Permit CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT #: ELC2007-00317
COMMUNITY DEVELOPMENT DATE ISSUED: 5/9/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S109AD -00700
SITE ADDRESS: 14545 SW 126TH AVE ZONING: R -7
SUBDIVISION: BLUE RIDGE LOT : 007 JURISDICTION: TIG
PROJECT: MCCULLOUGH
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:
MELAINIE MCCULLOUGH D & L ELECTRIC INC
14545 SW 126TH AVE PO BOX 367
TIGARD, OR 97223 WEST LINN, OR 97068
Phone: 503 - 624 -9150 Contact #: PRI 503- 656 -5623
FAX 503 - 650 -1918
FEES
Description Date Amount Reg #: ELE 3 -161C
[ELPRMT] ELC Permit 5/9/2007 $53.50 LIC 88069
[TAX] 8% State Surcharge 5/9/2007 $4.28 SUP 2662S
Total $57.78 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 throu.h OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUN .:t 503.246` 1'699 0 1.800.332.2344.
I
Issued By: I / . Permittee Signature: _ .,l ribll■ ,
OWNER INSTALLATION ONLY I
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.
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Electrical Pe ico_14-ppjictt ion . FOROFFICE USE ONLY . . -. '• • ,
Received .„..-- 46 Electrica 4/
V C Date/By:
C / / Sign
C • of Tigard MAY - Planning Appro 9 2007 al
Date/By:
Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 UIL
CITY° Permit I F T/GARD Date/By: Peit No.:
B
Phone: 503-639-4171 Fax: RR3QPINNON Post-Review Land Use
Atrotlihipai A Date/By: Case No.:
Internet: www.ci.tigard.or.us cA11■ I Contact Juris.: El See Page 2 for
24-hour Inspection Request: 503-639-4175 "--"' ' Name/Method: " Supplemental Information.
gf;Z:UMWES:=5:4AOTYPE5OP,VOlitag&TANAIBRIa2 WitianTOANIgEYWW:AtlaWitreWrilritriakilMegatdaA
0 New construction El Demolition 0 Service over 225 amps- 1:1 Health-care facility
commercial El Hazardous location
0 Addition/alteration/replacement El Other: 0 Service over 320 amps-rating of 0 Building over 10,000 square feet,
0-sq1040'-1.2210A1RE-70,00KOVIONSTRUOTTOIN:AratifiZet 1 & 2 family dwellings four or more residential units in
1 & 2-Family dwelling El Commercial/Industrial 0 System over 600 volts nominal one structure
0 Building over three stories 0 Feeders, 400 amps or more
0 Accessory Building 0 Multi-Family 0 Occupant load over 99 persons 0 Manufactured structures or RV park
0 Master Builder 0 Other: 0 Egress/lighting plan 0 Other:
.i."2eaftn30131:grtglINEWRIVE4,140110tti.WATIONINAVig Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /Vs vs' 561.1 /2Z 4i 6" t'iT:::: ::TMilatMl11tkif$01ttiatnUitikantatinfafe
Suite #: Bldg./Apt.#: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
New residential-single or multi-family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map/parcel # Each manufactured home or modular dwelling
ritAltniattal-naj,S.:00,TIONIORWORIOFCCIP.4"qt&V service and/or feeder 90.90 2
.. Services or feeders - installation, •
'174,0 0 LI 7 i i? e 6 A /I, /.7 alteration or relocation:
200 amps or less 80.30 2
7 "2.-e...-t 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
AgtitOOMMOWINUMEA t tai 010,0RIIM4rtei, 6 Over amps to 1000 amps 240.60 2
ver 1000 amps or volts 454.65 2
Name: rn,..014,v4 / Reconnect only 66.85 2
Address:j '/5 , 's' .5/A1 /2..4 i-i.v.e' Temporary services or feeders - installation,
alteration, or relocation:
City/State/Zip: l'? a,/t A' e , 77 2,z.3 200 amps or less 66.85 1
Phone: ‘2, i - q/ 5-6 Fax: 201 amps to 400 amps 100.30 2
. _ . . _. 401 to 600 amps 133.75 2
: qi' In iO--ONMilrFalg-.- Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit i 6.65
.-.
City/State/Zip: B. Fee for branch circuits without purchase of / 13
service or feeder fee, first branch circuit / 46.85 Q b' ' - 2
Phone: Fax: Each additional branch circuit 6.65 2
E-mail: • Misc.(Service or feeder not included):
Fa h pump or irrigation circle
alringERINSINCONIM.VOCRSIMFMaiaME -- "E a c c h - • • • 53.40 2
sign or outline lighting 53.40 2
Job No: - Signal circuit(s) or a limited energy panel,
Business Name: 2g1, 6" , _ alteration, or extension ' Page 2 2
ie - E"he-IX)4,- --4." Description:
Address: ,d. 4 96t4e ,3 4 '7
- Each additional inspection over the allowable in any of the above:
City/State/Zip: ,GC$,' 6,,,_i ,940_ 5 7 c) Ce Per inspection per hour (mm. 1 hour) 62.50
Phone: 5a-s6 Fax: 45--b-/.7./ - i3 Investigation fee:
CCB Lic. #: b 61 Lic. #: g-/e../6 Other:
' tat,ATAttkTd.tVetiia_tiPi7OTlittifA__W.atWe
Supervising electriciah . Subtotal $ 5" 3 ,
...
signature required: i f , , / .,---- . Plan Review (25% of Permit Fee) _ $ :-----,
Print Name04/4, / . Z Lic. #....24<-6 _ State Surcharge (8% of Permit Fee) $ 1 1.- V
TOTAL PERMIT FEE $ s 7. - 70
Authorized ,- Notice: This permit application expires if a permit is not obtained within
Signature: ---' f 0. Date:
A 180 days after it has been accepted as complete.
*Fee methodology set.by Tri-County Building Industry Service Board.
(Please print name)
i: \ Dsts \Permit Forms \EIcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2.= Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
n Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
n Heating, Ventilation and Air Conditioning System
n Vacuum Systems
ri Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
El Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation
n Fire Alarm Installation •
n HVAC
EI Instrumentation
Intercom and Paging Systems
n Landscape Irrigation Control
n Medical
n Nurse Calls
n Outdoor Landscape Lighting
n Protective Signaling
IT Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forins\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD
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BUILDING DIVISION t PERMIT #: ELC2007 -00317
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/9/2007
Phone: (503) 639 -4171 ;���n�4�,�i ^� +
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 5/2512007 TIME: 7:17AM PAGE: 58
SITE ADDRESS: 14545 SW 126TH AVE CLASS OF WORK:
SUBDIVISION: BLUE RIDGE LOT #: 007 TYPE OF USE:
PROJECT NAME: MCCULLOUGH
DESCRIPTION: 2 branch circuits.
OWNER: MCCULLOUGH. MELAINIE PHONE #: 503 - 624 -9150
CONTRACTOR: D & L ELECTRIC INC PHONE #: 503-656-5623
Inspection Request Scheduled For: Date: 5/25/2007 Pour Time:
Code # Inspection Description Confirm • Contact # Message
199 Electrical final 049048-01 50. • .4-9150 N
Corrections /Comments /Instructions:
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d PASS I PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: I‘ '68 Lg
Date: S` Al On Phone #: (503) 718- 1.--144L
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CITY OF TIGARD
BUILDING DIVISION PERMIT #: E.Lk.;200/ i30:T'i?
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 5/9M0/
Phone: (503) 639 -4 ' ,I •
. 'Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR - - 'DATE_: 5/ /4/2007 TIME: 7 :01AM PAGE:
SITE_ADDRESS: '14645 :.1R/ 126TH AVE CLASS OF WORK:
BLUE RID 007
SUBDIVISION" LOT #: TYPE OF USE:
PROJECT NAME: MCCULLOUGH
DESCRIPTION: 2 branch circuits.
OWNER: MCUULLQyGH, I EL AIN!E PHONE #: 503-04
CONTRACTOR:
FD & L. E:LITCTRIC INC \ PHONE #: 603- C 66 • 5623
Inspection Request Scheduled For: Date: 5/14 /2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 Underground * J. 040181.01 505 -656 -562:3 Y t.\
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Corrections /Comments /Instructions:
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:SS , PARL APPROVAL__.) CANCEL n NO ACCESS
FAIL 14 L FORK -I .: SPECTION n ADDITIONAL FEES-
Inspector: �' , Date: Phone #: (503) 718 (