Permit •
4 c ' . • CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00772
af �i�4. • DEVELOPMENT SER` /11ES DATE ISSUED: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S1096A 08000
SITE ADDRESS: 13658 SW LEAH TERR ZONING: R -
SUBDIVISION: DAFFODIL HILL LOT : 006 JURISDICTION: TIG
Project Description: 4 branch circuits.
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:
ANDREA BAILY DAVID JEROME ELECTRIC
13658 SW LEAH TERR PO BOX 751
TIGARD, OR 97224 HILLSBORO, OR 97123
Phone: 503 - 579 -0442 Phone: 503 - 648 -5144
FEES Reg #: LIC 36051
SUP 2877S
Description Date Amount ELL 34 I9C
[ELPRMT] ELC Permit 10/12/200' $66.80
[TAX] 8% State Surcharge 10/12/200: $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. 4.
Issued By: ■ ,/ �272 J Permittee Signature: d '7 _ .0 / _ _
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- 4175by 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. .
, s
Q001
04/30/2004 08:31 FAX 5035981960 CITY OF TIGARD
c_SIO D-- C- tio
Electrical Permit •
1 2 2005 - Datam : ew - • ' ' 0 .1:' - - F ;
'TICE.. ,U., r i tl iqi ( ....1 . :1 -.'
City of Tigard OCT Received
Permit No, P V e
13125 SW Hall Blvd., lIgard, OR 97223 •
Plan Revi -
Phone: 503.639.4171 Fax: 503-598,1mo oF it., f ' 1.
.ilogiliri? Datray. Other Permit'
Inspection Line: 503.639-4175 BUILD:hi „ Ti — nA •RD ...-JV-0, -0 ' I Date RCadyniy; lifirl PI See Page 2 for .
Internet wl.vw.eitigard.or LI us - DM m
SIO .”. —
anecumeawd: ' A suppi..t.ai inrorm.a..
ItERT Vrir: . l'i i'' CIVAti" "Ir ''''''''Sizt
0 New construction 0 Addition/alteration/replacement Please check all that apply;
0 Demolition laOilier LIServi over 225 amps, comm'l 0l4azardous location
OS .1
ervwc over 320 amps - rating DBuildng over 10,000 sq. ft,
w ,:•,7 , e:7 NR4 IFWITEM 1
of 1- and 2-family dwellings 4 or more new residential
WI- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0SYstem over 600 volts nominal units in one structure
1.
CI multi b d 0 Oth EIBuildmg over three stories OPeeders, 400 amps or more
Master er er: -family El uil 1
Occu /pad over 99 persons OMenufactured structures or
mmrhim l' '.6 amiamfiR sv ,,,. :z.,igilci, 1 DEg Plan RV park
0 0 ther: '
Job no." 3 a_kti,(„, Job site address: (... ( ...sk.) ,,,,,...„,1)1 °Health-care factlitY
r Submit 2 geth of plans with any of thc above.
.--- i
City/State/ZIP; P; i The above are not applicable to temporary construction SerViee.
1 l , .:
( LEMEgoil'IMMIta0Wil:eXciannall=
Suite/bldg./apt. no.: Project name;
- Description 1 Q. MEI Total ila
.---
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 Sq. ft or less 1111a11111•111311
Subdivision: ‘. 0(. - .Q 0 j„.. j — g..,...1( Lot no.: jcz„ Ea. add'l 500 sq. ft or portion 33.40 IN
Limited energy, residential MI 75.00 1E11 ,
Tax maplparcel no.: g, .s. I 0 • • AilIMMINEEMIll united. .....r..idential nil 75.00 ai
7... 75:;' VIT
t:-, .,,,,,e,V: _ 1 .-,,v,,,,,Lnl,r,V7.140 0 -, ., "! , uat,t,...0.p.ani,4 - ..". , -.1-81fetuo
Each manufactured or modular
) ___.. c............. IM dwelling, service and/or feeder 90,90 2
A -
"........4:-..edeeeee Services Or feeders installation, alteration, and/or relocation
4L-eJA ( 1A.si_a._a_T • i 41a/
200 amps or less 1
ess 80.30 Ell
FT,TriTilipzsr p ,i. r .,, .ligloa, '* 201 aMpS to 400 amps 7 106.8.5 Es
ao., I I --zike.a . . 00 7 ' AtitRa.to 4kti
0 .jIIIIIINIIIIIIIIIIIIIIIIIII 401 amps to 600 amps i 160.60
Name: - lEll
\ 4 Iv 601 amps to 1,000 amps 240.60 131
— w # Ell
Address: 1 (i= .5 S Lep - . 1`1/•--- O ver 1,000 amps yr volts 454.65
Reconnect only 66.85 Ell
City/State/ZIP: 77
Temporary services or feeders installation, alteration, and/or
, . relocation I
Phone: ( ) 5 4 -0-i--t- 2 I Fax: ( ) .
200 amps or less ____ 66.85 1
Owner Installation: This installation is being made on property that Town which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exc Ant go to ORS 447, Ind al—._ . ' 401 amps to 600 amp 133.75 . 2
_
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
rjiitt.77-',J7t7V7.;7;":"eijriFer,cir., :i iii - "X? : 701 11 71: . .7 , 1 7 ,7, , I)1,7 7 .77,1.Fa u TaWfTriggINVALWIrlliff0 A, Fee for branch circuits with
!7 r: '''''':.i:E.st6-- A ' ■ .!tIN,..T.Ar" J:,.•_.3. a . or f0000r f , cach
6.65 2
Business name: - ,...17, „,, . k - -' z. ,..._ :_.---,..._ branch circuit
B. Fee for branch circuits
Contact name: L....- ■ „-,. S„....._. V.„\-- „ t-1.-........„....._.2 without service or feeder fee. ( 46.85 g -'re
each branch circuit
Address:
r____ Each add'I branch circuit 6.65 (ei IS" 1111
City/State/ZIP: . Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Pax: : ( • ) ' •
Sign or outline lighting 53.40 2
E-mail: Signal circuit(S) or limited-
fliFF4Fja,M.... ,;E:. r '' ' f EgIP3177f.IANO,' ;, ;tam; energy panel, alteration, or
extensmn. Describe: Page 2 2
. .
Business name - ._1.1' erome _ - c a
Address: PO B 751 Each additional Inspection over allowable in any of the above
. Per inspection 62.50
City/State/ZIP: H i 1-1 s b o r o OR 97123 investigation per hour (5 hr min) 62.50 Ell
, Industrial plant per hour 73.75 III
Ph°ne:(503 Pax' k5 0 3) 6 4 8 - 9 7 2 3
CCB.Liol 5 e 1 1 ,.,9. ,,,. m Li 4 - 119 c Suprv. Lie.: 2_8 7 7 s lir- Subtotal 6 L-3
' '''..' ' , 0" ' ' ,41 4••"..; i . .,., ,..,,';': , o 7 ! ', 3,12 . 12 n ver. : , ,____,, Of Perl,lt fce) ::
1 ' surcharge (83/415f pen nit tbe) -
Print name: Da v i A Jerome Date: to
TOTAL PERMIT r gE *.... i
Authorized signature: This permit application expires it permit is not obtained within la.
days after it has been accepted as complete •
Print name: Date: • Fee Methodology set by Tri-County Building Incluz,try Service 8 oard
" - • • Number of inspections per permit anowed,
1:1130dheamitikELC-PcnnitApp.doc 12/03 4404613111 0/02/COM/W2.13
•
CITY OF TIGARD
ELC2005 -00772
BUILDING DIVISION - = PERMIT #: 10/12/2005
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 higl0f i
Inspection Requests (24 Hrs.): (503) 639 -4175 J °='' L.
10/24/2005 7:02AM 103
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
13658 SW LEAH TERR
SITE ADDRESS: DAFFODIL HILL 006 CLASS OF WORK:
SUBDIVISION: EMILY LOT #: TYPE OF USE:
PROJECT NAME: 4 branch circuits.
DESCRIPTION:
BA!LY, ANDREA 503 -579 -0442
OWNER: JEROIMME ELECTRIC, DAVID PHONE #: 503-648-5144
CONTRACTOR: PHONE #:
10/24/2005
Inspection Request Scheduled For: Date: Pour Time:
C o l e # N Ir a oapSDaeiscription Sg SegVatim MesIlage
Corrections/Comments/Instructions:
c
•
PASS, I_ PARTIAL APPROVAL ____ 1 CANCEL NO_ ACCESS
__ ___ --
❑ FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
// ti/li
Inspector: f'�1i ��"` Date: i Phone #: (503) 718 -