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Permit CITY OF TIGARD ELECTRICAL PERMIT ° PERMIT #: ELC2008 -00666 COMMUNITY DEVELOPMENT DATE ISSUED: 12/9/2008 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1 S 125D D -01000 SITE ADDRESS: 06695 SW VENTURA PL ZONING: R -4.5 SUBDIVISION: WASHINGTON SQUARE ESTATES LOT : 030 JURISDICTION: TIG PROJECT: LOF Project Description: Installing (1) service. 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/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10): SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS 0 - 200 amp: 1 W /SERVICE OR FEEDER: 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: JAMES LOF OWNER 6695 SW VENTURA PL TIGARD, OR 97223 Phone: 503 - 246 - 6331 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 12/9/2008 $80.30 [TAX] 12% State Surchar 12/9/2008 $9.64 Total $89.94 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 enter • - ules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100 You may obtain copies of these rules or direct questions to OUN at 0 • • 1 800 332 2344. � � Qn � Issued By: 5 J �Q� �Q � �� n � Permittee Signature: ,����� - ra,iJ _• • 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. - Electrical Permit Application FOR OFFICE USE ONLY (' City of Tigard Received Date/B `( ` �. Permit No C C •• I . " i 4 q 13125 SW Hall Blvd ,Tigard, OR 9 - : t Plan Review KJ ' C Phone 503 639 4171 Fax 50 ,`,,\' • .. OD Date/By Other Permit T I G A R D Ins Line 503 639.4175 C f \� Date Ready /By suns la See Page 2 for Internet www ngard -or gov S 0 ) V 0� Notified/Method T 1 C Supplemental Information TYPE OF WORK 0 4i) PLAN REVIEW E] New construction Addition /alterati�gent Please check all that apply (submit 2 sets of plans w /items checked below) . l ❑ Service or feeder 400 amps or more ❑ Building over three stories ❑ Demolition ❑ Other: Vv 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 a(mcultural Af I - 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 INFORM AND LOCATION ❑ Emergency system larger separately derived system . • ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: Job site address: K DEC S� V � pi_ I Six or or more occupancy ❑ Six or more residential units ❑ Recreational vehicle parks City/State /ZIP' 1 IGA.,i2.D OP,... '-12z ❑ Health -care facilities ❑ Supply voltage for more than ❑ Hazardous locations 600 volts nominal ;� Suite/bldg. /apt. no.: Project name: p ,..,,,,, c�aA� ❑ Service or feeder 600 amps or more FEE SCHEDULE Cross street/directions to job site: V GA. cT, Description I Qty. I Fee. I Total I • New residential single- or multi- family dwelling unit. Includes attached garage. Lot no.: 1,000 sq ft or less 145 15 4 Subdivision: �I� a� 6 �xig., Ea add] 500 sq ft or portion 33 40 1 Tax map /parcel no.: Limited energy, residential 75 00 2 DESCRIPTION OF WORK (with above sq fl ) I A Limited energy, multi- family � 11\1 PI L,�.r-1 residential (with above sq ft ) 75 00 2 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: c W ► .) 1 WT 401 amps to 600 amps 160 60 2 601 amps to 1,000 amps 240 60 2 Address: �(D1 .1..i \ li\D -7. Over , Over 1,000 amps or volts 454 65 2 City/State /ZIP i 1�N 0 C) 0) 1 21 3 Temporary services or feeders installation, alteration, and/or relocation Phone: (56S) 754Co _ Co' I ' Fax: ( ) 1.1 J, 200 amps or less 66 85 1 Owner installation: T ' sta i do s be g made on property that I own which is not 201 amps to 400 amps 100 30 2 intended for sale, Ie.: - , , ex • ,n• >, according to ORS 447, 449, 670, rid 701. 401 amps to 599 amps 133 75 2 signature: Branch circuits— new, alteration, or extension, per panel Owner si g // 1� Date: i2, b J O� A Fee for branch circuits with ❑ LICANT O ❑ CONTACT PE O ' • above service or feeder fee, 6 65 2 each branch circuit Business name: QL.)1■17 B Fee for branch circuits without service or feeder fee, Contact name: first branch circuit 46 85 2 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 Business name: Signal circuit(s) or limited - 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 (I hr min) 62 50 CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73 75 ELECTRICAL PERMIT • FEES - n Suprv. Electrician signature, required: Subtotal Z t Plan review (25% of permit fee)' el Print name: Date: State surcharge (12% of permit fee) ei. tog Authorized signature: TOTAL PERMIT FEE 9 9 , 9 et 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- PermitAppdoc 05/23/06 440- 4615T(II /05 /COMM'EB Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: RESIDENTIAL WORK ONLY: Fee for all residential systems combined ... $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: COMMERCIAL WORK ONLY: Fee for each commercial $75.00 system (SEE OAR 918- 309 -0000) Check Type of Work Involved: ❑ Audio and Stereo Systems ❑ Boiler Controls ❑ Clock Systems ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation ❑ Intercom and Paging Systems ❑ Landscape 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 \Bwldmg\Permos\ELC- PermiApp doc 03/23/06 J � 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: ,I own, reside in, or will reside : in the completed structure andiny general contractor is: , Name - CCB# _ Expiration Date _ : I will instruct iny;general contractor that, all subcontractorswho work `on`the structure must be : " r • �_ licensed with the Construction Contractors Board.: or I . will be performing work On property I own, a residence that I reside in, or. a. residence that I will • "reside in If I hire subcontractors, I will hire only subcontractors licensed with the Construction ':',Contractors Board: If I 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 C I struction v ` - :Responsibilities contained on these two pages and hereby, certify th • i i 'o • tionichecked 'and _ completed above is correct and accurate: - - o01.. Print name of permit applicant - • it a ure of pa, applicant - This form is supplied to building Permit #: ��C7 YU ©a� permit offices by the Oregon �r � Address: ( O(aqS (A) UJ1,VV1 rn �• Construction Contractors Board, tr� ►r�' r T as required by ORS 701.055 (6) i a���� C�� g7223 Issued by: i6 Date: 2 �c This copy to issuing permit office t' CITY OF TIGARD �,p / BUILDING DIVISION PERMIT #: E icvota' 0061 13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: Phone: (503) 639 -4171 ^ tii Inspection Requests (24 Hrs.): (503) 639 -4175 . INSPECTION WORKSHEET FOR DATE: c.ir 6 TIME: PAGE: SITE ADDRESS: Los- 6 w \ atJ % PI- - CLASS OF WORK: SUBDIVISION: LOT #: TYPE OF USE: PROJECT NAME: DESCRIPTION: OWNER: PHONE #: CONTRACTOR: PHONE #: Inspection Request Scheduled For: Date: 611510 1 Pour Time: Code # Inspection Description Confirm # 1 Contact # Message Corrections /Comments /Instructions: . 0 4 F tLov I Df (j •! cyl b 3 foA-- \i ci t)N4i-3. 6 ' Pe (4 . ) AltitA ;R-fso Ito (4tko "ibcpitil wail .1 "t C (1 - % ' 41, -.` \\ V . ce:041V1 v 0Na.- ilvtt- e)•0 . X] PASS El PARTIAL APPROVAL ❑ CANCEL IPI NO ACCESS ❑ FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: v l` Date: if qt Phone #: (503) 718- :4i_k)_2