Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00256
o. , *1 DEVELOPMENT SERVICES DATE ISSUED: 4/13/2005
13125 SW Hall Blvd., Tigard, OR 97223 503-639-4171 PARCEL: 2S103BD -04700
SITE ADDRESS: 12535 SW 116TH AVE ZONING: R -4.5
SUBDIVISION: HUNTER'S GLEN LOT : 003 JURISDICTION: TIG
Project Description: (2) branch circuits.
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: 1 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:
TRUMMEL, ERIC J + DANETTE J OWNER
12502 SW 116TH AVE
TIGARD, OR 97224
Phone: 503 - 579 -5086 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 4/13/2005 $53.50
[TAX] 8% State Surcharge 4/13/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
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: 2 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.
Electrical Permit Application j O ' -- , ` TOR OFFICE`USEONLY
0- V _ �y�
City dF T igard �j� Date/By: ed L� ,J SS /�)
13125 SW Hall Blvd., Tigard, OR 97 3 Plan Review
Phone: 50 3.639.4171 Fax: 50 3.598.1960 R 1 200 ,�� l ' i - i Fo 11I Date /By: Other Permit:
Inspection Line: 503.639.4175 �+ 7 O1 . Date Ready /By: turis Ei See Page 2 for
Internet: www.ci.tigard.or.us Nodtied/Method. "r I(r Supplemental Information
SIGl►R D
• TYpza ' V J I slos , PLAN REVIEW
tivi:DI ❑ New construction ZrAddatorrattera /replacement Please check all that apply:
❑Service over 225 amps, comm'l ❑Hazardous location
❑ Demolition ❑ Other: ❑Service over 320 amps - rating ❑ Buildng over 10.000 sq. ft.,
•CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
0 and 2 family dwelling ❑ CommerciaUindustrial ❑ Accessory building ❑S over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi family ❑ Master builder ❑Other:
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑E /lighting plan RV park
Y;i ❑Health -care facility ['Other:
Job no.: Job site address: i 2 ,S S S t.... Jf G A vg Submit 2 sets of plans with any of the above.
City/State /ZIP: i6/421, 0 q - 7 - Z 3 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE **
Description Qty. Fee. Total
Cross street/directions to job site: 3Q 0 /moo `� s Q rlJ n C> // T New residential single- or multi - family dwelling unit.
Includes attached garage.
SO C.4 7 H 0 (.tom 4 L iv /a 7 1,000 sq. ft. or less 145.15 4
Subdivision: / ti .- 1,3 Pi G L E R> Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map/parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
/ Z' _ dwelling, service and/or feeder 90.90 2
A o o Z [3 iz 4,tJ f-/ r 7/2.e.:(.. ,r — / G rL Services or feeders installation, alteration, and /or relocation
/ Z (' V 6 ti / A ti b / 19 //Z C OA./ `J 200 amps or less 80.30 2
.__ElROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
_ 401 amps to 600 amps 160.60 2
Name: / G ni C/ /n m 6. e 601 amps to 1,000 amps 240.60 2
Address: / 2 s " 3 S sf-t, /,/ ta ! /-e 4 v„ Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: - 77, b4 n e 0 rz. 9 7 2 2. 3 Temporary services or feeders installation, alteration, and /or
f`0, ) Fax: relocation
Phone: (
1 �/ `S c ( ) 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 exc e, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signaturre - 2----,, Date: 4 - / - / - 3 b S _ Branch circuits - new, alteration, or extension, per panel •
.2 <ms / PPLIICANT .2 PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 46.8 2
Address:
Each add'I branch circuit 1 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ( ) Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address:
Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr mm) 62.50
Phone: ( ) Fax:( )
Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: Electrical Lic.: Suprv. Lie.: Subtotal r3
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) y,1'
TOTAL PERMIT FEE 5 l, 7
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
i:lBwldmsAPermitsVLLC- Pcmii[App doc 8103 430-4615T( I0 /02 /COxt /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*
n Burglar Alarm
Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
I Vacuum Systems*
Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
Data Telecommunication Installation
Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control*
n Medical
n Nurse Calls
Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\ Building \Permits \ELC- PcnnitApp.doc 01/03
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00256
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/13/2005
Phone: (503) 639 -4171 .. Jaillit
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7:09AM PAGE: 83
1 .
SITE ADDRESS: 12535 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 003 TYPE OF USE:
PROJECT NAME: TRUMMEL
DESCRIPTION: (2) branch circuits.
OWNER: TRUMMEL, ERIC J + DANETTE J, PHONE #: 503 - 579"5086
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 6/24 /2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 010045-01 503 - 557 -2220 Y
Corrections /Comments /Instructions:
dc-. SIKH c
L Ai _ , Aar Ai ` X. S - v -
6. i
PASS ! PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL RI *ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Insect.: Date: f0one #: (503) 718 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: MEC2005 -00112
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/16/2005
Phone: (503) 639 -4171 0„„,, ili it
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 6/24/2005 TIME: 7:09AM PAGE: 84
—
SITE ADDRESS: 12535 ` 116T . • CLASS OF WORK:
SUBDIVISION: HUNTE • N LOT #: 003 TYPE OF USE:
PROJECT NAME: TRUMMEL
DESCRIPTION: AC install
OWNER: TRUMMEL, ERIC J + DANETTE J, PHONE #: 503 - 579.5086
CONTRACTOR: TRI COUNTY TEMP CONTROL PHONE #: 503 - 557 -2220
Inspection Request Scheduled For: Date: 6/24/2005 Pour Time:
Code # Inspection Description - Confirm # Contact # Message �' '. 0 0
699 Mechanical final 010043 -01 503 -557 -2220 Y ' 77 ,s
Corrections /Comments /Instructions: 5�1 -� 6
ci
C______
•
*SS m PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑FAIL E 'ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
■ Inspector: Date: Z 1 1 Phone #: (503) 718 -