Permit C ELECTRICAL PERMIT
CITY O F TIGARD PERMIT #: ELC2005-00497
DEVELOPMENT SERVICES DATE ISSUED: 7/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S1036C -07000
SITE ADDRESS: 12244 SW LANSDOWNE LN ZONING: R -4.5
SUBDIVISION: FYRESTONE LOT : 009 JURISDICTION: TIG
Project Description: Addition & fountain plug.
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: 3 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:
MICALLEF, VINCENT A + DEBORAH D A + J ELECTRIC
12244 SW LANSDOWNE LN PO BOX 330
TIGARD, OR 97223 FOREST GROVE, OR 97116
Phone: 503 - 359 -5891 Phone: 503 - 359 -5891
FEES Reg #: LIC 959
4534S
Description Date Amount SUP 34-IC
ELE 34 -1C
[ELPRMT] ELC Permit 7/12/2005 $66.80
[TAX] 8% State Surcharge 7/12/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
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: :27 -Z Permittee Signature: � a„e ,c
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.
Jul 12 05 12:56p (503) 359 -1981 p.2
Electrical Permit rAW12- ation 1, 0 FOR OFFICE USE ONLY •
City of Tigard t Received
Day: 7 _/ -0.4c Z�,2 , Permit No. 6 LLB j - � 4yln l
1 2005 a
Date/By:
13125 SW Hail Blvd., Tigard, OR 97223 1_ .. ?l Review
Phone: 503.639.4171 Fax: 503.598 - 1'9`50 I ? DatelBv: Other Permit:
Inspection Lirte: 503,639.4175 CITY OF TIGARD 1 .. :ate Ready /By Jiu : El See Page 2 for
Int ernet: www.ci.tigard.or.us RI M l ll�l[ niVISION Notified/Method: ^�/) SupplcrnentaI Info rasa don
i::::: >; >.: :,!1: : ;4 : : ;i:::: >:.::: ;:« ' :::i::T:YPEs OF =:10' : 1. <: »';i S :<> •'< :<: . :' :3:.:::' • : c.:i> i: i sa> ?;<:z::.:::;a : .; ...::. s:: >: :: :.
❑ New construction ® Addition /alteration/replacement Please check all that apply:
❑ DBIrlOhtiOri ❑Other: ['Service over 225 amps. c ouun'I ❑1-lazardous location
E1Service over 320 amps rating 0Buildng over 10,000 sq. ft ..
........ . .:... ...: . ::..: .: .:. .:: .... gA' rgC, t< t. IiY .C}TmQlYS'1.ApG``1'Io!;;!T ::.•:.::.::::: >:r: »:: = >ic;:
:: <r:•s:: >z:::: >' ::::::: » ::' of 1 -a 2-family dwellings 4 or mare new
... ... .... ::.:.. .: .:,... o resident ie]
® 1- and 2- family dvwelli ig ❑ Commercial/industrial ❑ Accessory building ESystem over 600 volts nominal units in one structure
' ❑ Multi -fami( Master builder ❑ Other ❑Building over
three stories ❑ Feeders. 400 amps or more
: >:< • <:.;::;::. >:::: Y :: .;> .. ..:;:.,• -._...:::.,....•;:;:: ❑ Occupant load over 99 persons ['Manufactured structures or
:;:: ::• :::.. :,:.[ :::::::::::::: Jt>8 . $.._l ....kOZ2 1 740.1:::rLls0i::, C i! c.* VO14l. aa:::.: : >rt::'= :;:':.::: :.. : : r 'o RV' park
...... : :..:. •..: Cgres g p lan P
Jobno.: Job site address: 12244 SW Lansdowne La j ❑Health - care facility El Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP: Tigard, OR 97223 The above are not applicable to temporary construction service.
. " i
. ... :: ::::;' > :- =: `;i. FEE *;::5 >HaDtL .::;:;!::: j: ::: ':::::.> :
Suite/bldg. /apt no.: Project name:
Description I Qty. Fee. I Total
Cross street/directions to job site: New residential single- or tnulli- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less . 145.15 , I 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75 -00 2
Limited energy, non - residential 75.00 2 ::.::., : < .:...:..:. ..::
......, ....: :
-;: Ak �a,S Li7P':IIO�.. Ql�; ��r;!I3ItTi: >' >: > > v:> <_ t » >: : ;: ; ;; : << : :>
..... .
..... :. . .
..... ...... ........:..........:::..:..:..... ..: ..:....: : • :.- :..:: :.:...; Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Addition and fountain plug -
Services or feeders installation, alteration. antUor relocation
200 amps or less 80.30 2
.. � :.:.:. ..:... :. .;• : - .. - .,.:: ;:;
::: 201 ampsta 400 amps I06 -85 2
:.;:.::.. ;.. . tog . ..0?lY1K .. 12 :.; :; ;. :'::. � .T ... :: . . .. .:::::
401 amps to 600 amps 160.60 2
Name: Deb Macalles _ 601 amps to 1,000 amps 240.60 ' 2
Address: 12244 SW Lansdown Lit Over 1,000 amps or volts 454.65
Reconnect only i 66.85 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, andior
relocation
Phone: ( ) j 0- 9/�� t✓r J 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, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 Drips 133.75 2
Owner Date:
signature: Branch circuits -new, alteration, or extension, per panel
g
` -: : : .:: • ApT+C}XCr1oi: E s:. ?::• ❑ i.Qh3:'TAC'F 1?$RoO4 - -: A. Fee 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,
S
Address: each branch circuit 46.85 y� 2
Eachadd'l branch circuit 3 b.65 N 2
City/State/=: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( )
Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited - •
:;;:.:::< s: : >:::::._.:< .:::.:.:.:....::::; ::::a :::::= s >:r:.;:; CON'1'1t4CT' :. •::.: :: . . :::::
: . : . 1'::::::: : a;:.::::<::„ r: ::: :.::.::;<:: ::a:;;:;: en
;.:? : er Panel. alteration- or
Olt.. - <. :.
extension. Describe: Page 2 2
Business name: A & J Electric, Inc
Address: PO Box 330 _ Each additional Inspection over allowable in any of the above
Per inspection j 62.50
City /State/ZIP: Forest Grove, OR 97116 Investigation per hour (1 hr rain) 62.50 .
Phone: (503) 359 -5891 Fax: (503) 359 -1981 Industrial plant per hour 73.75
- ... £ :`:: I :E.GTIOC'ALl'A MRM1'1` : .';a::::::..
CCB Lic.: 959 ElectricalLic.: 34 -1C Suprv. Lic.: 4068S Sutal . '. e�t
Suprv- Electrician signature, required: . eial- an review (25° a of p ermit bt fee) ��- \�\.l'`Date: 7 /12/05 � � State surcharge (8% of permit fee)
S�
Print name:
--- - - — TOTAL PERMIT FEE.. . \�
Authorized SgtatllrC: This permit application expires ir e permit is not obtained within 180
Print name: days after it has been accepted us complete
Date: w Fcc methodology set by Tri- County Building Industry Service Board
w" Number of inspections per permit allowed.
i :. Building \J'err-itsELC- PennitApp.doc 11.03 .A0- 16IST(10/0VCOVF'WEB
CITY Y OFTIGARD
BUILDING D I V ISION PERMIT #: ELG200S -0 497
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/12/2005
Phone: (503) 639 -4171 mai iu l i l i+ �
Inspection Requests (24 Hrs.): (503) 639 -4175 ......_,WP - __..
INSPECTION WORKSHEET FOR DATE: 7/15/2005 TIME: 7 :11AM PAGE: 76
SITE ADDRESS: 12244 SW LANSDOWNE LN CLASS OF WORK:
SUBDIVISION: FYRESTONE LOT #: 009 TYPE OF USE:
PROJECT NAME: MICALLEF
DESCRIPTION: Addition II fountain plug.
OWNER: MICALLEF, VINCENT A + DEBORAH D, PHONE #: 503 - 359 - 5891
CONTRACTOR: A + J ELECTRIC PHONE #: 503 -359 -5891
Inspection Request Scheduled For: Date: 7/15/2005 Pour Time:
•
Code # Inspection Description Confirm # Contact # Message
105 Underground/slab cover 011291 -01 503-341-7134 N
CorrectionsrComments /in'structions:
LA/ AL-iNvt I J 21 S r, 1%a. ` ' Ipe►fi w/ S
X PASS n PARTIAL APPROVAL ^ __❑_CANCEL_ — _ _ __O-NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: -. 1\ 2,\ N oeJ Lr Date: '1 IS 4 Phone #: (503) 718- 2y4L