Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT#: ELC2008-00668
COMMUNITY DEVELOPMENT DATE ISSUED: 12/10/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102DC-00510
SITE ADDRESS: 09115 SW EDGEWOOD ST ZONING: R-4.5
SUBDIVISION: EDGEWOOD LOT: 013 JURISDICTION: TIG
PROJECT: LARSEN
Project Description: (1) branch circuit for A/C
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: 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:
PAUL&LORI LARSEN OWNER
LORI MEG
9115 SW EDGEWOOD
TIGARD, OR 97224
Phone: 503-639-6325 Contact#:
FEES
Description Date Amount Reg#:
[ELPRMT] ELC Permit 12/10/2001 $46.85
[TAX] 12%State Surchar 12/10/2001 $5.62
Total $52.47 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 N. ification enter-hose rules - e set forth in
OAR 952-001-0010 through OAR 952-001-0100 Yo •• opies of these rules or direct questions,to OUN - 503 246 6699 or :00 332 2344.
Issued By: � i `ANC -- -- 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.
Electrical Permit Application Reeeive� FOR OFFICE USE ONLY
City of Tigard d Permit No
114
13125 SW Hall Blvd,Tigard,OR 97223 Cdr Date/B /o ff V
- " ..'.
g Plan Review Other Permit
Phone 503 639 4171 Fax 503 598 1960 A 'O 2000 Date/By
Ti GARD Inspection Line: 503 639 4175 IOC.-L- 1 . Date Ready/By suns ® See Page 2 for
Internet www tigard-or govt + ,! Notified Method ` Supplemental Information
, :. TYPE OE'WORK C;11.'o G®�ISI® PLAN REVIEW',
❑ ❑ t Please check all that apply(submit 2 sets of plans whtems checked below)
New construction Addition/alteration,�t. ent
❑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
❑ 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
JOB SITE INFORMATION;AND,LOCATION ❑Emergency system larger separately derived system.•- .•,,LOCATION,- , • ❑Addition of new motor load of ❑"A","E","1-2","1-?",
Job no.: Job site address:/ !'l IOOHP or more occupancy
(`/ �`C l J 1 ❑Six or more residential units. 0 Recreational vehicle parks
City/State/ZIP: , E 7J l p d t o ` ❑Health-care facilities
❑Hazardous location s ❑Supply voltage for more than
600 volts nominal
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE; .. ,
Cross street/directions to job site: Description' I Qty. I Fee. ITotal 1
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 145 15 , 4
Ea add'I 500 sq ft or portion 33 40 1
Tax map/parcel no.:
Limited energy,residential 75 00 2
, ''DESCRIPTION OF WORK` w ,' . ' (with above sq ft)
•
�IaN Limited energy,multi-family 75 00 2
(/!� c�✓jtit i� residential(with above sq 11)
Services or feeders installation,alteration,and/or relocation
200 amps or less 80 30 2
❑'PROPERTY.OWNER, ` _ '`,•: TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160 60 2
Name:
:7;ek,c_ A- . A-IR /0 601 amps to 1,000 amps 240 60 2
Address' G}/`� .(� f� � .2- ,p -c 2 Over 1,000 amps or volts 454 65 2
City/State/ZIIP•—77 i'f(�) ( t 2 9 7�� 3 Temporary services or feeders installation,alteration,and/or
// �� 9 relocation
Phone:(5 ) b 17Z, .1 Fax:( ) 200 amps or less 66 85 1
Owner 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, ••exc . ge, . . ording to ORS 447,449,670,and 701. p 401 amps to 599 amps 133 75 2
n n0 Branch circuits—new,alteration,or extension,per panel
Owner signature: `y __ ��, � Date: /01 �!/ A Fee for branch circuits with
" ,y above service or feeder fee,
® 'APPLICANT `' ,; . 1=1, CONTACT.'PERSON _ 6 65 2
each branch circuit
Business name: B Fee for branch circuits
without service or feeder fee,
Contact name: 46 85
first branch circuit f
Address: Each add'I branch circuit 6 65 2
Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling,service and/or feeder 90 90 2
Phone:( ) Fax: :( ) Reconnect only 66 85 2
E-mail: Pump or irrigation circle 53 40 2
,_ , , • :',,CONTRACTOR • • ' '• . . Sign or outline lighting 53 40 2
Business name: (2 .� Signal panel,a)er or t on or
energy panel,alteration,or
Address: extension Describe Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62 50
Phone:( ) I Fax:( )
Investigation per hour(I hr mm) 62.50
CCB Lic.: I Electrical Lie.: 1 Suprv.Lie.: Industrial plant per hour 73 75
- . ._ •_ ; ELECTRICAL PERMIT FEES ; .
Suprv.Electrician signature,required: Subtotal t(( , -
Print name: Date:
Plan review(25%of permit fee)
State surcharge(12%of permit fee) 5---,&
Authorized signature: �a- TOTAL PERMIT FEE. 5).4
� / (� This permit application expires if a permit is not obtained within 180
Print name: ���� ' • S>�nQ Date: /, % _, days after it has been accepted as complete.
* Number of inspections allowed per permit
I\Building\Permits\ELC-PermitApp doc 05/23/06 440-4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
PRESIDENTIAL WORK ONLY: - -
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating,Ventilation and Air Conditioning System*
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK'ONLY :
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1\Buddmg\Permtts\ELC-PermtApp doc 03/23/06
. , •
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)1
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be fi led with the permit.
Please:,.check the appropriate box and 'coign ' lete'the;.followin,',''statement:-
,:Ye?�, �1. - - ;:;;,::,,,„,1::,.;::- ;•fi;;• - , -.
own re side'in.''or'will`r e in the c om 1 " r`
`,' ��;' •,, s ,, , esld p eted:�strictu e-nand my",general conti•actor�is
•'t
am
°CG'B Ex���i'* gate,`'`
�;�,.,. ratioii��D
- ';:AY
na
nstruct rri y ��•ei�ei�al contractor.thatallsubcontractors>�who work.on the structure�iii�ust�be;: �:
11CenSeCl �1 2rY:•`
Wlthf the,'Construction Goi tractors'Board:
:-o .',';',%--.=1
�,j� I w� 1
1 lie.-�erf� in �w��rle�`n r �`e�: V<7 wn
,p orm .g.. °o o prop Y = o ,.aR=:residence tliat'I:Freside in:;or-a residence that i,.�will',:'.
reside in.If'I hire''subcontractors,YI>w'ill hire:fonly`subcontracto`rs licensed with the.Construct on e.
'„-�'~''°ref: ;Contractors Board •.If'I_cha7-7,-,,,.. .....::e np^°mind`and`hire'a, eneral:contrac'tor .L will:contract`witli.a'
vM: cactor wh'o is licensed oith e CCB and will'`mined atel notif the"office::issuing'.this_ °„i
,,,,,:::::,,, ,,,;;',',3'.:4,,,,,„:.,.,:3,,,..,< °z' ". g, bu Idin,
errrii r
•�:.,.
of.tlie'n ine `f:.t}ie�~e•�"ntr`°
��� t a o o acto .��° _ :.x:°
{ Z{-
�i
A,�.
- - ''e"is - -
. -
:-r
'Y.
_ - �:3 - �k Win.
,
hhave`'.'readand understand<the°Information:Notice'to,pro�- er y.O:wners:about Constructio .';
P., t3',
'.Res o'n'si d;'a es:contained on.thesertw_o pages and I h"ereb. .certi th`at`the in•formati'" checked
�'com: let s�:,corre Ali' `:accu ,ate:
.
nt:.r `Ip
,n
rte'
Pr_in_t:name of .--'ermit':a' Tie antra:- , /J(
" nature o ermit,applicant
:`''.
p,• pP r g P pP„
L
- -
Permit #: k=�C -2Cx> Gam(
This form is supplied to building F o ( ��� f '
4., ;
permit offices by the Oregon Address:
Qpsi
Construction Contractors Board, `" ;:14'; j _
as required by ORS 701.055 (6) '• ' ''�' v 7,
Issued by: _ Date: iy/vK
This copy to issuing permit office
. _
CITY OF TIGARD
07._,
BUILDING DIVISION PERMIT#: ELC2008-00668
13125 SW Hall Blvd.,Tigard, OR 97223 DATE ISSUED: 12110/2008
Phone: (503) 639-4171 AWilifite
Inspection Requests (24 Hrs.): (503) 639-4175 ..44. ;AI!
INSPECTION WORKSHEET FOR DATE: 121 1, 2008 TIME: 7:00Am PAGE: 6 •
i
SITE ADDRESS: 09116 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOD LOT#: 013 TYPE OF USE:
PROJECT NAME: LARSEN
DESCRIPTION: (1) branch circuit for NC.
OWNER: LARSEN, PAUL &LORI PHONE #: 603..639,6325
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 12/12/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 079021-01 503-442-1632 N
Corrections/Comments/Instructions:
.'"r■
iv:_,:_, __=•
• PARTIAL APPROVAL 7 CANCEL 0 NO ACCESS
I I FAIL f CALL FOR INSPECTION ADDITIO AL FEES ASSESSED
■-- I 1Z--/Q5
/-6A
Inspector: .. Date: Phone #: (503) 718-
-4- 1611111m.billi.