Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT DATE PERMIT ISSUED: #: E 10 1- / C2008 10/2008 00581
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 DC - 00100
SITE ADDRESS: 15580 SW ALDERBROOK CIR ZONING: R -
SUBDIVISION: SUMMERFIELD NO.8 LOT : 448 JURISDICTION: TIG
PROJECT: ILG
Project Description: Panel change and (6) 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 HMI SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: 1 W /SERVICE OR FEEDER: 6 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:
MIKE ILG CAMERON THOMAS LLC
15580 SW ALDERBROOK CIR P.O. BOX 5324
TIGARD, OR 97224 ALOHA, OR 97006
Phone: 503 - 704 -0049 Contact #: PRI 503- 704 -0049
FAX 503 - 638 -0938
FEES
Description Date Amount Reg #: ELE 34 -526C
[ELPRMT] ELC Permit 10/10/2001 $120.20 LIC 138773
[TAX] 12% State Surchar 10/10/2001 $14.42 SUP 4633S
Total $134.62 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 w' • - • • :. accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
mor: han 180 days. :TTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Cent . Those rules are set forth in
OA r' 952 - 001 -0010 throb,: OA' • - - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 51 .246.6699 or 1.800.332.2344.
Issu • By: . 44 .l ■li ,/i Permittee Signature: `//
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:
/
CO•'T"A TOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: AT DATE:
S ea■----
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
City of Tigard Received
Permit No.: E �/ g- - fi g/
Date/By: /o /. d
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
111 � Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Other Permit:
T 1 G A R D Inspection Line: 503.639.4175 Date Ready /By: .run ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method• "1 r Supplemental Information
TYPE - WORK " ' . * REV , . .,
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /Items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• r ° .CAT_ EGORY `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 0 Emergency system. larger separately derived system.
. 0 Addition of new motor load of ❑ "A "E ", "l -2 ", "l -3 ",
IOOHP or more. occupancy.
Job no.: Job site address: /5 5 So stA) ,4LJJ F O/L ❑ Recr eational vehicle
❑ Six or more residential units. parks.
p
City /State /ZIP: l \(3yy�� ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ( ..... C .. 1 ❑ Service or feeder 600 amps or more.
FEE- - SCHEDULE . ' '
Cross street/directions to job site: Description tom. I Fee. ` 9 I Total '
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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
75.00 2
. DES _ CRIP _ TION OFD WORK. (with above sq. ft.)
Limited energy, multi- family 75.00 2
CUP-i0ei 'Fel is. -1 _ S(eit,I -P.N /bb , 0( Mirs residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
•A'-) 3 G (2LOLTS "F0 AponrCYJ'X cL L( (D-a -r w_y 200 amps or less t 80.30 2
El PROPERTY, OWNER - - ❑ TENANT- _ • 201 amps to 400 amps 106.85 2
Name: hA l V `LLB 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: (o3) 7t ! tt7. 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 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 q
0' APPLICANT ..
6.65 CONTACT PERSON above service or feeder fee, / _ 6.65 / 9 6) 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 2
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not 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, 7 Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 0 A uC .`L iota -,S G energy panel, alteration, or
Address: � . ..,--,2., 4 extension. Describe: Page 2 2
City /State /ZIP: AC.0 ,4A. O c7o�0 Each additional inspection over allowable in any of the above
Per
Phone: (5 ) -70 OOe.4 3 1 � - Fax: (S0 631g d Investigation e s ti ga 62.50
gatti on per hour (I hr min) 62.50
CCB Lie.: 138773 Electrical Lic.: 3V-5 Suprv. Lic.: 4.14,Z 3s Industrial plant per hour 73.75
6 .___ _____..-- ELECTRICAL PFRMTT Subtotal: FEES Suprv. Electrician signature, required: Date: !� �[0 0 da p . ` , r Plan review (25% of permit fee):
Print name: ..e--vi Ai /.
c -R�rl t e State surcharge (12% of permit fee): / y . f �`
Authorized signature: TOTAL PERMIT FEE: / ./ ` 0 9
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- 4615T( I 1 /05 /COM /WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
;RESIDENTIAL WORK O NL Y :.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
.=.COIVIMERCIALnWORK`ONLY:a � . .�° t uri _ �, .�
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
• Audio and Stereo Systems
• Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
• Instrumentation
• Intercom and Paging Systems
E l Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
• Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I. \Building\Permits\ELC- PermitApp doc 03/23/06
CITY OF TIGARD
a..
BUILDING DIVISION
v PERMIT #: FLC200800581
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/10/2008
Phone: (503) 639 -4171 i %ill • Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 10/16/2008 TIME: 7:01AM PAGE: 31
SITE ADDRESS: 15580 S!N AL DERC3ROOK CIR CLASS OF WORK:
SUBDIVISION: tiUMIv1F_RFI[-!_C) NO LOT #: 448 TYPE OF USE:
PROJECT NAME: ILr
DESCRIPTION: Panel change and (6) branch circuits.
OWNER: ILG, MIKE PHONE #: 503 - 0049
CONTRACTOR: CAMERON THOM" A LLC PHONE #: 603-704.0049
Inspection Request Scheduled For: Date: 10/16/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 076766 -01 503- 781 -5425 N
Corrections /Comments/ Instructions:
71 OO 0 17 vt 01( — r) A 1 se ,�:
y ] PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
H FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1 Date: I 11 V 1$ Phone #: (503) 718 -