Permit CITY OF TIGARD ELECTRICAL PERMIT
°
PERMIT D: ELC2008-00526
COMMUNITY DEVELOPMENT
DATE ISSUED: 9/10/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S134CD -03200
SITE ADDRESS: 12055 SW 119TH AVE ZONING: R -4.5
SUBDIVISION: LERON HEIGHTS NO.3 LOT : 067 JURISDICTION: TIG
PROJECT: COUNTRYWIDE
Project Description: Reconnect only.
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: SIGNAUPANEL:
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
COUNTRYWIDE HOME LOAN, INC.
12055 SW 119TH AVE
TIGARD, OR 97223
Phone: 503 - 539 -3675 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 9/10/2008 $66.85
[TAX] 12% State Surchar 9/10/2008 $8.02
Total $74.87 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.
Sep 10 08 09:41a Ronald E. Popick 5035903874 p.1
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• tON
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RECEWED
` � Electrical Permit Application Current Planning
Washington County, 155 N. l AV, Suite 350 12 OR 97124,
C ( *rex& t Phone: 503 - 846 -3470, Fax: 503 -846 -3993, 1�0 ll � P # E_/-C,,/car —
�� Inspection Requests: 503- 846 -3699, ww�, (` 0
TYPE OF WORK ON PLAN REVIEW
ID New construction ID Additiotv'alteration /replacement t er: VISI Please chock all that apply:
❑ Service or feeder 400 amps ❑ Hazardous locations
CATEGORY OF CONSTRUCTION or more where the available Service foxier ier600ampsormore
fault current exceeds ❑ Building over three stories
[2g 1 - and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or❑ Ivtarinas and boatyards
less to ground, . exceeds ❑ Floating buildings
❑ Multi family ❑ Master builder CI Other.
14,000 amps for r all other
JOB SITE INFORMATION AND LOCATION installations ❑ Commercial -use agricultura
0 Fire pump buildings
Job no.: Job address: 12055 SW 11 9th Av ❑ installation of 150 K`r'Aorlarger
❑ Emergency system separably derived system
CiTy.'State /Z1P: Tigard, , �R 972 ❑ Additi o f new motor
4 :I "A . • , E, „- •I "1-3 occupancy
load of iOUHP or more
Suite /bldg-/apt- no.: Project namee ��}/ . I 71 ❑ Recreational vehicle parks
j ❑ S :xormor' re identialunits
❑ Health -care facilities ❑Supply voltage for more Than
Cross street/directions to job site: Katherine 600 volts pout nal
FEE SCHEDULE
Description I Qty. I Fee 'total " '
S HEIGHTS 03 Lot no.: 67 Residential singles or multi - family dwelling unit.
Includes attached garage.
Tax map /parcel no.: 1,000 sq. ft or less '53.00 4
DESCRIPTION OF WORK Ea. add'I 500sq. 9. or portion _ 43.00
Limited energy, re 2
Site inspection 61.00
p (with above sq. R.)
Limited energy, multi - family
2
residential twnh above sq. It) 67.00
Q PROPERTY OWNER I ❑ TENANT Services or feeders installation, alteration, and /or relocation
Name: 200 amps or less I 92.00 2
Countrywide Home Loan, Inc. _ 201 amps to 400 amps 122.00 2
Address: 12 0 55 SW 119th Av 401 amps to 600 amps � 1 44.00 2
Ciry. /StatelZlP 60 t amps to 1,000 amps 275.00 2
T igard, OR 97223 Over 1,000 amps or volts 514.00 I 2
Phone: (5 0 3) 539 Fax: ( 503) 590-3874 Temporary services or feeders installation, alteration, and/or
relocation
Owner installation: This install: ' : u• ode • - meas. 'or fa.. roperty owned by me or a member of 200 amps or less 79,50 2
my immediate family. roperty is .. Int- led for sat §a / rent (ORS 479.540(1 - ad 4'9.560(1).
201 amps to 400 amps 110.00 I 2
Owner signs e: .411a.:0"...-
ey Date: 401 amps to 599 amps 153.00 I 2
n APPLICANT I ❑ CONTACT PERSON Brooch circuits - new, alteration, or extension, per panel
A. Fcc for branch circuit, with l
Business name: above service or feeder foe, tt.`15
each branch circuit 2
Contact name: Ronald Po pick p B. Fcc for branch circuits
without service or feeder 61.00
Address: 12995 SW Pacific Hwy. _ fee. first branch circuit 1
City /Stare/z1P: Tigard, OR' 97223 Each acd'1 branch circuit 8.75
Miscellaneous (service or feeder not included)
Phone: (503) 539 -3674 I Fax: (503) 590 -3874 Each manufactured or modular '
E - mail: popick @coho.net
dwelling, service, and,'or feeder 104.01/
Reconnect only -�/ 7950 1f .07I
ONTRACTOR Pump or irrigation circle 61.00 2
Business name: Sign or outline lighting 61.00 2
Signal circuitlsl or limited -
Address: energy panel, alteration, or
City /State /ZIP:
extension. Describe: 61'00
Phone: ( ) Fax: ( ) Each additional inspection over allowable in any of the above
Per inspection 90
E -mail: CCB lie. no.: Investigation fee (Seccompli;m_c) '
Electrical lie. no.: City or metro lic.: Othe /
Supervising electrician ELECTRICAL PERMIT FEES Cpl .k5
signature, required: Subtotal . 3-9-:-S-e' 9/ �
a
Print name: I Date: Plan review (25% of permit fee) - 18.88 $'
1 Authorized State surcharge (12% of per $
mit fee} 0 5
signature: TOTAL PERMIT FEE i .1-
Print name: This permit application expires if a permit is not obtained
Date: within 180 days after it has been accepted as complete / (/
`Number of inspections allowed per penult Revision 6108 7 '-'•� •
•
CITY OF TIGARD
BUILDING DIVISION
. .. A
PERMIT #: ELC2008- 0t)626
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/10/2008
Phone: (503) 639 -4171 : " Inspection Requests (24 Hrs.): (503) 639 -4175 :_..
INSPECTION WORKSHEET FOR DATE: 9117/200B TIME: 7:00AM PAGE: 27
SITE ADDRESS: 12055 SW 119TH AVE CLASS OF WORK:
SUBDIVISION: LERON HEIGHTS NO.3' LOT #: 067 TYPE OF USE:
PROJECT NAME: COUNTRYWIDE
DESCRIPTION: Reconnect only.
OWNER: COUNTRYWIDE HOME LOAN, INC., PHONE #: 501539 -3575
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 9/17/ 2008 Pour Time:
Code # Inspection Description Confi #�, Contact # \ssage
115 Electrical service 076549 -01 501539-3675 Y
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❑ PASS ❑ PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
11 FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: GM Iv be Date: Ifilt Phone #: (503) 718- 7-9111