Permit II
111 CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00279
COMMUNITY DEVELOPMENT DATE ISSUED: 5/15/2008
- TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DD-00801
SITE ADDRESS: 11565 SW 67TH AVE. ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 003 JURISDICTION: TIG
PROJECT: MERCER
Project Description: Reconnecting electrical 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: SIGNAL/PANEL:
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
ROSS & VICKI MERCER ROBERT HAUSER ELECTRICAL INC
11535 SW 67TH PO BOX 20396
TIGARD, OR 97223 PORTLAND, OR 97294
Phone: Contact #: PRI 503 - 253 - 5753
FAX 503 - 253 -5537
FEES
Description Date Amount Reg #: ELE 26 -402c
[ELPRMT] ELC Permit 5/15/2008 $66.85 LIC 13476
[TAX] 12% State Surchar 5/15/2008 $8.02 SUP 1553S
Total $74.87 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 �,% j `- Permittee Signature: / � At ?, " f
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.
May 14 08 08:46a p.2
Electrical Per Applicatio � ���
�` FOR OFFICE use ONLY'
City of Tigard Received y
��� Date/3: J ' , JJ Permit No.: 4a� -ask•` a 9
; ; � °- 13125 SW Bab Blvd.. Tigard,OR 97223 ( `. Plan Review ��� 1
Phone: 503.639.4171 Fax: 503.598.1960 `' K Date/By: Other Penn:
T 1 G A It D Inspection Line 503.639.4175 O g' G rate Readyf3y; rurir. See Page 2 for
Internet: uw w.tigard or.gov [ 1 NonftedRNethod: Supplemental Information
.r- - rt' ,. , pit a �, , n- v - ran 3.n
t P.r ; t 1': t t in 4 ' C � ` 5 y i i ;te t 31 0 "3: lfiQ.s': :i
❑ New construction !;1 Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ D ❑ Other
l_ _ vt r where the available fault eucurrent 0 Marinas and boatyards.
q � t r r tt C l e a a [I w,r } t a �4 ;." iii, exceeds 10,000 amps at 150 volts or 0 Floating buildings
µ less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1- and 2- family dwelling igi Commercial/industrial 0 Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder _ Other: 0 Fire primp. 0 Installation of 75 KVA or
;eye r, * 4x +� r ; ,,.� 7 . : 0 0 Emergency system, larger separately derived system.
: � . :I ts3fr -J111:4 ❑Addition anew melon lead of ❑ .•A» •'E ", "] -2 ", "1.3"
Job n o . : ? ? ./e I Job site address: f /• . F� r , 6" l j Y I OOHP or more. occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: IL.> . '' r 9 ? 5 0 Health -care facilities. 0 Supply voltage for more than
j r
t ' , '' " ❑ Hazardous locations. 600 volts nominal.
Suite /bldg./apt no.: ! Project name: . 0 Service or feeder 600 amps or more.
is a:F 9 950 T t1J 'eta.: l
., `` / f- , r �° ., m 1 , r .
Cross streetldirections to job site: %1
! L� 4•• / �`�l �� l��G. l Description Qty. 1 Fee Tornl
New residential single- or multi - family dwelling unit.
..- FLi.:(, 7 7 - - - --- Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or Jess I45.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no Limited energy, residential
s �r
i.,.lt a ya' r '" '9^ -i # s - `� 7�u��,q-,t�.. : 75.00 2
. ,.'f1 nit. 5.- `t . mti+r1 U FIP- .zt.2r ati_. 3 Ict�. _r.: - M i r ; : • (with above sq. ft)
—
Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
{ Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. e :r . Vi e}' : r l tat nr t 201 amps ',!-:••• .. .at., :! n+ 1 . , a t:. !r4_rT;, .'. .�.;; _ r .�pk P 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 i 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I 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 j , 133.75 2
Branch circuits - new, alteration, or extension, ter panel
Owner signature. Date: A Fee for branch circuits with
': gl . 1 ; 0 00 M , , `r 1 ' � g}g, , �i t n 1 r 1 above service or feeder fee,
r_ ru zyt"8rr. t ^ each branch circuit 6.65 2
Business name: B, Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 46.85 2
-
Address: Each add'i 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: ( ) I Fax: : ( ) Reconnect only 7 66.85 t4,4,4-) . 2
E - mail: Pump or irrigation circle 53.40 2
, ' ' jr 1 1 .x '!j; , . _ '4 ; aiMt ,!:' , ` a J'r �'l i tt �a Sign or outline lighting 53.40 2
Business name: (�� r. Signal circuit(s) or limited-
11 ` E f +G�: -fit 1 < = . E; : energy panel, alteration or
Address: ,f-.tf' , - r"1G�:, ,max 5 c� 4, extension. Describe: Paget 2
City /State/ZIP: 9 `'a 5.2:,i Each additional inspection over allowable in any of the above -
Phone: i Per inspection 62.50
(!L �) . j - i - ..= `"7 i Fax: (2' i ) !J,� 7 5 i Investigation perhour(1 hr min) 62.50
co) Lic.: / ;C{ 7 .- Electrical Lic. f`;.- + Suprv. Lic.: /6 [ndustnall plant per hour i 73 75
y J tl 7/1 d / U / /u Pi t' . ., , - r; J : �±�1 r - 4rj4j! ,
Suprv. Electrician s gnaturc, required:
Subtotal: j . , 5
_ir. i
Print name: Data r i `�
-..--• Plan review (25% --- -..—
of permit fee): •,
l ' t %t / t J � C , L C. l n (� �� / �� State surcharge (12% of permit fee): , o � ;,
Authorized sign Q -G� ��. / , . f TOTAL PERMIT FEE: 71 i 7
Print name: x i 77 ll Datef7 Thrs Permit application expires ifa permit is net obtained Within 180
b C' _ ( L: r~ /w ( �,'_ _� C� (� r' I , ' days atter it has been accepted as complete.
" Number of inspections allowed per permit.
iVuildins :'ermits\ELC- PermitApp.doc 05123/06 440- 4615T(ilt0SiCQN/WEB
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BUILDING DIVISION PERMIT #: EI C200B•00279
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/15/2008
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 ....,. .
INSPECTION WORKSHEET FOR DATE: 6/13/2008 TIME: 7;01AM PAGE: 30
SITE ADDRESS: 11565 SW 67TH AVE CLASS OF WORK:
SUBDIVISION: WEST PORTLAN[7 HEIGHTS LOT #: 003 TYPE OF USE:
PROJECT NAME: MERCER
DESCRIPTION: Rec.orinectinq electrical service.
OWNER: MERCER, ROSS & VICKI PHONE #:
CONTRACTOR: ROBERT HAUSER ELECTRICAL INC PHONE #: 503 -253 -5753
Inspection Request Scheduled For: Date: 6/13/2008 Pour Time: 1
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 071349 -01 136- 091 -0525 Y Ca/1 Yi Q
1 od 1/0 55-45 _E ,e
Corrections /Comments /Instructions:
(
•
J PASS ❑ PARTIAL APPROVAL ❑ CANCEL fI NO ACCESS
❑ FAIL ❑ CALL F•R INSPECTION ❑ ADDITIONAL FEES ASSESSED
�,,
Inspector: 718- o
ector: 9' /, Date: / /3 / 111/ Phone #: i c Y p �