Permit CITY OF TIGARD
ELECTRICAL PERMIT
PERMIT #: ELC2007 -00420
1111 ° COMMUNITY DEVELOPMENT DATE ISSUED: 6/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S109DB -03300
SITE ADDRESS: 13104 SW HAZELCREST WAY ZONING: R -7
SUBDIVISION: SUMMIT RIDGE LOT : 071 JURISDICTION: TIG
PROJECT: CHAMBERS
Project Description: (1) branch circuit for new a/c unit.
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:
TRACIE CHAMBERS OREGON ELECTRIC GROUP
13104 SW HAZELCREST WAY 1010 SE 11TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: 503 - 430 - 8279 Contact #: FAX 503 - 535 - 2763
PRI 503 - 234 -9900
FEES
Description Date Amount Reg #: ELE 26 - 95C
[ELPRMT] ELC Permit 6/19/2007 $46.85 LIC 203
[TAX] 8% State Surcharge 6/19/2007 $3.75 SUP 4818S
Total $50.60 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 -0108 You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued / � j / � 1 / // Permittee Signature: p A p I l e a ,
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.
JUN -1) -2007 02:44PM FROM -OR ELECTRIC SVC 5035352763 T -743 P.001 /002 F -238
tAhctr;i ;a1 rermit .app >icauuu
I Received ( / 6, ✓� ELC ea - ./
r- 1 t Permit NO.:
City � ?�igard Dsm/13 .
13125 SW Had Blvd., Tigard, OR 9722 + P an R ev i ew Other Permit: C? .•r,vl?., �� )
Phone: 503.639.4171 Fax: 503.598,1960 w Date/B 4 ask ��7
inspection Line: 503.639.4175 JUN 1 9 Zo , ,L I�I�i DateReady /Hy: Jv : El Sec Pse 2, for
Internet: www.ci.tigard.ot.us
Notified/Method Supplements] Information -
CITY OF TIGARD PLAN REVIEW
• • Li_;- 1 _. /.: iU .. V ION ,i
El New construction ® Addition/alteration/replacement Please check all that apply:
0 Service over 225 amps, comm'I ❑ Hazardous location
❑ Demolition 0 Other: ❑Service over 320 amps rating ❑ Buildng over 10,000 sq. ft.
CATEGORY OF CONSTRUCTION .. of 1- and 2- family dwellings 4 or more new residential
® 1- and 2- family dwelling 0 Commercial /industrial ❑ Accessory building 0 System over 600 volts nominal units in one Structure
0 Building over three stories OFeeders, 400 amps or more
0 Multi - family ❑ Master builder ❑ Other ❑Occupant load over 99 persons ❑ manufactured structures or
I JOB SITE INFORMATION . AND LOCATION Q Egress/lighting plan RV park
❑health -care facility ['Other:
Job no.: 21352 Job site address: 13104 SW HAZELCREST WAY Submit 2 sets of plans with any of the above.
City/State/ZIP: TIGARD, OR 97224 The above arc not applicable to temporary construction service.
• a t. no.: Project name: TRACIE CHAMBERS FEE* SCHEDULE
Suite/bldg./apt. �' / Pro p Description I Q t y . Fcc. I Total I •r
Cross street/directions to job site: New residential single- or multi - family dwelling unit,
Includes attached garage.
I,000 sq, ft, or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. tt or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy. non - residential 75.00 2
' DESCRIPTION OF WORK , Each manufactured or modular
WIRE NEW OUTDOOR UNIT dwellin ., service and/or feeder 90.90 2
__. Services or feeders Installation, alteration, and/or relocation
200 amps or less 80,30 - 2
201 amps to 400 amps 106.85 2
i❑ PROPERTY OWNER — 1 ❑ TENANT. 160.60 2
401 amps to 600 amps
Name: TRACIE CHAMBERS 601 amps to 1,000 amps — 240.60 2
Address: 13104 SW HAZELCREST WAY Ovcr 1,000 amps or volts 454,65 2
Reconnect only 66.85 2
City/ State/ZIP: TIGARD, OR 97224 Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation _ - -
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, lt. se, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
I 0 APPLICANT —1 ❑ CONTACT PERSON A, Fcc for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit ,
B. Fee for branch circuits
Contact name: without service or feeder fee, , 46.85 )4 •$ 2
each branch circuit
Address:
Each addi branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
- S ign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited-
• C ONTRACTOR energy panel, alteration, or
extension. Describe: Paget 2
Business name: Oregon Electric Group _ —
Address: 1010 SE 11th Ave Each additional inspection over allowable in any of the above
Per inspection 62,50
City/ State/ZIP: Portland, OR 97214 • Investigation per hour (i lrr min) 62.50
Phone: (503) 234 - 9900 Fax: (503) 535 - 2763 - Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES"
GCB Lie_: 203 Electrical Lie.: 26 -95C Suprv. Lie,: 45495 Subtotal Li lg .'3S
Suprv. Electrician signature, require qt lit
1 ,yr . ■ R Plan review (25%ofpermit fee)
Print name: -RI- c_ U. r� Mc. E 11 j 0'j Date: 06/19/07 State surcharge (8% of permit fee) 3 . `1 5
� TOTAL PERMIT PEE So . (00
Authorized signature: s y � . y, This permit application expires if a permit is not obtained within Inn
, I ( days after it has been accented as complete
Print name: -� 1 C I V 1 U1 v-C1 �/� 1- \ C £ 1V Date: 06/19/07 • Fcc methodology Oct by Pi-County Building Industry Service Board
• • Number of inspections per permit allowed,
iMuildinr ■PenniutPLC- PemitApp,doc l /03 440.4615T(10/Q1/COM/W2a
{ ,
CITY OF TIGARD
BUILDING DIVISION - PERMIT #: ELC2007 -00420
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 6/19/2007
Phone: (503) 639 -4171 ; Inspection Requests (24 Hrs.): (503) 639 -4175 .1.
INSPECTION WORKSHEET FOR DATE: 6/26/2007 TIME: 7:00AM PAGE: 413
SITE ADDRESS: 13104 SW HAZELCREST WAY CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE LOT #: 071 TYPE OF USE:
PROJECT NAME: CHAMBERS
DESCRIPTION: (1) branch circuit.for new a/c unit.
OWNER: CHAMBERS, TRACE PHONE #: 503 - 430 -0279
CONTRACTOR: OREGON ELECTRIC GROUP PHONE #: 503 - 234.9900
Inspection Request Scheduled For: Date: 6/26/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 050934 -02 503-357-4013 Y
Corrections /Comments /Instructions:
P
PASS PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
N66Lt L 26
Inspector: Date: p 1 Phone #: (503) 718- 1/ tit