Permit liii �'�� ®� TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00294
;r COMMUNITY DEVELOPMENT
DATE ISSUED: 5/1/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S125DB-02600
SITE ADDRESS: 09130 SW 74TH AVE ZONING: R - 4.5
SUBDIVISION: BOULEVARD HEIGHTS LOT : 004 JURISDICTION: TIG
PROJECT: RASMUSSEN
Project Description: Panel change and (1) branch circuit for (4) smoke detectors.
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: 1 W /SERVICE OR FEEDER: 1 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:
LEE & MONA RASMUSSEN DISTINCT ELECTRIC, INC
9130 SW 74TH 4742 LIBERTY RD STE 219
TIGARD, OR 97223 SALEM, OR 97302
Phone: Contact #: PRI 503 - 910 -9216
FAX 503 - 763 -6880
FEES
Description Date Amount Reg #: ELE 24 -523C
[ELPRMT] ELC Permit 5/1/2007 $86.95 LIC 161089
[TAX] 8% State Surcharge 5/1/2007 $6.96 SUP 18295
Total $93.91 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 ay . NTION: 0 - ;on law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 -0 -0010 through e ' R 9 . -00 -0 10. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued , ( �/� i / Permittee Signature: . y- --
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 I STALLATION ONLY
SIGNATURE OF SUPR. ELEC' Al / ' r.� ✓/I — 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.
r
Elecfricar Permit Application °
." City of Tigard Date /Bea JV � Permit No.: �/� (��� ' /,
III '1 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
® ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
TIGARD'
Inspection Line: 503.639.4175 Date Ready/By: UM !3 See Page 2 for
,� . ,fix e` Internet: www.tigard - or.gov Notified/Method: Supplemental Information
' . TYPE OF WORK. PLAN REVIEW
❑ New construction 51, 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Xl- 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
J SITE INFORMATION AND LOCATION. ❑ Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "I - ",
y � j � i � IOOHP or more. occupancy.
Job no.: Job site address: 9 L '1 GI ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: ` - 1 t R l 6 C` ❑ Health -care facilities. ❑ Supply voltage for more than
6 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Th ,ik9 r5 fZ, f 1 Description 1 Qty. 1 Fee. 1 Total 1 "
• 1 New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
P6v 1 CA t , ! ` Q ! i..c A ej c4&1:5 residential (with above sq. ft.)
•
Services or feeders installation, alteration, and /or relocation
200 amps or less f 80.30 .,30 2
tq PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: [..�. t✓ , ;f e'tnej � t e ... e 1 401 amps to 600 amps 160.60 2
y
601 amps to 1,000 amps 240.60 2
• Address: Wass ass ' ?tits__ ,i Over 1,000 amps or volts 454.65 2
City /State/ZIP: 1"t OR, I? 22:7)) Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or Tess 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ ,APPLICANT CONTACT PERSON above service or feeder fee, I 6.65 CO 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: p without service or feeder fee, 46.85 2
`'"=d`� first branch circuit
Address: Each add'l 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: (303 ) 3131 402.3 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: T C It \ Signal circuit(s) or limited-
' ' V t S . L - .cit G 1N. C energy panel, alteration, or
Address: j, ; extension. Describe: Page 2 2 il
City /State /ZIP: :91 j C rri (, aZ p 3 0'Z, Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (5 )1(6 -9 Z a 6 Fax: ( ) Investigation per hour (1 hr min) 62.50
• CCB Lic.: 16(o-sc Electrical Lic.: 9.5? - ( Suprv. Lic.: j g z.a - Industrial plant per hour 73.75
ELECTRICAL PERMIT 'FEES
Suprv. Electrician signature, required: , Subtotal: it ,'i
A , Date: y / Plan review (25% of permit fee):
Print name:
/����ut C °��t 1/ • �/! / Q 7 State surcharge (8% of permit fee): 6 , ci C
Authorized signature: TOTAL PERMIT FEE: q 3 "if
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.
1:\ Building \Pemllts\ELC- PennitApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
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:
1- COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
. 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
1:\ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007- 00291
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/1/2007
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/2/2007 TIME: 7:01AM PAGE: 78
SITE ADDRESS: 09130 SW 74TH AVE 11 C i CLASS OF WORK:
SUBDIVISION: BOULEVARD HEIGHTS LOT #: TYPE OF USE:
PROJECT NAME: RASMUSSEN
DESCRIPTION: Panel change and (1) branch circuit for (4) smoke detectors.
OWNER: RASMUSSEN, LEE & MONA PHONE #:
CONTRACTOR: DISTINCT ELECTRIC, INC PHONE #: 503 - 010 - 9216
Inspection Request Scheduled For: Date: 5/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
189 Electrical final 047481 -01 503.810 -8216 N
ections /Comments /Instructions:
\2
•
j PASS Ti PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
n FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector; C� �� Date: &'2 61 Phone #: (503) 718 -