Permit CITY OF TIGARD ELECTRICAL PERMIT
I 2 . COMMUNITY DEVELOPMENT PERMIT #: ELC2008 -00487
DATE ISSUED: 8/25/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103 B C -02500
SITE ADDRESS: 12355 SW ALBERTA AVE ZONING: R -4.5
SUBDIVISION: CANOGA PARK LOT : 009 JURISDICTION: TIG
PROJECT: KELLEY
Project Description: Changeout 200 amp panel, add 200 amp subpanel & (2) branch circuits. Work being done in phases.
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: 2 W /SERVICE OR FEEDER: 2 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:
DANIEL & MELODIE KELLY OWNER
12355 SW ALBERTA ST
TIGARD, OR 97223
Phone: 503 - 579 -5446 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 8/25/2008 $173.90
[TAX] 12% State Surchar 8/25/2008 $20.87
Total $194.77 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- -0010 t • • e' - 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 y: - /� // ie Permittee Signature: /4
OWNER INSTALLATION ONLY
Th e installation is being made on grope Y own which is not intended for sale, Ease, ., rent.
p
OWNER'S SIGNATURE: / x V G DATE: D 5 O '
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 .; FOR OFFICE USE ONLY
I City of Tigard Date /B �� 7. / Permit No.: E( C g y.
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Pho ne: 503.639.4171 Fax: 503.598.1960 Dat /By: Other Permit
'
TI GAR D Inspection Line: 503.639.4175 Date Ready /By: Juri_ ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: / ( Supplemental Information
TYPE: OF, WORK '. PLAN_REVIER ``-
Please check all that apply (submit 2 sets of plans w/iterns checked below).
❑ New construction E. Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
C ATEGORY_ OF CO ' - - exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
J 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
- ❑ Emergency system. larger separately derived system.
' ' JOB SITE INFORMATION AND. "LOCATION m , ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: (23S"i 100HP or more. occupancy.
r i $ w. /1C�E�I CI:'
❑Six or more residential units. Recreational ❑ ecreational vehicle parks.
City /State /ZIP: ;, ,� ❑ Health -care facilities. ❑
600 y volts Doane for more than
/ap /
❑ Hazardous locations.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
- F EE` SCH - - -
u _
Cross street /directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
12 f ' 4- ite, j.tr 6x 9 r 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 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
a J /9,44, f25 /I $$.4 f 14 ('� ?O � pay ----I residential (with above sq. ft.)
✓ Services or feeders installation, al ration, and/or relocation
(4;(7 0 /(.P V 'rr 2LV l-, h'i 200 amps or less 80.30 /664./e0 2
t•PROPERTY .OWNER. : , , . r, r� D. TENANT ` 201 amps to 400 amps 106.85 2
n 401 amps to 600 amps 160.60 2
Name: ca. c / c=; Kyle_ t a r . tc.11 601 amps to 1,000 amps 240.60 2
Address: j(5 9c4 ,49)bertz. 5 f. Over 1,000 amps or volts 454.65 2
City /State /ZIP: �/ 0 ?-7227 Temporary services or feeders installation, alteration, and /or
S 1 relocation
Phone: (so3 ) 51? ' y 6 - 9'r ) S 10- i e . 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
. intended for sale, 1 se, rent, or excha ge, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
8 ` 24 / 0q Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: ( A. Fee for branch circuits with 2�
- ❑ APPLICANT ,' - la CONTACT PERSON , .. above service or feeder fee, 2 6.65 /5.56 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add] 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 Lie.: Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
E
.. LECTRICAL PERMITr,FEES. _r
Suprv. Electrician signature, required: _ Subtotal: l 73 •
Print name: Date: Plan review (25% of permit fee): —
State surcharge (12% of permit fee): 0 9, 0 ..8 -7
Authorized signature: TOTAL PERMIT FEE: / 9411. 7 7
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I'\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T(t t /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
FOsiDENT,IAL WORK ONLYi, ;t ._
Fee for all residential systems combined $75.00
Check Type of Work Involved:
Fl Audio and Stereo Systems*
O Burglar Alarm
O Garage Door Opener*
Pi Heating, Ventilation and Air Conditioning System*
Vacuum Systems*
n Other:
r COMMERCIAL v omoNLYc fiy,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
• Audio and Stereo Systems
O Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
• HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
O Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
O Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I \Budding\Permos\ELC- PermitApp doe 03/23/06
CITY OF TIGARD W
4 q. tei A
BUILDING DIVISION . -d or PERMIT #: ELC2008 -00487
13125 SW Hall Blvd., Tigard, OR 97223 _ DATE ISSUED: 8125/2008
Phone: (503) 639 -4171 ` ,
Inspection Requests (24 Hrs.): (503) 639 -4175 .. `, I L.
INSPECTION WORKSHEET FOR DATE: 8/27/2008 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 12355 SW ALBERTA AVE CLASS OF WORK:
SUBDIVISION: CANOGA PARK LOT #: 009 TYPE OF USE:
PROJECT NAME: KELLEY
DESCRIPTION: Changeout 200 amp panel, add 200 amp subpanel & (2) branch circuits. Wotk being done in phases.
OWNER: KELLY, DANIEL & MELODIE PHONE #: 5035795446
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 8/27/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message ,
115 Electrical sorvice 074690 - 971- 570.4967 Y ' w`4"^ i 1 WI MIS
Wit t o v,
Corrections /Comments/ Instructions:
•
y i ) PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
p Ins ector: Date: i 0 Phone #: (503) 718 - qq°