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Permit
rl CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00398 T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/15/2011 Parcel: 2S 111 DB02600 Jurisdiction: Tigard Site address: 15435 SW ALDERBROOK CIR Project: Earl Subdivision: Lot: Project Description: (1) 200 amp or less service panel and (1) branch circuit for microwave Contractor: NORTH LAKE CONTRACTORS Owner: EARL, HELEN L 12900 NW LOVEJOY CT 15435 SW ALDERBROOK CIR PORTLAND, OR 97229 TIGARD, OR 97224 PHONE: 503 - 709 -0985 PHONE: FAX: 503 - 641 -3168 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 07/15/2011 $100.70 Specifics: amps or less 1 crt Branch Circuits w /Purchase 07/15/2011 $7.42 Type of Use: SF Service or Feeder Class of Work: ALT 1 ea 12% State Surcharge - 07/15/2011 $12.97 Electrical Type of Const: Occupancy Grp: Total $121.09 Required Items and Reports (Conditions) This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the 180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 9 2- -B 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: Permittee Signature: /1/s/ // / /�'e9-�d 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' Date: LICENSE NO. Call 503.639.4175 by 7:00 a.m. for the next available inspection date. 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. Jul 15 11 05:50a p.2 Electrical Permit Applicati' • I . H,CEIVED • . FOR O E isF ONLY d ` - - - City of Tigard Received ��J /�, Permit No.6 aft -Op3 qdro 13125 SW Hall Blvd., Tigard,OR 972L 15 2011 Plan Review Phone: 503.718.2439 Fax 503.598.1960 DateBy: ChherPermit: Inspection Line: 503.639.4175 Date Ready/By: orris r ® See Page 2 for TIGARD Internet: www.tigard- or.gov C ITY OF TIGARD N o tifi ed.'Method: Supplemental Information TYPE MI NG DIVISION PLAN REVIEW Q New construction jgAdditionlalteration /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 g 1- 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 , "I - ", ` 1 - . r IOOHP or more. occupancy. Job no.: Job site address: �1 3� .$ 4 L.b€ f3 �pC?l� ❑six or more residential units. ❑ Recreational vehicle parks. ✓ ,. ` �- ❑ Health -care facilities, 0 Supply voltage Cm-more than City /State./ "LIP: / 6,4-M ©� 7 25/ R at= t El Hazardous locators. 600 volts nominal. Suite/bldg. /apt. no.: f Project name: IIII 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description 1 Qtr. I Fee. I Total 1 • _ New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: • Lot no.: 1,000 sq. ft. or less 168.54 4 - Ea, add'I 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. ft.) 75.00 2 Limited energy, multi- family 7500 2 15 A f AttJ E'L t4 ,4 ACC' rn tcs.ocAirANiCce R t rr' residential (with above sq. ft.) i Services or feeders installation, alteration, and/or relocation 200 amps or less / 100.70 619710 2 ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2 Al 401 amps to 600 amps 200.34 2 L Name: C ( 4 t — N 601 amps to 1,000 amps 301,04 2 Address: --C Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City/State /ZIP: relocation Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2 Branch circuits- new, alteration, or extension, per panel Owner signature: Date: A. Fee for branch circuits with ❑ APPLICAr T ❑ CONTACT PERSON I above service or feeder fee, j I each branch circuit i' 7.42 7 ti`T.' 2 Business name: B. Fee for branch circuits without service or feeder fee, fist 56.18 2 Contact name: branch circuit Each add'! branch circuit 7.42 2 Address: _ Miscellaneous (service or feeder not included) City/State ZiP Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 Pump or irr;gation circle 67.84 2 E -mail: Sign or outline lighting 67.84 . 2 CONTRACTOR Signal circuit(s) or limited - energy panel, alteration, or extension. Page 2 2 Business name: f vf,,(Zia LAKE' Co p/ At:T.0a r Each additional inspection over allowable in any of the above .Address: [ 2-i O &AI LA) [' L v C m+ -- Additional inspection (I hr min) 66.25/ hr _ Investigation (1 hr min) 66.25/ hr City/State/ZIP: P( (O � 47 industrialplant(1 hrmin) 78.18/hr Phone: (o-5'o3 D 9 , � 225 Fax: ( ) lit I I �3 Inspections for which no fee is 90.001 hr 7 ` 1 I 1 /0 - specifically listed ('h hr min) 1 CCB Lic.: f 1./ i 7 q Electrical Lie.: ( t 3 l Suprv. Lie.: L (Cl' ELECTRICAL PERMIT FEES / / !J Subtotal: j OR , (2_ Suprv. Electrician signature, required Z. W LLL Cwv„,, Plan review (25% of permit fee): Print name: (, W T t r Date: _, I , l State surcharge (12% of permit fee): ( , 97 ` TOTAL PERMIT F `it , 07 • 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: * Number of inspections allowed per permit. 11 Building 'Pernits'ELC- PennitApp.dec 07/01/10 420.46151(1 t/O5'COM/WEB City of Tigard Tel: 503.718.2439 Location: Inspection Date: 15435 SW ALDERBROOK CIR, TIGARD, OR, 97224 Record Type: Record ID: Residential - Electrical ELC2011 -00398 Inspection Type: Inspector: 199 Electrical final David Young Result: PASS - NoCofO Comments: Supplemental grounding installed. Violation Summary: Inspector Contractor