Permit ELECTRICAL PERMIT
IA CITY l n F TIGARD PERMIT #: ELC2007 -00560
:. COMMUNITY DEVELOPMENT DATE ISSUED: 8/10/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103AA -03700
SITE ADDRESS: 12300 SW 106TH DR ZONING: R -4.5
SUBDIVISION: CLYDESDALE LOT : 017 JURISDICTION: TIG
PROJECT: NEWTON
Project Description: (1) branch circuit for a /c.
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: 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:
ELIZABETH NEWTON DISTINCT ELECTRIC, INC
12300 SW 106TH DR. 4742 LIBERTY RD STE 219
TIGARD, OR 97223 SALEM, OR 97302
Phone: 503 - 579 -9276 Contact #: PRI 503 - 910 -9216
FAX 503 - 763 -6880
FEES
Description Date Amount Reg #: ELE 24 -523C
[ELPRMT] ELC Permit 8/10/2007 $46.85 LIC 161089
[TAX] 8% State Surcharge 8/10/2007 $3.75 SUP 1829S
Total $50.60 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 -8 00. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued Bile/iv /.1 / Permittee Signature: 1� /
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 Applicati FOR OFFICE USE ONLY
SW g OR
223 / � d ,/__C....2/70.?. - 5 a: 0
Cl of Ti a '[1 :, _ Date By: O S i / Permit No.: . n 13125 S Hall Blvd., Tigard, O Plan Review
Phone: 503.639.4171 Fax: 503.598tA1U 1 0 2007 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready /By: lures. . l� ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: I V Supplemental Information
TYPE O WP®I G D1 SION - PLAN REVIEW .
Please check all that apply (submit 2 sets of plans w /items checked below):
0 New construction
Addition /alteration /replacement
❑ 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
>4:1- 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
/ / 1 100HP or more. occupancy.
Job no.: Job site address:
/ Z�tJQ B �¢ UJ C V 0 i1 �. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /StatC /ZIP: / �y/J , Q p ❑ Health -care facilities.
0 Supply voltage for more than
/ t 111 /` - f� ❑ 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: t_ Description I Qty. I Fee. i Total I •
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'l 500 sq ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
.DESCRIPTION OF WORK ' , (with above sq. ft.)
Limited energy, multi - family 75.00 2
u ..r A1C AC r /mvuez.�.r residential (with above sq. ft.)
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
401 amps to 600 amps 160.60 2
Name: g ujf.i . itk r/7/0 601 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: (SO'3) -- 92 Fax: ( ) 200 amps or less 66.85 , 1
Owner installation: This installation is being made on property that I 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 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for, branch circuits q—
Contact name: without service or, feeder fee, ( G `) ,
46 " 0 2
first branch circuit
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: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
•
CONTRACTOR Sign or outline lighting 53.40 2
1i 5'77 /t C r Signal panel, or limited -
Business name:
i [, �G Cj'i�CC ` /A/c energy panel, alteration, or
Address: Z , / ,t y /� extension. Describe: Page 2 2
City/State /ZIP: S' / r „ „ 2 G f ® e Each additional inspection over allowable in'any of the above
Phone: ( A3 ) �� �'l 5 Per
in
62.50
Ct (d — Fax: (� Investigattion ion per hour (1 hr min) 62.50
Q
CCB Lic.: /go cf Electrical Lic.: Z(/ 5ZYC Suprv. Lie.: �ZccS Industrial plant per hour 73.75
`L l t ELECTRICAL PERMIT - FEES
Suprv. Electrician signature, required: 77 y Subtotal: /
� R
Print name: //'� z Date: Plan review (25% of permit fee):
(MY F . State surcharge (8% of permit fee): 3.7S
Authorized signature: TOTAL PERMIT FEE: S d , 6 0
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 \Permits\ELC- PermitApp.doc 05/23/06 440- 46t5T( I 1/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDEN'TIAL:WORK;ONLY :: .
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
"COMMERCIAL,WORK ONLY:.- '
Fee for each commercial $75.00
system
(SEE OAR 918-2S0-260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n 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 .
BUILDING DIVISION PERMIT #: ELC2007 -00560
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 8/10/2007
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 8/13/2007 TIME: 7:01AM PAGE: 35
SITE ADDRESS: 12300 SW 106TH DR CLASS OF WORK:
SUBDIVISION: CLYDESDALE LOT #: 017 TYPE OF USE:
PROJECT NAME: NEWTON
DESCRIPTION: (1) branch circuit for a/c.
OWNER: NEWTON, ELIZABETH PHONE #: 503-579 -9276
CONTRACTOR: DISTINCT ELECTRIC, INC PHONE #: 503 - 910
Inspection Request Scheduled For: Date: 8/13/2007 Pour Time:
Code # Inspection Description Confirm Contact # Message
199 Electrical final 053834 -01 503- 851 -7094 N
Corrections/Comments/Instructions:
•
/,PASS ❑ PARTIAL APPROVAL ❑ CANCEL I NO ACCESS
FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Cr" N 6 LE" Date: *in_ Phone #: (503) 718 - 2- M
•