Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00519
': COMMUNITY DEVELOPMENT DATE ISSUED: 9/8/2008
TIGARti 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CA-00706
SITE ADDRESS: 11925 SW SUMMER CREST DR ZONING: R - 4.5
SUBDIVISION: BURLWOOD NO.3 LOT : 041 JURISDICTION: TIG
PROJECT: VANSCHAIK
Project Description: (2) branch circuits to connect furnace and heat pump.
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/ SVCI 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: 1 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:
JOANNE VANSCHAIK PRO CIRCUIT ELECTRIC LLC
11925 SW SUMMERCREST PO BOX 3948
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: 503 - 925 -2008 Contact #: PRI 971 - 563 -8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3 -601C
[ELPRMTI ELC Permit 9/8/2008 $53.50 LIC 161382
[TAX] 12% State Surchar 9/8/2008 $6.42 SUP 51075
Total $59.92 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:
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.
i,
Electrical Permit Application CF ,� � " " *, , � , ` `'? s °yl
Via' r. ;, . .'�a OR I I(.i l - 1 . , i�i.,1* '__?n -,.e ?.,... sr , ....__„..k'
a City of Tigard no w te/e �'.. �/� ,'
r O Zo Plan Review
Other Permit:
�► 4 13125 SW Hall Blvd., Tigard, OR 97223 C ® i3 Phone: 503.639.4171 Fax: 503.598.1960 SE ? Date/By:
e r a i I a?j Inspection Line: 503.639.4175 G , r li Date Ready /By' hint la See Page 2 for
fi- "1'::'.;71 Internet: www.tigard-or.gov Ty OF . i • ilied/Method: —6 Supplee,cutal Information
TYPE OF wORWJIL 's a PLAN REVIEW
❑ New construction Addition /alterationireplacement Please check all that apply (submit a sets of plans whiems checked below).
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or steads 14,000 13 Commercial -use agricultural
D I!4,1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. D Installation of 75 KVA or
0 >magen o system. larger A", separately ", system.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of ❑ "A", "E", "1 - ", "1.3",
Job no.: Job site address: e tooilP or more. 7 -
9 1� e 1. Six or more residential units. ❑ Recreational vehicle parks
City /State./71P: --radvo Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: � ` 4 ` �t ❑ Service or feeder 600 amps or more.
��J FEE SCHEDULE
Cross street/directions to job site: Description 1 per. 1 r•R. l Tom I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 145.15 l 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
p p Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
Limited energy, multi- family 75.00 2
Z crev m co ct'" N C t� fAki E- t residential (with above sq. ft.)
T PwvtP Services or feeders installation, ntteration, and/or relocatio
200 amps m less 80.30 2
ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
` 401 amps to 600 amps 160.60 2
Name: L'i► L y AA `: A, ll I . I i 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 I 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. on amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits rvirh
0 APPLICANT ❑ CONTACT PERSON above service or feeder fee, c i , t 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 q6.05- 2
first branch circuit
Address: Each ndd'I branch circuit t - 6.65 4,--- - 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mai I: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
I'lo ('f' J� G, .:.�f'� Signal circuits) or limited-
Business name: P � wr1.. GL��•l energy panel. alteration, or
Address: ir . ®, I: , �?� i4 9 extension. Describe: Page 2 2
City/ State/ZIP: 1J:'1 i f ;1 1e , OP, ' 1767D Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (C['„) 563 8z t I Fax: (5b3 Q 1 341 Investigation per hour (1 hr min) 62.50
CCB Lic.: got Z 81 Electrical Lic.: 7 L Suprv. Lic.: 61 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES Q
Suprv. Electrician signature, required:
t, . _,_ Subtotal: �t:«> -`�
Print name: F (0� ` Date: Plan review (25% of permit fee):
f State surcharge (12% of permit fee): r I'LL
Authorized signature: TOTAL PERMIT FEE: S • R'z_
Print name: Date:
This permit application expires if a permit is not obtained within 180
days after ii has been accepted as complete.
• Number of inspections allowed per permit.
Rituitdin TertnitiaLC- PermitApp.doe 05/23/06 440.461ST(1 t/WS/COM/WEB
2/2'd 096ti86S2 :Ol 6172T99220S 13 1I110dI0 021d:W0ad d9S:LO 8002 -9 -d3S
CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00519
COMMUNITY DEVELOPMENT DATE ISSUED: 9/8/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CA-00706
SITE ADDRESS: 11925 SW SUMMER CREST DR ZONING: R - 4.5
SUBDIVISION: BURLWOOD NO.3 LOT : 041 JURISDICTION: TIG
PROJECT: VANSCHAIK
Project Description: (2) branch circuits to connect furnace and heat pump.
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: SIGNAUPANEL: •
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: 1 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: •
JOANNE VANSCHAIK PRO CIRCUIT ELECTRIC LLC
11925 SW SUMMERCREST PO BOX 3948
TIGARD, OR 97223 - WILSONVILLE, OR 97070
Phone: 503 - 925 - 2008 Contact #: PRI 971- 563 -8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3
[ELPRMT] ELC Permit 9/8/2008 $53.50 LIC 161382
[TAX] 12% State Surchar 9/8/2008 $6.42 SUP 5107S
Total • $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent. •
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
•
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
INSPECTOR'S SIGNATURES ARE NOT
Inspections Required for: r1 ,c4,)$ t-0,5/ REQUIRED ON GREEN INSPECTION CARD.
Code I Inspection Description I PASS Date I By t/ Code I Inspection Description 1 PASS Date I By
BUP - Building Permit ELC - Electrical Permit
405 Excavation 105 Underground /slab cover
410 Fill 110 Temporary electrical service
415 Grading 115 Electrical service
205 Footing y 120 Electrical rough -in
805 MFG - Structure grading /footing ,\ 125 Wall cover
210 Foundation walls 130 Ceiling cover
215 Footing drain 135 Low voltage
220 Slab 140 Sign installation
310 Crawl drain 145 A/C or heating unit circuit
225 Post /beam structural 150 Hot tub /spa /pool
230 Underfloor insulation 195 Misc. inspection:
235 Shear walls /anchors k 199 Electrical final
240 Exterior sheathing
245 Firewall
250 Roof nailing ELR - Restricted Energy Permit
255 Wtr proofing basement walls 135 Low voltage
. 260 Tilt -up panel 195 Misc. inspection:
265 Masonry 199 Electrical final
270 Reinforcing steel (rebar)
275 Framing
810 MFG- Structure set -up MEC - Mechanical Permit
280 Insulation 605 Post /beam mechanical
285 ' Drywall nailing 610 Gas line
287 Suspended ceiling 615 Mechanical rough -in
295 Misc. inspection: 620 Hydronic piping
899 MFG- Structure final 625 Duct work
498 Grading final
•
630 Fire damper
299 _ Final inspection 635 Smoke detector shutdown
640 Exhaust hood
•
695 Misc. inspection: •
699 Mechanical final
BUP - Fire Protection System Permit
- 905 Sprinkler underfloor /slab
910 Sprinkler rough -in PLM - Plumbing Permit
915 Fire alarm rough -in 305 Plumbing underslab
310 Crawl drain
920 Suppression trip test •
315 Post /beam plumbing
995 Misc. inspection:
998 Alarm final 320 Plumbing rough -in
999 Sprinkler final 322 Shower pan
330 Water service
335 Rain drain
340 Storm drain
SIT - Site Work Permit 505 Sanitary sewer
405 Excavation 345 Culvert /catch basin
410 Fill 350 Septic tank
415 Grading 395 Misc. inspection:
205 Footing _ 399 Plumbing final
210 Foundation walls
215 Footing drain .
420 Sprinkler supply lines SWR - Sewer Permit
495 Misc. inspection: 505 Sanitary sewer
498 Grading final 595 Misc. inspection:
499 Final inspection _ 599 Final inspection
I:\ Building \Forms \InspCard- AOP- Blank.doc 02/02/07