Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00470
COMMUNITY DEVELOPMENT
DATE ISSUED: 7/11/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S115AD-05900
SITE ADDRESS: 10627 SW TUALATIN DR ZONING: R -4.5
SUBDIVISION: DOVER LANDING LOT : 042 JURISDICTION: TIG
PROJECT: VANDERHEIDEN
Project Description: Install (3) branch circuits for a/c and furnace connections and service 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: 2 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:
ANN VANDERHEIDEN BOB'S ACTION ELECTRIC INC
10627 SW TUALATIN DR 2700 NE BURTON ROAD #A
TIGARD, OR 97224 VANCOUVER, WA 98662
Phone: 503 - 329 -8168 Contact #: PRI 360 - 254 -7200
FAX 360 - 254 -8219
FEES
Description Date Amount Reg #: ELE 37 - IC
[ELPRMT] ELC Permit 7/11/2007 $60.15 LIC 53136
[TAX] 8% State Surcharge 7/11/2007 $4.81 SUP 4322S
Total $64.96 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 / /G� f /� Permittee Signature: y 1 ,- 7
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 Application / ; \ FOR OFFICE USE ONLY
City of Tigard ��C _ L. R. Received ,
Date/B 1 I , I t P
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• t
Phone: 503 639.4171 Fax. 503.598 1960 � �'"w)T I i D ateB . Other Permit E 1 • et y
�
Inspection Line' 503 639.4175 i� n Date ReadyBy 0 See Page 2 for
Internet www.ci.tigard.or us Notified/Method Supplemental Information
CITY OF TIGARD
- - . ; _ ,. ; `,',TYPE:.OF r MING NVISION:: '� _ ,i 'PLAN4EVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply•
❑ Demolition ❑Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
' : , CATEGORY..OF CONSTRUCTION' -, :s' • : -• :: �, '.:'•'.-' of 1- and 2- family dwellings 4 or more new residential
. . . -• . _
® 1- and 2- family dwelling ❑ ComrnerciaUindustrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
El Multi - family ❑Master builder ❑ Other: ❑Building over three stones ❑Feeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
- • JOB SITE INFORMATION AND LOCATION . _ . . ['Egress/lighting plan RV park
❑Health -care facility ❑Other.
Job no.: 07_794 Job site address: 1 0627 SW Tualatin Dr. Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service
Suite/bldg./apt. no.: Project name: ' ;FEE *„ : • "
Description I Qty. I Fee. - Totoi
Cross street/directions to job site New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145 15 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
,DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and /or feeder 90 90 2
A/C & Furnace connections & service plug Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,, 201 amps to 400 amps 106 85 2
❑ PROPERTY; OWNER ,. " r. ,. ❑' TENANT,. _ -
401 amps to 600 amps 160 60 2
Name: Ann Vandenheiden 601 amps to 1,000 amps 240 60 2
Over 1,000 amps or volts 454 65 2
Address: 10627 SW Tualatin Dr. Reconnect only 6685 2
City /State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and/or
Phone: ( ' F a x: ( ) relocation
503 357 - 8168 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 amps 133 75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
' . s ® - APPLICANT • -' - ' ' • ® CONTACT. PERSON 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,
1 46 85 46.85 2
Address: each branch circuit
Each add'l branch circuit 2 6.65 13.301 2
City /State /ZIP: 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-
. • . . - - • :-.,'CONTRACTOR, f -" , energy panel, alteration, or
extension Describe Page 2 2
Business name: Bob's Action Electric
Address: „ „ Each additional inspection over allowable in any of the above
2700 NE Burton Rd. "A" Per inspection 62.50
City/State /ZIP:
Vancouver, W 98662 Investigation per hour (1 hr nun) 62 50
Phone: ( 360) 254 -7200 I Fax: ( 360 ) 254 -8219 Industrial plant per hour 73.75
` .. 'ELECTRICAL, :PERMIT TEES*.; `ii''''!" '
CCB Lic.• 53136 Electrical Lic.: 37- 1C Suprv. Lic.. 4322S Subtotal 60.15
Suprv. Electrician signature, required 7 Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 4.81
Kev B rose ll e 7/9/07
TOTAL PERMIT FEE 64.96
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i \Building\Permns\ELC- PermitApp doe 12/03 440.4615T(10/02/COM/WEB
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00470
13125 SW Hall Blvd., Tigard, OR 97223 D ATE ISSUED: 7/11/2007
Phone: (503) 639 -4171 A
Inspection Requests (24 Hrs.): (503) 639 -4175 ' L
INSPECTION WORKSHEET FOR DATE: 7/19/2007 TIME: 7:03AM PAGE: 67
SITE ADDRESS: 10627 SW TUALATIN DR CLASS OF WORK:
SUBDIVISION: DOVER LANDING LOT #: 042 TYPE OF USE:
PROJECT NAME: VANDERHEIDEN
DESCRIPTION: Install (3) branch circuits for a/c and furnace connections and service plug.
OWNER: VANDERHEIDEN, ANN PHONE #: 503 -329 -8168
CONTRACTOR: BOB'S ACTION ELECTRIC INC PHONE #: 360.254 - 7200
Inspection Request Scheduled For: Date: 7/19/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 05222901 360.254 -7200 Y
Corrections /Comments /Instructions: n ��
r -K(.\.- IA G
• PASS ❑ PARTIAL APPROVAL El CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G r *tie ur Date: ` l 19 I C17 Phone #: (503) 718 -10