Permit • ELECTRICAL PERMIT
CITY4DIF TIGARD
PERMIT #: ELC2008 -00621
COMMUNITY DEVELOPMENT DATE ISSUED: 11/4/2008
• TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136DA -01102
SITE ADDRESS: 11576 SW PACIFIC HWY ZONING: C -G
SUBDIVISION: FRUITLAND ACRES LOT : 005 JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: Reconnect only.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: • Contractor:
ANDERSON, MELDREN W •
GLADYS P
11570 SW PACIFIC HWY STE B
PORTLAND, OR 97223
Phone: Contact #:
•
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 11/4/2008 $66.85
[TAX] 12% State Surchar 11/4/2008 $8.02
Total $74.87 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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
/
Issued By: �y Permittee Signature.
Arai 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 acation FOR OFFICE USE ONLY
Cl of Ti and Receive
+ . `J g Date/B /Jr , .-...fir ' ermit No.: s _ _, ,, r , r
14
• 1 3125 SW Hall Blvd., Tigard, OR 97223 Plan Review 1
` I Phone: 503.639.4171 Fax: 503.598. ` DateBv: Other Permit:
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: 'urn ® See Page 2 for
Internet: www.tigard or.gov a Notified/Method: /2 Supplemental Information •
r
TYPE OF OR " N V PLAN REVIEW
❑ New construction ❑ Addition/alteratiONie l tldli s�� P lease check all that apply (submit 2 sets of plans w /items checked below):
V O \ � ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other: 4 ` tai where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONN 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.
❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "1 -3",
Job no.: - Job site address: I OOHP or more. occupancy.
�5 ?l 0 • c 1 v-.4., ❑ Six or more residential units.
0 Recreational vehicle parks.
City/State/ZIP: I ❑ Health -care facilities. ❑ Supply voltage for more than
' `��' T "� ��'� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I tpy. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I 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 (with above sq. ft.)
KO -. Won l 4 Q c ✓l t '�
Limited energy, (with above s multi-family 75.00 2
�j� )n residential (with above sq. ft.)
1 11 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ` I ❑ TENANT I 201 amps to 400 amps 106.85 2
Name: ty �
t • I At t lc+M 1 l�l U /'I,,,P f sulk- �r U S-c, 401 amps to 600 amps
601 amps to 1,000 amps 160.60
240.60 2
�" "' • 2
Address: V,3- .c a X 1� 0 Over 1,000 amps or volts 4 2
perm l
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
l! '"� ' relocation
Phone: (9 I) /4)1 b _ oQ� I Fax: ( ) 200 amps or less 66.85 1
Owner i stallation: This inst late n is bein • made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, r t, or ex • o ding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
� . i,,, �, .- , J _.ante. 1 Branch circuits- new, alteration, or extension, per panel
Owner signature:
,(- �1._ • �/,
'i A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PE ON above service or feeder fee, 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'l 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: ( ) I Fax: : ( ) Reconnect only / 66.85 /0„0 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: 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 min) 62.50
CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (pr
Print name: I Date: Plan review (25% of permit fee): V
w State surcharge (12% of permit fee): n . t >�
Authorized signatu =. / - • `C'/' II TOTAL PERMIT FEE: 711'
/ This permit application expires if a permit is not obtained within 80
Print name: \ yr ��/� Date: l 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(II /05 /COM/WEB
•
Electrical Permit Application - City of Tigard
Page.2 7 , Supplemental Information f .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑` Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El Other '
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Prnnits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
I
BUILDING DIVISION PERMIT #: ELC2008.00671
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/4/2008
Phone: (503) 639 -4171 e�4
Inspection Requests (24 Hrs.): (503) 639 -4175 I
INSPECTION WORKSHEET FOR DATE: 11/14/2008 TIME: 7:OOAM PAGE: 13
SITE ADDRESS: 11676 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FFRUITLAND ACRES LOT #: 005 TYPE OF USE:
PROJECT NAME: ANDERSON •
DESCRIPTION: Reconnect. only.
OWNER: ANDERSON, MELDREN W, PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 11/1412008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 078093-01 , 971 - 219.7908 N
Corrections /Comments /Instructions:
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1%PASS ❑,P RTIAL APP D ❑ CANCEL ❑ NO ACCESS
a ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • N 6 L� Date: 1` 1 `g Phone #: (503) 718- 7-.'i
CITY OF TIGARD
BUILDING DIVISION -�... ' PERMIT #: ELC2008.00621
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 11/412008
Phone: (503) 639 -4171 4,.. `' ��l
Inspection Requests (24 Hrs.): (503) 639 -4175 __..
INSPECTION WORKSHEET FOR DATE: 11/6/2008 TIME: 7 :00AM PAGE: 52
SITE ADDRESS: 11576 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: FRUITLAND ACRES LOT #: 005 TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Reconnect only. t Q
R NA
tf .
OWNER: ANDERSON, MELDREN W. -)2 A PHONE #:
CONTRACTOR: G A� - ' •
Inspection Request Scheduled For: Date
s\11/61200 Pour Time: 0441.'
Code # Inspection Description Confirm -# ontact # Messa• =
199 Electrical final 077697 -01 971-219-7908 N
Corrections /Comments /Instructions:
IN Q A Gc_ S s --
A
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Z 6;z_iz4N1lk)7E> cF 6t, Vi c
MO rn "rc R,
❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
X FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 - - ' 1 \ 1 6 6 L Date: 41 1403 Phone #: (503) 718- 211__L___