Permit ` 4 '' CITY OF TIGARD ELECTRICAL PERMIT
'1 1 PERMIT #: ELC2006 -00686 • .. COMMUNITY DEVELOPMENT DATE ISSUED: 12/4/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 501639.4171
PARCEL: 2S103BD -06200
SITE ADDRESS: 12664 SW 116TH AVE ZONING: R - 4.5
SUBDIVISION: HUNTER'S GLEN LOT : 018 JURISDICTION: TIG
Project Description: (1) branch circuit for sunroom.
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:
RON GENIUCH GORGE ELECTRIC INC
12664 SW 116TH AVE POBOX 806
TIGARD, OR 97223 HOOD RIVER, OR 97031
Phone: 503 - 579 -4633 Contact #: PRI 541 - 386 -2468
1
FEES
Description Date Amount Reg #: ELE 14 -20C
[ELPRMT] ELC Permit 12/4/2006 $46.85
LIC 111706
[TAX] 8% State Surcharge 12/4/2006 $3.75 SUP 4856S
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 1
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to ODU C at 503.246. •i��• • •� i. .2344.
Issued By: - / 1 j 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 Applicatiol�EC FOR o 1 ici USE ONLY City of Tigard Date/By , --- " V ► e ' ermit No" 7i ►P• V -/U t.
v 13125 SW Hall Blvd., Tigard, OR 97223 ET( 0 I=, 2006 Plan Review
' ' C Phone: 503.639.4171 Fax: 503.598" 1960 l' 0 Dates " Other Permit:
Ti G A R D Inspection Line: 503.639.4175 (���� Date Read /B ® See Page 2 for
Internet: www.tigard- or.gov CITY OF Notified/Method: Supplemental Information
g L�NG D%VIS O .
TYPE OF W R PLAN REVIEW
❑ New construction R Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
.ry
W es - 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.: 1 Job site address: (� / d IOOHP or more. occupancy.
2 b 7 so,...) / I b�� *OF ❑S ix or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP• 7 1 car op, 9 - 7 2_ 2_3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: p O - E ,' ,. L v ` ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Des 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
CI r C_. �. `t' - ^ pk_ k -t 5 - residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
C3 O "‘-'\ 200 amps or less 80.30 2
- Ea PROPERTY OWNER 0' TENANT - 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: O — i L k,,k 601 amps to 1,000 amps 240.60 2
Address: I Z C L y SW - (‘ ,(z* cAki 2 . Over 1,000 amps or volts 454.65 2
City/ State/ZIP: `� ", c,. Z 2 3 Temporary services or feeders installation, alteration, and /or
+ relocation
Phone: ( ) I 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
- m❑ APPLICANT I ❑ CONTACT' PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 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
/� 1 Signal circuit(s) or limited -
Business name:
LT O rc \� c_-\- T C energy panel, alteration, or
Address: c_ O , OX ? c S , extension. Describe: Page 2 2
City /State/ZIP: t--)- op 1 R.. eD 9' 0 3 , Each additional inspection over allowable in any of the above
(5-,-11 ) 3 F - Z `i O ( t) Per inspection 62.50
Phone: I Fax: S`i 3 � .� y ti u Investigation per hour (1 hr min) 62.50
CCB Lic.: 1 l l 70 (: I Electrical Lic.: I L' - Z c C_ I Suprv. Lic.: `-i i y (, 5 Industrial plant per hour 73.75
• ELECTRICAL PERMIT' FEES
Suprv. Electrician signature, required: / �T Subtotal: 46 ,
Print name: O 6 C 1a _ I Date: / Z- kj Plan review (25% of permit fee):
State surcharge (8% of permit fee): 3. - 7 S
Authorized signature: /Z___, D (�,, TOTAL PERMIT FEE: S O _ , , 0
Print name: A ' Z
Date: � - CA —C3� This permit application expires if a permit is not obtained within 180
GE f t-1 + --J days after it has been accepted as complete.
• Number of inspections allowed per permit.
C \Building\ Permits\ ELC- PermitApp "doc 05/23/06 440- 4615T(11/05/COM /WEB
Electrical Permit Application - City of Tigard ' • r {
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
;RES'IENTI.
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- PermitApp doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006-00686
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/412006
Phone: (503) 639-4171
Jill
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 21712007 TIME: 7:01AM PAGE: 39 •
SITE ADDRESS: 12664 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'StEEN LOT #: 018 TYPE OF USE:
PROJECT NAME: GEWILICH
DESCRIPTION: (1) branch circuit for SUfirM11.
OWNER: GENIUCH, RON PHONE #: 503-579-4633
CONTRACTOR: GORGE ELECTRIC INC PHONE #: 541-386-2468
Inspection Request Scheduled For: Date: 2/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 043075-01 503-580-7822
Corrections/Comments/Instructions:
SO) llt ON L
A PASS PARTIAL APPROVAL fl CANCEL 0 NO ACCESS
H FAIL I I CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G NOG Date: '1 Phone #: (503) 718- 2414
CITY OF TIGARD
BUILDING DIVISION F PERMIT #: E1.t12006 00686
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: /214/2006
Phone: (503) 639-4171 °"1111,410I '
.'�
' Inspection Requests (24 Hrs.): (503) 639 -4175 L ..
INSPECTION WORKSHEET FOR DATE: 2/2/2007 TIME: 7 :03AM PAGE: 74
SITE ADDRESS: 12664 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 01B TYPE OF USE:
PROJECT NAME: GENIUCH
DESCRIPTION: (1) branch circuit for sunroom.
OWNER: GENIUCH, RON PHONE #: 503- 6794633
CONTRACTOR: GORGE ELECTRIC INC PHONE #: 541-386-2468
Inspection Request Scheduled For: Date: 2/2/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 042881 -01 603.522 -4686 h!
Corrections /Comments / Instructions:
PAN
I b
I PASS I I PARTIAL APPROVAL ❑ CANCEL ‘. 71\1O ACCESS
>SFAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: V * Ng6 �� Date: 1 0 Z, Phone #: (503) 718 - 2.1-Vib
CITY OF TIGARD .
BUILDING DIVISION ,., , ..
„. PERMIT #: ELC2006-00686
13125 SW Hall Blvd., Tigard, OR 97223 ' ”" DATE ISSUED: 12/4/2006
Phone: (503) 639-4171 Ilrigtil
Inspection Requests (24 Hrs.): (503) 639-4175 ...„......W ii.
INSPECTION WORKSHEET FOR DATE: 12/6/2006 TIME: 7:01AM PAGE: 4
SITE ADDRESS: 12884 SW 116TH AVE CLASS OF WORK:
SUBDIVISION: HUNTER'S GLEN LOT #: 018 TYPE OF USE:
PROJECT NAME: GENIUCH
DESCRIPTION: (1) branch circuit for sunroom.
OWNER: GENIUCH, RON PHONE #: 503-579-4633
CONTRACTOR: GORGE ELECTRIC INC yy\A RK, , , PHONE #: 541-386-2468
Inspection Request Scheduled For: Date: 1216/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
126 i'lnrover c?-5 - 1 N 040746-01 603-622-4686 V
R-0 Oa_ C-b1■21cL
Corrections/Comments/instructions:
1 ARQ G L- 61 a Ziqi—{
.........
'411 Its.M.. .. 111W A , ill■AA 'J% r illb' . :w_ Alt
tIfflitt-. • A ( . W _VMA I NSWINIMAILIII
...,
1 w
IL litho.- ittik.--0 iit• ..,,...ftkAik 4.
7‘1_,,,\WINIONMEMIIILI
A .
c._
OPP ,
r-
\(O f2 11,)Fta_vm i 4.
n
ja PASS I I PARTIAL APPROVAL r CANCEL Li NO ACCESS
rAiir.411 .ar L FOR INSPECTION n ADDITIONAL FEES ASSESSED
. .
Inspector: c----Ai N oe Lti Date: I -1 ‘i 0 Phone #: (503) 718-