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Permit
' ,1. t ' CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVEL PERMIT #: ELC2007 -00363 DATE ISSUED: 5/29/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S103AC -04200 • SITE ADDRESS: 12636 SW 114TH TERR ZONING: R -4.5 SUBDIVISION: WALNUT GROVE LOT : 011 JURISDICTION: TIG 1 PROJECT: LIBERT Project Description: Installation of (3) branch circuits for outdoor lighting, pond, and garage workbench. 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 FOR: 1 PER HOUR: 401 - 600 amp: EA ADD'L BRNCH CIRC: 2 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: LIBERT, SCOTT A AND CYNTHIA M OWNER 12636 SW 114TH TERRACE TIGARD, OR 97223 Phone: Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 5/29/2007 $60.15 [TAX] 8% State Surcharge 5/29/2007 $4.81 Total $64.96 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: ' / Permittee Signature: 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. •.l Elect»ical Permit Apr lication i OR OFFICE USE ONLY R p U q c +,�, ? 7 k ' y q (� _ 4 Received y^ Q� 111111 Clty DY gar q A. J � Date/By: 1 64- Permit No.: ■ 0 1312 SW Hall Blvd., Tigard, OR 97223 Plan Review Phone: 503.639.4171 Fax: 5 1 Q' Date/B Other Permit: I' 1 G A IZ n Inspection Line: 503.639.4175 N t ` i 20 0 1 Date Ready/By: Inns ® See Page 2 for , r Internet: www.tigard- or:gov : - / %.- . Notified/Method: Supplemental Information y'ST TIrI'E;OF W0 , : Authorized signature: ❑ New construction gl.V ddition '%alteafi -)I - Y Print name: ❑ Demolition ❑ Other: " '' - CATEGORY OF 'CONSTRUCTION, _ __ PLAN N 1- and 2- family dwelling El Commercial/industrial ❑ Accessory building Please check all that apply (submit 2 sets of plans w /items checked below): ❑Service or feeder 400 amps or more ❑ Building over three ❑ Multi- family ❑ Master builder ❑ Other: where the available fault current stories. . ,JOB' SITE INFORMATION, AND "LOCATION:.: exceeds 10,000 amps at 150 volts or ❑ Marinas and less to ground, or exceeds 14,000 boatyards. Job no.: Job site address: / Z.43 4 51.a1 It ( fk 7-672.9-401-- amps for all other installations. ❑ Floating buildings. City /State /ZIP: Tt (,. 4 1:_ p, U 772_2_3 A ❑Fire pump. ❑ Commercial -use ❑Emergency system agricultural Suite/bldgJapt. no.: Project name: buildings. ❑ I Addition of new motor load of O V i � 1 Cross street/directions to job site: W ' /L -A/Li T Si. 100HP or more. ❑ Installation of 75 ESix or more residential units. KVA or larger separately derived system. 1,1/4. 6_,e0,,,:-. El Health -care facilities. Subdivision: t AJ .' T Lot no.: i f ❑ ❑ Hazardous locations. 3•• occupancy. Tax map /parcel no.: Z S j 3 A C - 0 -/ Zoo ❑ Service or feeder 600 amps ❑ Recreational vehicle "DESCRIPTION OE WORK _ �' ` ` or more. parks. 3 /3 e.4 n/c 1 ❑ Supply voltage for , / / more than C ! Z O r/ CI 6 ,T T, NG / ,u I) 4- Ci - 40t1 c-t Nci j 600 volts nominaL — '' ® 'PROPERTY''.OWN ❑TEN - ., L C7 l % L i l3 &2 1 t ' FEE SCHEDULE . Description I Qty. I Fee. I : Name: S Total I Address: / 2 - 693 (p SO ii 44-14 'T1 -IZ -4c 1= New residential single- or multi - family dwelling unit. Includes attached garage. City / State/ZIP: 'Tl (12 t4e -i t 0 R ' Z 2 3 1,000 sq. ft. or less 145.15 4 Phone: (S v) 5 - `t g g ? Fax: ( ) Ea. add'l 500 sq. ft. or portion 33.40 1 Owner installation: This installation is being made on property that I own which is not Limited energy residential 75.00 2 (with above sq. ft.) intended for sale, lease, re t, or exchang , according to ORS 447, 449, 670, and 701. Limited energy, multi - family 75.00 2 1Z ©7 Owner signature:_ �`' _Date:_ . _ residential (with above sq. ft.) ' PPLIC ANT '. 7 ' • * -. I .,: ,n" ' . CONTACT. PERSON- Services or feeders installation, alteration, and/or relocation Business name: 200 amps or less 80.30 2 201 amps to 400 amps 106.85 2 Contact name: 5 L 0 - r - T - LA a L a - i 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 260E / Over 1,000 amps or volts 454.65 2 City / State/ZIP: �vI Temporary services or feeders installation, alteration, and/or Phone: ( ) I Fax: : ( ) relocation E -mail: Sc O ++ 1 t be r E. e '( t Z 200 amps or less 66.85 1 „ - n 2 201 amps to 400 amps 100.30 2 CONTRACTOR' 401 amps to 599 amps 133.75 2 Business name: © CO k) CIL Branch circuits — new, alteration, or extension, per panel Address: A. Fee for branch circuits with above service or feeder fee, City /State/ZIP: each branch circuit 6.65 2 Phone: B. Fee for branch circuits ( ) Fax: ( ) 2e1 / without service or feeder fee, y� . 2 CCB Lic.: . Electrical Lic.: Suprv. Lic.: first branch circuit Each add'l branch circuit c2 6 / 3 .3t� 2 Suprv. Electrician signature, required: - - Miscellaneous (service or feeder not included) Print name: Date: Each manufactured or modular 90.90 2 dwelling, service and/or feeder CITY OF TIGARD . , - BUILDING DIVISION PERMIT #: ELC2007 -00363 - 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/29/2007 Phone: (503) 639 -4171 g olltil ll# Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 81/6/2007 TIME: 7:00AM PAGE: 2 SITE ADDRESS: 12636 SW 114TH TERR CLASS OF WORK: SUBDIVISION: WALNUT GROVE LOT #: 011 TYPE OF USE: PROJECT NAME: LIBERT DESCRIPTION: Installation of (3) branch circuits for outdoor lighting, pond, and garage workbench. OWNER: LIBERT, SCOTT A AND CYNTHIA M. PHONE #: CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 8/16/2007 Pour Time: Code # Inspection Description C on m #. Contact # Message 199 Electrical final 05414 -3-01 503- 590.9888 N Corrections /Comments /Instructions: i • i PASS n PARTIAL APPROVAL n CANCEL I I NO ACCESS n FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED Inspector: & 4 " CQS ' Date: i `i O7 Phone #: (503) 718- -of% .. CITY OF TIGARD BUILDING DIVISION PERMIT #: ELC2007 -00363 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/29/2007 • Phone: (503) 639 -4171 /4,4 u'144I • Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 8/ 10/2007 TIME: 7:00AM PAGE: 15 SITE ADDRESS: 12636 SW 114TH TERR CLASS OF WORK: SUBDIVISION: WALNUT GROVE LOT #: 011 TYPE OF USE: PROJECT NAME: LIBERT DESCRIPTION: Installation of (3) branch circuits for outdoor lighting, pond, and garage workbench. OWNER: LIBERT, SCOTT A AND CYNTHIA M, PHONE #: CONTRACTOR: OWNER SQ PHONE #: Inspection Request Scheduled For: Date: 8/10/2007 Pour Time: Code # Inspection Description onfirm • N Contact # Message 120 Electrical rough -in 053803.01 503- 590 -9888 N Corrections /Comments /Instructions: ��' ' S€t L ; r cam ELF -o } ate oC p AN��.. w. 67 G `P ,M efrib 10 PA et.a c� L, act. (L.00pi) A to Rg4 E� is PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS n FAIL I CALL FOR INSPECTION I I ADDITIONAL FEES ASSESSED Inspector: ` Date: d1 ` t)( ®1 Phone #: (503) 718- 2- . r/4401. ( 64 ci 7121' p....411[111 _ , ___, : - 0.' 0 clicksziAGe. - — L 1(o K }. • ! . • W 4 PRNEw Pty 14 �. 1 I f_ i--9 c ice y { E - "0A ' ''''''.. + V SCE ! £ °� , W �r� I, ° e as �a w_. • " y ti., _Cor%r� t __.. -- -y i .n: 1 C l R! 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