Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008-00544
COMMUNITY DEVELOPMENT
DATE ISSUED: 9/24/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 134DD -01100
SITE ADDRESS: 11645 SW TIEDEMAN AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: ANDERSON
Project Description: Reconnect only.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMPIIRRIGATION:
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, GERALD L JEROME ELECTRIC
CHARLOTTE A PO BOX 751
11645 SW TIEDEMAN RD HILLSBORO, OR 97123
TIGARD, OR 97223
Phone: Contact #: FAX 503 - 648 -9723
PRI 503- 648 -5144
FEES
Description Date Amount Reg #: ELE 34 -1 19C
[ELPRMT] ELC Permit 9/24/2008 $66.85 LIC 158119
[TAX] 12% State Surchar 9/24/2008 $8.02 SUP 2877S
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: ` �`�, Permittee Signature: �//?.:47C/?/
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.
09/24/2008 07:55 5036489723 JERMOE ELECTRIC INC PAGE 02
J` e,,, .
1, lectrical Permit A lica a FOIL OFFICE USE ()NIA'
City of Tigard k 1610 Received , r J Permit No:. • ; `/
f ihi 13!125 SW Ha1I Blvd., Tigard, OR 97 Plan Re
et • Phone: 503.639.4171 Fax 503.593 pa w Omer Permit/
T i G A R D Inspection Line: 503.639.4175 � 10° Sl o� Date Ready/By: Ws: ®Sec Page 1I tb r
Internet: www.tigard••or,gov i DX N otified/Method 7770 Supplemental Information
■ New construction Addition/alteration/replacement Please cheek ail that apply (thmit lieu ofptans Wilms theeleed below)!
❑ Demolition ❑ Other
ID Service or feeder 400 amps or more ❑ Building over three stories .
where the available feu current ❑ Marinas and boatyards
' '- -::'.; ;' : � F;r';f' '01 ; ;i •�_ ;�i 0i7•?., .. 7 a mps a t 1:1 Floating buildings.
�: - ' ' ' accede 0 000 150 volts
I 14 Cam I
-�. _,_._.,- ...:.,...:.... -..., .' .'..:,, . .r. r.- .; .............. ..... :..... ... -. ... ••... .:.:., .. .. • . , ass o ground, to exceeds 0 Commercial-use agricultural
�' ism
t 8m d, DO ❑ ial 'cu
`51 I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all caber installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other. ❑Fire pump. ❑ Indallation of 75 KVA or
❑ Emergency system. larger separately derived system
L ' • "ai;• •as1ra, :,10" 41r114r, 1.0;c % ?-91i_ ,, ;.: , ❑ Addition of new motor load of Li "A", "E"•"1_2 „,.1_3..
Job no.: 0 Job site address: 1 r – f .e 100Hp or more, occupancy,
❑
/� Six or mare residential units. . Recreational vehicle parks.
City/State/ZIP: t is 30r0k. Asi, ❑ H facilities. ❑ Supply voltage lbr more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg,/apt. no.: I Project name: soril ❑ Service or 'birder 600 am , a or more,
Cross street/directions to job site: Dgertptloa , Oh, Pew Teti! •
New residential single- or multi- family dwelling unit.
Includes attached g arag e.
Subdivision: I Lot Ito.: 1,000 sq. ft. or less 145.15 4
Ba, add'l 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: residential
- ...... -.. 75 00 2
r.l;:N ria Ob ,i)1; it _. (with ��ot R4.n•l
- , V l' uV 1 _ �t`Cf7 v e_ t Limited energy, multi-family 75.00 2
. residential (with above ea. ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80.30 2
, r”
is I w 201 am ps to 400 amps 106.85 2
- .. ,h;': n�� r Ai, .... , . , .
:.......: .. .....:.t., r• r .. Ili ' _. 1p ... .. .. .
Name: aA t� 5 u. 1/4 _,, iy riy� 401 amps to 600 amps 160.60 2
v 601 amps to 1,000 amps 240,60 2
Address: 4D 4 5 � �� d e Ie ��,,, N'„ ' Over 1.000 am • s or volts 454.65 2
City /State /Z1P: ^ek C):1 p2 pZZj Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ) 5 r i 6 2 1 pmt: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps - 100.30 2
intended for sale lease, • , exchange, according to Old. 447, 449, 670, and 701. 401 amps to 599 amps 133 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
c'.[,..,.';. :��:. � ":r1f — '.u., i • 'n 7i; l : ) ;i;Fi;m; edcrfi;c, 665 2
`:::rh;? �;:a� a bovoserviceorlb
J - � { r. each branch circuit
Business name: e ' f c L, , �•�,r � � r B. Fee for branch circuits
Contact name: .�� without service or feeder fcc, 46.85 2
flint branch circuit
Address: • Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included)
City /State21P: Each manufactured or modular 9090 2
dwellin_ service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect on, ISI 66•8S 11∎214 Q
E- mail: . Pum or Irrigation circle
H
Signal-
Business male: om f . A r ... ti energy 'a panel,
City/State/ZIP: ■lsb OR P11 3 Each additional Ins ection over atlowable in an of the above
Per ins tion 62.50
Phone: (5033) . 1• . . I lad Fax: (503) • . — i n t
CCB Lie t/ 5 9 Electrical Lic.: / – L 1J f• Suprv. Lie.' ' c i 1$ Indu
,.m 4p. :cat vji. i';n; `,1nk,oal:
Suprv. Electrician signature, required: A = r Sub '�
,�`/ _Q J� ` , Plan review 25% of . trail fee :
Print name: v1.11 l (/� /'t ' V'�►� ` –� '' State surcharge (1 of permit fie): 55 Dot;
•
Authorized signature: TOTAL PERMIT FEE: r ( I•I-
w.
,� nil permit application owl'," if a permit I. cot obtained within 180
Print name: I Date: ,taw .tear It hat h..e .MMfa -t ea rnninh`t-,
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: ELf:2008, 00r44
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
9l24l2009
Phone: (503) 639 -4171 iha�l
Inspection Requests (24 Hrs.): (503) 639 -4175 P'
INSPECTION WORKSHEET FOR DATE: 10!10/2008 TIME: 7:00AM PAGE: 48
SITE ADDRESS: 11645 SlNTIEDEMAN AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Reconnect only.
OWNER: ANDERSON, GERALD L, PHONE #:
CONTRACTOR: JEROME ELECTRIC PHONE #: 503 -648- 5144
Inspection Request Scheduled For: Date: 10/10/2000 Pour Time:
Code # Inspection Description Confirm # Contact # Message
109 Electrical final 076520-01 503 6485144 N
Corrections /Comments /Instructions:
1 1 I 'LAC hit ' • 441.4LAIMW-
/14 --- nt P , 1 klikA Ge ' • lArdk ".- f 4 7 44 l '5
'- / .tab , / ef`i/ A,0___,A ,' 'L_.■
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X PASS El PARTIAL APPROVAL El CANCEL NO ACCESS
►�i El CA FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: Date: f Ol ` Phone #: (503) 718 - "