Permit CITY OF TIGARD ELECTRICAL PERMIT
II
PERMIT #: E101-/C225/°2°070-700729 COMMUNITY DEVELOPMENT DATE ISSUED: 10/25/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 103 D B -06600
SITE ADDRESS: 11320 SW AMBIANCE PL ZONING: R -4.5
SUBDIVISION: GENESIS NO. 2 LOT: 020 JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: Replace main electrical panel.
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: 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:
BRIAN T. ANDERSON OWNER
11320 SW AMBIANCE PL
TIGARD, OR 97223
Phone: 503 - 963 -0055 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 10/25/200" $80.30
[TAX] 8% State Surcharge 10/25/200" $6.42
Total $86.72 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will • - 'one in aZto.P0ance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more . an 180 days. ATTE 10 . aregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR •52- 001 -0010 through S 952-11 -0100. You may obtain copies of these rules or direct que 'ins tobU at 503.246.6699 or 1,800.332.2344.
Iss -d By: /` Permittee S / , r�/ ,, ,
OWNER INSTALLATION ONLY
The installation is being made on roperty I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: " WA M:. 4—" DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
—±,.....
503 685 4324' Line 1 1 1:28:04 a.m. 10 -25 -2007 2 /3
Electrical Permit Applica' B CE JE , ,} FOR OFFICE USE ONLY
City of Tigard r Received
I • l . T eD /' i i / nJ Lj�4i� Permit No -: I7 /0 7 1
Date/B . � GC
13125 SW Hall Blvd., Tigard, OR 97223 plan Review
1. .. Phone: 503.639.4171 Fax: 503 5P$- 9.f. 6 IGRHD Date/13 . Other Permit:
T I G A R D Inspection Line: 503.639.41761 t Date Ready/By: 1 See Page 2 for
Internet: www.tigard- or.gov 'wit NG®BU'kI®i' Notified/Method: Supplemental Information
'; ^� .1k` "! w"§:. -. _ 'S`% F,. _ `v':Fi: ,Did ..A- ^} "�tv. •'.;aAS: -�^ reriX • -
'x -`f... 1, -s�;� - �rr� -
x. �,:_Yta` E -R'_; {/;�., .=i� •,x,.�• � 1,.x,r _ �,'`.�
4d � i:'; _O F. WORR . ,r°.�` "tY � q F �y `l�„1
�`- a:...._..e.. -sr.:` � �: - •fns„ ;e. � PL�ALN' -•
❑ New construction ® Addition/alteration/replacement ,W Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El ❑ Other:
` l , _ � Demolition where the available fault current 1:1 Marinas and boatyards.
• :iSk;;" b . °::,a':- r:�,a. Fktfc"2� - - - - - - - - - - ;i r::i:
- - ,r, =" _ � '. � -� l - :? ice;';. - .`s -��`_- - exceeds 10 000
,� >�.. ;��: -e.•. z, =� „� -r s: ; -�.. ,C�TE�iORY OF. � . a� :t,; :r' #= amps 150 volts or Floating buildings.
... ...:. ��:: t�t4� , ,.........__. .- CO1VS``fRTJCT!ION.;<., '• : -,�;> r�..� , P ❑ abn buildin
tpF,e #~ ' ” less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
IS 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
El Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.° _'r xfi -..- :: y ,: .d _ :: ;_ — ❑ Emergency s rem.
larger se separately derived system.
,, �,d , - ...,,.r _ n??h ? � f�, � i '` v -�. - ;i _ Ys P Y Y
:,i x ,,: ;: .> OB SITE
r :,,, J. 1 OR M AT101V= ANDLO'GATION ` -
,...,.:�av -:,� .,..au'>if.._ ,._.- ..4_v.z,�,. >.. = c,'?�_, ; .. ._ _ - , . -. ,.....�: ,<.,- ,.<._..es +;.'.'�;_.....' r -3':� 3s .,. 0 Addition of new motor load of „ _
Job no.: Job site address: 11320 SW Ambiance Place 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks -
City /State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Anderson Main Electrical ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Gaarde to 115 (R), Right on Genisis =D escription s - ee :,- 3. `° .• ... Qty. � F Fee. . ' { I Total F,::c
l
Loop, 2° Left on to Amibance Place (Second house on the left) New residential single or multi - family dwelling unit.
Includes attached garage.
Subdivision: Genisis #2 Lot no.: 20 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: R09984'79
Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
'` ., - new ,-��5i :F. , D v CRI I�`:�s "en-c• : 6, - a ,.:, .„ 75.00 2
��Ci�hsx ...,..sr..�' .z;�.3•,>y_..,.;,,�',., �,.., O�� <s- .,:.F�WORICr: %.., ` -- � _,, �``t:'r
'�i'�` >ii'�' (with above sq. ft.)
Limited energy, multi - family
Replace Main Electrical Panel residential (with above sq. ft.) 75'00 2
Services or feeders installation, alteration, and/or relocation
-r. : rr •::N <. :,- - 200 amps or less 1 80.30 80.30 2
tgk ?'r.,,'-ltOl?ER''PY O ER:. : - ; ._, .. Y : :,.
. <<;x�•:.r: „ .
'•. ®�,,., .,,.. �.�. - .x ; .�- sTENA: „ ti;1;<: 1;:a3 201 am ps ..,.H:.x >,. - ._. -._ ,.. -. , . ,,.. >a,;',... -. >.. •._ ........ .. :..:.'_....� , ,_ .. P 0400 amps 106.85 2
Name: Brian T. Anderson 401 amps to 600 amps 160.60 2
. 601 amps to 1,000 amps 240.60 2
Address: 11320 SW Ambiance Place Over 1,000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)963 -0055 Fax: (93 ) d3 5 - qo 2[./ 200 amps or less 66.85 1
Owner installation• is installation is being made on property that I own whi ch is not 201 amps to 400 amps 100.30 2
intended for sale, Ifa or a h. _e, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
i / Z 5 / Z Branch circuits - new, alteration, or extension, per panel
Owner signat r�
- D
, h : e:. p: r, ,';, < ., h : -� e; s,: 1 .k F: „ • , A. Fee for branch circuits with
. { 3' ^++�3„ .-<•.- ;3:✓,5� ' }:,5. _ ..,,�,^,, t,,.::aY `, "H,Ja'a i.Y'i -v`- �/i�'(.'' ^,`:
.g -: r;` =-:a P TCAN'C:e p ''' _ : >. f$I ..CONtTAG1.P RSON � ,. it above service or feeder fee
:... _ .,- ,- ...._: ...F ............... ....< „� ...r. 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'! branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular '
dwelling, service and /or feeder
Phone: 90'90 2
( ) Fax: ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
ti:% '== ki''�l'�rsu: ^,.;;s?:; ftF? _ ' 'r:�t ::iy. � _ . t,to-S
.vim +-sit,,, z.d_kgifg ;'.ii'.ix. '`v .4 ,.,r.y:,a.�t-f''.:.l i:?a- '=.`-i_.1_.,, -3
Sign or outlineligh
h „- ;,a; „ <r::i.a..�t,..._.,.:d =: lt Signal circuit(s) or � .. : >I:,,, ? ;.� lighting 53
lim limited-
r .40 2
Business name: energy panel, alteration, o
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
M.MIARMAILteliXteWatatfrAIEWAVAZW4g4R
Suprv. Electrician signature, required: Subtotal: 80.30
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 86.72
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit. •
I:1Building\Pern its\ELC- PensitApp.doc 0523/06 440-4615T(11/05/COM/WEB
CITY OF TIGARD
BUILDING DIVISION ` PERMIT #: 0...C7007-00729
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/2512007
Phone: (503) 639 -4171 ' .� t
Inspection Requests (24 Hrs.): (503) 639 -4175 '.-----^-- I .
INSPECTION WORKSHEET FOR DATE: 11/712007 TIME: 7 :00AM PAGE: 32
SITE ADDRESS: 11320 SW AMBIANCE PL CLASS OF WORK:
SUBDIVISION: GENESIS NO. 2 LOT #: 020 TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Replace main electrical panel.
OWNER: ANDERSON, BRIAN PHONE #: 603-963-0056
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
115 Electrical service 050169.01 503936.0056 N
Corrections /Comments / Instructions:
QN,
rA PASS n PARTIAL APPROVAL n CANCEL ❑ NO ACCESS
FAIL _ CALL FOR INSPECTION . ❑ ADDITIONAL FEES ASSESSED
Inspector: G.--. N 4® Ldg Date: _ 11 6) Phone #: (503) 718- At_____