Permit CITY OF TIGARD ELECTRICAL PERMIT
I .1 PERMIT # : ELC2006 -00697
COMMUNITY DEVELOPMENT DATE ISSUED 12/7/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S110DD -13800
SITE ADDRESS: 15495 SW 109TH AVE ZONING: R -25
SUBDIVISION: SUMMERFIELD NO.14 LOT : 708 JURISDICTION: TIG
Project Description: 1 branch circuit for HVAC.
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:
STERRETT, DOROTHY P STAR ELECTRICALSERVICE
15495 SW 109TH AVE PO BOX 1784
TIGARD, OR 97224 BEAVERTON, OR 97075
Phone: 503 - 620 - 3371 Contact #: PRI 503 - 579 -9201
FEES
Description Date Amount Reg #: ELE 26 -963C
[ELPRMT] ELC Permit 12/7/2006 $46.85 LIC 153627
[TAX] 8% State Surcharge 12/7/2006 $3.75 SUP 4313S
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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246. • : •'• or 800.332.2344.
Issued By: Permittee
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 I SE ONLY
City Tigard HI GEI Received /
J g Date/B f � 4 0 i Permit ... 4:7OG4
)14 ' 13125 SW Hall Blvd., Tigard, t ,9],22 Plan Review
II Phone: 503.639.4171 Fax: 5 .(�iggllgg 1 07 2006 D . Other Permit:
TI c, AR l Inspection Line: 503.639.4175 Date Ready/By: Jung. lid See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: T Supplemental Information
ZUILDING DIVISION
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
b ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ ther: where the available fault current ❑ Marinas and boatyards. 1
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
, q1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job no.: Job site address: 1/ % �� 5 ` O / 9 - �/ L ! / /7 ,4/ / ,/ IOOHP ormore. occupancy.
q J ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Health - care facilities. ❑ Supply voltage for more than
Tor d 0,4, j ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
job street/directions to ob site: Description I Qty. I Fee. I Total
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'I 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.)
4-
/� Limited energy, multi - family 75.00 2
14- EL.� `7 1 7 D residential (with above sq. ft.)
l (/ / Services or feeders installation, alteration, and/or relocation _
200 amps or less 80.30 2
° PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
�� 1111 - -1 401 amps to 600 amps 160.60 2
Name: ° ° ° ° ° °
n � 41,./ 601 amps to 1,000 amps 240.60 2
Address: 1 9p9 -- 9/ W / 05 'Z 4 t /� Over 1,000 amps or volts 454.65 2
/
City/ State/ZIP: I � nn'' ,n V Temporary services or feeders installation, alteration, and/or
/ l!/ / relocation
Phone: (4) fj 9 , d/ 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 I ❑ CONTACT PERSON above service or feeder fee,
/ each branch circuit 6.65 2
Business name: /' r / ttZ ,if , J- - f ( . B. Fee for branch circuits i
77 " without service or feeder fee, i t 46.85 2
Contact name: GI 14 D 1,,,,A 11,1\ first branch circuit
Address: F O \ 3 O; /1 y Each add'I branch circuit _ 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: �jj V w i a N / 0 g/ , 7 Each manufactured or modular 90.90 2
Z 9 dwelling, service and/or feeder
Phone: ( •, 7q, 9 p p I 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: r � /, 17 1 C " �� , _ V e ' energl p al, a) or t o , gsi pan alteration o or r
Address: 7 o + v / "7 extension. Describe: Page 2 2
Address: f ffi /` / / City/ State/ZIP: p � y � v � r � � Of,/ Each additional inspection over allowable in any of the above
C fJ Per inspection 62.50
Phone: ( ) /7 9 ?a O / Fax: ( )
/ / I Investigation per hour (1 hr min) 62.50
CCB Lic.. / i 3 W Electrical Lic.: ` (1 Suprv. Lie.: 4--, /� industrial plant per hour 73.75
� ELE CTRICAL PERMIT FEES
Suprv. Electrician si afore, required: /4 0 Subtotal: y&. $6j
�v Plan review (25% of permit fee):
1 ��
Print name: R P Da .
6� M 5)R State surcharge (8% of permit fee): 5 75
Authorized signature: TOTAL PERMIT FEE: 5 . 6,
Print name: Date •
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \ Permits 'ELC- PmnitApp.doc 3/06 440-4615TO1 /05/COM/WFB
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*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
E l Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
E l Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
E l Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building\Pamib\ELC- PemitApp.doc 03/23/06
CITY OF TIQARD
BUILDING "DT VISION PERMIT #
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELG2C06.006
Phone: (503) 639 -4171 ,,,,u N�uNl�('��I < � 12. - 6
Inspection Requests (24 Hrs.): (503) 639 -4175 ., � —
INSPECTION WORKSHEET FOR DATE: 2 -�� - Q 6 TIME: PAGE:
SITE ADDRESS: l 5 R% S W ti C�I kV • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION: 4 v N C rn ` 114 Lot ge g $�1 6
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: V24 1 1 4.r106 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Ti i ^i N PL
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • NI 06� Date: tii41'v Phone #: (503) 718- 2410
' CITY OF TIGARD
BUILDING DIVISION PERMIT #oeb• - o-
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: ELG2017
0•OQ617
Phone: (503) 639- 4171' ii4 �1� \Z -"j - O 6
Inspection Requests (24 Hrs.): (503) 639 -4175 . -�--
INSPECTION WORKSHEET FOR DATE: % 2• -1L - o6 TIME: PAGE:
SITE ADDRESS: I S A CkS S W 10 cf t Av • CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ( Kum. DESCRIPTION: H V �1 CL c,et1 1i O g p i1L 6 OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 0..1 14106 Pour Time:
Code # Inspection Description Confirm # Contact # Message
Ti F-i N'PL
Corrections /Comments/ Instructions:
A PASS 1 1 PARTIAL APPROVAL n CANCEL n NO ACCESS
I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • NI Q- Date: I1j b Phone #: (503) 718- 20o