial plant per hour 73.75
ELECTRICAL PERIMII'F FEES
Suprv. Electrician signature, required: Subtotal: / t 1,,
Print name: RANDALL ROBERTS Date: Q / o A Plan review (25% of permit fee):
/� + / 1 O State surcharge (12 %, of permit fee): "7 , z 2
Authorized signature: - "�, {,{ ��; '6// , », /f ,�� TOTAL PERMIT FEE: (
., - 3 '7 .
Ls 111111
. This permit application expires if a permit is not obi:1;n within 180
Print I Ill! name: Date: day's after it has been accepted as complete.
• Number of inspections allowed per permit.
1 : tiu/ Iung\l'enui :s\ El.C•I'cnnitApp.doc 05/23101, 440-1615T( I /WED
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: ELC2008 00483
DATE ISSUED: 8/21/2008
T 1 c A D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
P
•
ARCEL: 1S133DC-14700
SITE ADDRESS: 13269 SW TAMERA LN ZONING: R -12
•
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK LOT : 002 JURISDICTION: TIG
PROJECT: PEDERSON
Project Description: Installing (3) branch circuits for heat pump, furnace and GFI outlet.
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/ SVCI 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:
RICHARD & FLORENCE PEDERSON • WEST SIDE ELECTRIC CO INC
13269 SW TAMERA LANE 1834 SE 8TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 771 -7871 Contact #: FAX 503 - 231 -9987
PRI 503- 231 -1548
FEES
Description Date Amount Reg #: ELE 26 - 135c
[ELPRMT) ELC Permit 8/20/2008 $60.15 LIC 13306
[TAX] 12% State Surchar 8/20/2008 $7.22 SUP 4654S
Total $67.37 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. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: /� f ...•111, ...•111, Permittee Signature: � - l
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.
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: c 8? c oys3 REQUIRED ON GREEN INSPECTION CARD.
1 ✓ • Code I Inspection Description PASS Date By ✓ Code Inspection Description PASS Date By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing 120 Electrical rough -in
•
805 MFG- Structure grading /footing 125 Wall cover
210 Foundation walls 130 _ Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain • 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors ,)( 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG - Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 • Drywall nailing 610 Gas line
287 Suspended ceiling • 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG - Structure final 625 Duct work
498 Grading final 630 Fire damper
299 Final inspection 635 Smoke detector shutdown
640 Exhaust hood
695 Misc. inspection:
699 Mechanical final
BUP - Fire Protection System Permit
905 Sprinkler underfloor /slab
910 Sprinkler rough -in PLM - Plumbing Permit
915 Fire alarm rough -in 305 Plumbing underslab
920 Suppression trip test 310 Crawl drain
995 Misc. inspection: 315 Post /beam plumbing
• 998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain,
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin .
410 Fill 350 Septic tank
415 Grading • 395 Misc. inspection:
205 Footing _ 399 Plumbing final
210 Foundation walls
215 Footing drain
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
L 499 Final inspection 599 Final inspection
I: \Building \Forms \InspCard- AOP- Blank.doc 02/02/07