Permit ig V >` 9 TY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00465
° ! COMMUNITY DEVELOPMENT 't'5 - DATE ISSUED: 7/9/2007
NrtF r, i' 9
,, G D 1 3125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 10 3 D B -00900
SITE ADDRESS: 13355 SW 110TH AVE ZONING: R -4.5
SUBDIVISION: MIRA PARK LOT : 005 JURISDICTION: TIG
PROJECT: CLARK
Project Description: (4) branch circuits for kitchen remodel.
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:
SCOTT E. CLARK OWNER
13355 SW 110TH AVE
TIGARD, OR 97223
Phone: 503 - 624 -7274 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 7/9/2007 $66.80
[TAX] 8% State Surcharge 7/9/2007 $5.34
Total $72.14 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 s spended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notifica on Center. Those rules A set forth in
OAR 95 1 -0010 .ugh OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUN \.t 503.246.6699 or 1.8010.332.2344.
Issu d By: 6w --,L' Permittee Signature: _-4111V,`r 141■
- OWN: R INSTALLATION ONLY
The installation is being made . e t op - \'� I own w • no' intended for sale, lease, or rent.
OWNER'S SIGNATURE: x���- _ � DATE:
7�t
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.
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A) 1;; City of Tigard Date /B : AM Permit No.: ii 46 Ill .
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review Received
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
„IT s �� ek, Ins Line: 503 Date Ready/By: Juns: El See Page 2 for
G'A R �o
i ca Internet: www.tigard-or.gov Notified Method: 1 Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction XAddition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
X 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 ", "1 -2 ", "1 -3 ",
Job no.: Job site address: , - t ` ` /p, ,y IoOHP or more. occupancy.
1 � �r S L) `1 \J "Y - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: \\ c'A O q ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 0111-4(2,K1 ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: , � Description 1 Qty. 1 Fee. 1 Total 1 "
i New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
` Limited energy, multi - family 75.00 2
I
N\ 6 v) L • sJr I!M ul Ast AV'Z * rk b ale (%_, Vm 1 4) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
■'i Ott E14 200 amps or less 80.30 2
lit PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: S C \ �., 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: \sasS- 5 NJ 1`z,�,. 1 vg Over 1,000 amps or volts 454.65 2
City/State /ZIP: '—'5iG, A RD O 91 m� es, a Temporary services or feeders installation, alteration, and /or
O�O"� relocation
�
Phone: ( 6o3 a 4 k ,.. 7 0 77 t Fax: ( ) 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, tri.�t, or exchang: .ccording to ORS 447, 449, 670, d 70 401 amps to 599 amps _ 133.75 2
Branch circuits - new, alteration, or extension, per panel
-�
Owner signature: .,__;,:;40,17 , . — Date: A. Fee for branch circuits with
❑ APPLICANT • ❑ CONTACT PERSON 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 3 • 6.65 /Q. (/ 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 -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: O cc N i_ Signal circuit(s) or limited -
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: ( ) Fax: ( ) Investigation per hour (i hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: p (p .
Plan review (25% of permit fee):
Print name: Date: ,-
State surcharge (8% of permit fee): � . yi
Authorized signature: TOTAL PERMIT FEE: 7 a , 7 (
This permit application expires if a permit is not obtained within 180
Print name: Date: 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(11 /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
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
1 Garage Door Opener* •
•
❑ Heating, Ventilation and Air Conditioning System*
0 Vacuum Systems*
El Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
• Boiler Controls
❑ Clock Systems
• Data Telecommunication Installation
0 Fire Alarm Installation
❑ HVAC
❑ Instrumentation
El Intercom and Paging Systems
▪ Landscape Irrigation Control*
fl Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
• Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL C2007-00465
t)t14C;5
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/9
Phone: (503) 639 -4171 AI, pI
Inspection Requests (24 Hrs.): (503) 639 -4175 .� 1 I� _
INSPECTION WORKSHEET FOR DATE: 7/24/2008 TIME: 7,OOAm PAGE: 37
SITE ADDRESS: , OF WORK: (C
13356 W 110TH AVE:
SUBDIVISION: MIRA PARK LOT # OO�i TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: (4) blanch circuity for kitcheir remodel.
OWNER: CLARK, SCOTT PHONE #: 503.624 - 7274
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7f24/ ?OOI3 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073130 -01 501624 -7274 Y
Corrections /Comments /Instructions:
•
PASS 1 1 PARTIAL APPROVAL ❑ CANCEL 7 NO ACCESS
FAIL I I CALL FOR INSPECTION 7 ADDITIONAL FEES ASSESSED
Inspector: �_ L ►_., 4 Date: 7 -2 } - p Phone #: (503) 718-
CITY OFTIGARD girl,,
BUILDING DIVISION cfro 121 PERMIT #: ELC2007-00465
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: I 70!2007
Phone: (503) 639 -4171 '�I
Inspection Requests (24 Hrs.): (503) 639 -4175 . �' F ' -.-•
INSPECTION WORKSHEET FOR DATE: 7/23/2008 TIME: 1M2AM PAGE: 34
SITE ADDRESS: 13355 SW 110TH AVE CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: 005 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: ( branch circuits for kitchen remodel.
OWNER: CLARK, scuff PHONE #: 503-624-7274
6244 -7274
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 7/23/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Eletical final 073064 -01 503.624 -7274 N
Corrections /Comments /Instructions:
T k ii _ t
I f npidu (9f pyoW & ok4/Ve WO eil (4t,;" 6)
lU o` 1 5 .5 (A- .
•
(l PASS n PARTIAL APPROVAL ❑ CANCEL U NO ACCESS
,!41 FAIL I' CALL FO'. INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: )1 Date: 1 fg Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007.0 4615
13125 SW Hall Blvd., Tigard, OR 97223 -- DATE ISSUED: 7 /9/2007
Phone: (503) 639 -4171 I�L
Inspection Requests (24 Hrs.): (503) 639 -4175 .._': _..
INSPECTION WORKSHEET FOR DATE: 11/7/2007 TIME: 7:00AM PAGE: 57
SITE ADDRESS: 13355 SW 110TH AVE. CLASS OF WORK:
SUBDIVISION: MIRA PARK LOT #: t ?05 TYPE OF USE:
PROJECT NAME: CLARK
DESCRIPTION: (4) branch circuits for k tchen remodel.
OWNER: CLARK, SCOTT PHONE #: 50 3 6247274
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 11/7/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 EElectiical rough-in 059127 -01 503 - 524 -72%4 Y
Corrections /Comments /Instructions:
e
D P� i Oi 2 c vtz.,c.)% - c6 - 20 A
pm mg Ati
C) PPc 1 hZxoe i cL o N U iii IT . t • C-b IZ CN1 ■2
* (1 C?.. QN - h! o-F-q, (a a 7 . ! 14 i .
(co 1 .) .) .-.- )
PASS ❑ PARTIAL APPROVAL ACANCEL pi NO ACCESS
FAIL ❑ CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: G ---- ' 1 r Olg Le
Date: _ VI 1 V1 Phone #: (503) 718- Ngt)_