Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00682
COMMUNITY DEVELOPMENT DATE ISSUED: 12/22/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 112CA - 06900
SITE ADDRESS: 15365 SW 79TH AVE ZONING: R -
SUBDIVISION: ASHFORD OAKS LOT : 023 JURISDICTION: TIG
PROJECT: LEVIGNE
Project Description: (1) branch circuit and all encompassing limited energy.
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: 1
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: 1 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:
EDWARD & DEBRA LEVIGNE WILLAMETTE ELECTRIC INC
15365 SW 79TH AVE PO BOX 230547
TIGARD, OR 97224 TIGARD, OR 97281
Phone: 503 - 620 -9478 Contact #: PRI 503 - 624 -3631
FAX 503 - 624 -2938
FEES
Description Date Amount Reg #: ELE 34 -283C
[ELPRMT] ELC Permit 12/22/2001 $121.85 LIC 75059
[TAX] 12% State Surchar 12/22/2001 $14.62 SUP 4226S
Total $136.47 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 too OU at 503.246.6699Ior 1.8
Issued By: % Q._ A i : � y l ( 1 A Permittee Signature: -: *4 l,(Q (�AM* - )
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.
illin /2008 THU 17:08 FAX 5036242938 Willamette Electric 0]001 /001_____ _ - - ____
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got In;ctioi, l..ine: 50:t.4 0 -- .._.__...- I ,
��° I ;e ®F TIGAF1D Date ftcac!y'3y: _.._....._......___..• °- °-
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`. .... www.tigard NotdiedNlcthod: i
_ ,uppieum„talInformation
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1 P ` k WORK PLAN R1'aV1 Vil
Please cheer: 311 that apply (subn)tt 2 sell ofplm,s w/items ehec!:e7- bcl0w): __
El NOM' construction Addition /alteration /replacement
r -- I 0 Service or feeder 400 amps or 01010 0 Budding over three stories
❑ Demolition Iv1 Other: where r1,c available fault current 0 Marinas and boatyards.
-- -- CATEGORY OP CONS'FRUC: I"IO 4 exceeds 10,000 amps at 150 solIs 01' Floating buildings.
-- . -. -- -- --- -.- -- less to ground, or exceeds 14,000 0 Commercial -use agriculntrel
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps forali other installations. buildings.
111 Multi - family ❑ Master builder 0 Fire pump. ❑ Other: V V ❑ Installation of 75 KVA of
[J Emergency system. larger separalciy derived system.
JOB SITE INFORMATION AND LOCATION
_ ❑ Addition of new motor load of ❑ ";1 ", °f "I 2" "1 1"
Job n0.: �ry I Job site address: /5 ` 6;,9 5t.tj 7? fix i' 100H1' or u,orc. occupancy.
L -_ ( - _- ..---- L _____ _. .__ _ / 7 [] Six a' more residential units. ❑ Recreational vehicle parks,
City /State /"LIP: e 4,V, p t1� 7 e(' ❑ Health -care facilities. ❑ Supply voltage for more Man
.__.____ -,_-_ . -_. ❑Hazardous locations. 600 votes nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or 10010.
. • . FEE SCHEDULE .
Cross street /directions to job site: Descri ! on t . p
~- - New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot 110 1,000 sq. f4. or less 145.15 4
Tax map /parcel no.: T - Ea. add'I 500 sq. 6. or portion 33.40 1
Limited energy, residential 75.00 2
• . • .DESCRIPTION OF WORK • . • : (with above sq, R)
C t �� n � 0 r � Limited energy, multi-family
f7 y� /447r ,r/9� / N 75.00 2
D� t f t� reSidcn (wirh a bove sej. fj.) __ _
Services or feeders installation, alteration, and /or relocation
-- _ __ 200 amps or Icss 1 80.30 ( 2
❑ PROPERTY OWNER -T --
TENANT 201 amps to 400 amps 106.55 1 ?-
Name: 401 amps to 600 amps 160.60 2 1
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, andlor
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 133.75 - 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: - --
_.-_-_._ ..- ...- ..._._____...- .- _.__..._ A. Fee for branch circuits with
❑ APPLICANT 0 CONTACT PERSON above service or feeder fee,
' each branch circuit 6.65 2
Business name:
B. Fee for branch circuits
without service or feeder fee, / ii�, 2
Contact name: 46.85
first branch circuit
Address Each add'/ branch circuit _- 6.65 2
- -- - - Miscellaneous (service or feeder not it eluded)
City /State /ZIP: Each manufactured or modular '
-- -.__.- 90.90 2
dwelling, service and /or feeder
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: Willamette Electric Inc. Signal circuit(s) or limited -�W _ �" _ -
energy panel, alteration, or / Address: PO Box 230547 " _ - extension. Describe: ( ( Page 2 2
City /State /ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 624 -3631 Fax: (503) 624 -2936 - - - ,_ -
..... _ -.- -.- - _.___ - __ _-_ Investigation per hour (1 hr min) 62.50
CCB Lic.: 75039 Electrical Lic.: 34 -283C: Suprv, Lic.: 4226 -8 Industrial plant per hour 73.75 J
,__ _ -_ --_ -_ ELECTRICAL PERMIT YIIT F12ES
f
Suprv, Electrician signature, required: _.:; b- ,, . Subtotal: f yl-
Print name: David Fife Date: I gc.l Gc Q g Plan review (25 %ofpermit fee): - -_ -
- - -- - - - -- -- State surcharge (12 %of permit fee): /
Authorized signature: TOTAL PERi IT FEE: f 13 /, ,47
Print name: ____. "Phis permit application expires if a permit is not obtained within 180 " -
Dale: days after it has been accepted as complete.
Number of inspections allowed per permit.
r' a1,, diting1 0erniis\t:r-c.re' 050,.1/06 440.461 s'r'{, i:os /COM•'tvrn
„ , •
CITY OF TIGARD
BUILDING DIVISION ,- --
PERMIT #: ELC1003-006B2
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/23/2008
Phone: (503) 639-4171 Vilit
Inspection Requests (24 Hrs.): (503) 639-4175 ...,, ' ---,
INSPECTION WORKSHEET FOR DATE: 12/30/2008 TIME: 7 PAGE: 2
SITE ADDRESS: 16366 SW 79TH AVE CLASS OF WORK:
SUBDIVISION: ASHFORD OAKS LOT #: 023 TYPE OF USE:
PROJECT NAME: LEviGNE:
DESCRIPTION: (1) biancii circuit and an encompaning limited 01
OWNER: LEVIGNF, EDWARD & DEBRA PHONE #: 503-520-9478
CONTRACTOR: VVII_LAMEITE ELECTRIC INC PHONE #: 5'03
Inspection Request Scheduled For: Date: 12/30/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'--,.
199 Electrical final 079270-01 503-624-3631 Y
n LA ().1
Corrections/Comments/Instructions: 1
1 R cp.‘xo e - Y31 b” Li
'30
)
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PASS D PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
0 FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G. 1•1 (%1. Date: Ill 1011 Phone #: (503) 718-