Permit f �i ,� CITY OF TIGARD, ELECTRICAL PERMIT
PERMIT #: ELC2006 -00719
:, : . „_
COMMUNITY DEVELOPMENT DATE ISSUED: 12!19/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S133DD -01000
SITE ADDRESS: 11747 SW 129TH PL ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT : 049 JURISDICTION: TIG
Project Description: Service and 7 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: 1 W /SERVICE OR FEEDER: 7 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
TRACEY BUNCH TICE ELECTRIC
117474 SW 129TH PL. PO BOX 15009
TIGARD, OR 97223 PORTLAND, OR 97293 -5009
Phone: 503 - 590 -8043 Contact #: FAX 503 - 872 -8290
PRI 503 - 233 -8801
FEES
Description Date Amount Reg #: ELE 26 -126C
[ELPRMT] ELC Permit 12/19/200( $126.85 LIC 166
[TAX] 8% State Surcharge 12/19/200( $10.15 SUP 25865
Total $137.00 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: �C i.�- cAJ�W U Permittee Signature: Ca-1 j r ` o � i —� ' ( �
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.
Mectrical Permit rip 1i at'oz�
City of Tigard hi 1 0 R...d RR i
pate/By: /� (o_ i ci W � PernlitNp. 6 - 6 7 7 9
/
13125 SW Hall Blvd., Tigard, OR 97223 9 Plan Review
Phone: 503.639,4171 Fax: 503,598,1960�EC 1 9 2006 - h, . ,r, , . r y'.l `r-t, i �'' 2�at�B : Other Perrttit:
Inspection Line: 503.639.4175 . `•' Date R adyBy: laris: RI See Page 2 for W
Internet: www.ci.iigatd.oe.us CITY OF -WARD Notified/Method: Infor Ludo a ^w
_ ) a a .. S '. PLAN REVIEW
❑ New construction ,,,,,H on/alteration/rsplaeement k'lcasc check all that apply:
❑ Demolition ❑ Other;
0 Service over 225 amps, cornm'l Dlazardous location
E — ❑ Service over 320 amps -- rating ❑Builting over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
K4 I - and 2- family dwelling r] Commercial/industrial [] Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi ❑Building over three stories ❑Feeders, 400 amps or more
❑M aster builder ❑Other: ❑Occupant load over 99 persons ❑lvianufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
❑,Flealtb - care facility ❑Other:
Job no„ 80.175 9 Job site address; 1 1 74 7 SW 129th Place Submit 2„ sets of plans with any of the above,
City /State/ZTP: Tigard, OR 972 2 3 The above are not applicable to temporary construction service.
FEE* SCIXEDULE
Suite/bldg. /apt. no.: Project name; Bunch pescrsptlpp I Qty- I tree. 1 Total 1 ••
Cross street/directions to job site: New residential single- or multi- family dwelling unit.
Includes attached garage.
• 1,000 sq. ft, or less 145,15 4
Subdivision: Lot no,: Ea. add'l 500 sq. ft. or portion 33.40 1
. - - Limited energy, residential 75,00 _ 2
Tax reap /parcel no.: Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK • Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Remo del k i tchen / li ving room Services or feeders installation, alteration, and /or relocation
200 amps or less 1 80.30 S • • 2
201 amps to 400 amps 106.85 2
12:1 PROPERTY OWNER I ❑ TENANT 401 snips to 600 amps 160.60 2
Name: Tracey Bunch 601 ampato 1,000amps — _240.60 2
Address: 1 1 7 47 SW 1 29th Place Over 1,000 amps or volts 454,65 2
Reconnect only 66.85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone' (0 3 ) 59 0 — 8 04 3 Fax: ( ) . 200 an pa or less 66.85 i
Ow 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 600 amps 133.75 2
Owner signature: Date: w Branch circuits — new, alteration, or extensio per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with ' 7 46.55
service or feeder fee, each
6.65 2
Business name: branch circuit
"" B. Fee for branch circuits
M Contact name: without service or feeder fee, 46.85 2
each branch circuit
Address: Each add'l branch circuit 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 -
CONTRA,CTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Tice Electric Co _
Address: 5405 N Lagoon Avenue Each additional inspection over allowable in any of the above
Per inspection 62.50
_
City /State /ZIP: Portland, Oregon 97217 Investigation per how (1krrtdn) 62.50 —
Phone: ( 503) 233 -8801 Fa (503 ) 872 -8290 Industrial plant per hour _ 73.75
ELECTRICAL PEIttvx.IT FEES* _
CCB Lic.: 166 I j Electrical Lie.: 26 - 26C Suprv. Lic.: 25865 Subtotal 126 - 8 5
Suprv. Electrician signature, required: /If e e / Plan review (25% of permit fee)
Print name: John J. Maloney loney y Datc; 1 2 / 9 / 0 6 Stat surcharge (8% of permit fee) 1 0 . 1 5
_ „_.
TOTAL PERMIT NEE 13 7. 00
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: I Date: • Fee methodology set by TYi- County Building industry Service Board
ttt *" Number of inspection& per permit allowed,
is` \21_C- I'credtAIM,a0c 17/03 440-4615T(10/02/CONLWEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005r00719
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 12/19/2006
Phone: (503) 639-4171
Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 31/5/2007 TIME: 7:01Aivi PAGE: 80
SITE ADDRESS: 11747 SW 129TH PL CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 2 LOT #: 049 TYPE OF USE:
PROJECT NAME: BUNCH
DESCRIPTION: Service and 7 branch circuits.
OWNER: BUNCH, TRACEY PHONE #: 503.5908043
CONTRACTOR: TICE ELECTRIC PHONE #: 503 - 233 -8801
Inspection Request Scheduled For: Date: 3/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 044827 -01 503 - 341 -7302 N
Corrections /Comments / Instructions:
.(
PASS I I PARTIAL APPROVAL I I CANCEL PI NO ACCESS
I I FAIL n CALL FOR INSPE( I n ADDITIONAL FEES ASSESSED
Inspector: ` 69 31-E - AdL, Date: 3 I� On Phone #: (503) 718 -
I i