Permit ELECTRICAL PERMIT
CITY OF TIGARD
PERMIT #: ELC2007 -00662
r COMMUNITY DEVELOPMENT DATE ISSUED: 9/24/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25101 DC - 00900
SITE ADDRESS: 13935 SW 72ND AVE ZONING: I -H
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: CICERONE
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 HMI 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:
PAUL CICERONE
15993 SW KREICK PL
TIGARD, OR 97224
Phone: 503 - 407 -5630 Contact #:
FEES
Description Date Amount Reg #:
II L.PRMTI ELC Permit 9/24/2007 $66.85
ITAX 18% State Surcharge 9/24/2007 $5.35
Total $72.20 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 a - in- accordance w' • approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more th 180 days. ATTENT or- • •n law requires you to follow rules adopted by the Oregon U ii y- Notification Center. Those rules are set forth in
OAR 2- 001 -0010 through' iAR 95 I S $ 100. You may obtain copies of these rules or direct ue tions to OUNC at 503.246.6699 or 1.800.332.2344.
Iss ed By: jl • ►j �S—Asf Permitte Signature: /j „." +J� /
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 Y - ' 1 ^ r ` I OR (9 11(1 ' uS1 01 , '.'
, t - ,: R eceived / /
,. � City of T i p, e 7 Permit No.: i�' /! �oo7 l�l / 69-
° Date/By: 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
.' ll: ' Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit.
nryr AR Inspection Line: 503.639.4175 Date Ready/By: Juris: H See Page 2 for
s48604 Internet: www.tigard- or.gov Notified/Method: /a. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Pg Addition/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.
dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 -and 2-family g ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ A ", "E ", "1 - ", "I - ",
Job no.: I Job site address: 13 q ASS 5 W -72,vul Ave A e 10011P or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City/State/ZIP: ' T � .� O 912.23 ❑ Health -care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ! I Project name: C l ( . i n a. p
❑ Service or feeder 600 amps or more.
11 FEE SCHEDULE
Cross street/directions to job site: Is vs+A I IZ M N t W of Bo 14 44 feiti oecription 1 Qty. 1 Fee. 1 Total 1 •
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.:
DESCRIPTION OF WORK Ea. add'I 500 sq. ft or portion 33.40 1
' LCC%2tcjtL 3 C.oX rJ c-C--r —
Limited energy, residential 75.00 2
(with above sq. ft.)
PROPERTY OWNER I ❑ TENANT
` Limited energy, multi - family 75.00 2
Name: pawl C C.l tPonB, residential (with above sq. ft.)
Address: 115 get 5 SW K LA. r 1 Services or feeders installation, alteration, and/or relocation _
City/State/ZIP: '1410.,,,.-4_ 0 R q- 12.2){ 200 amps or less 80.30 2
Phone: (SOS ) 401 5430 I F a x : (5 )T4 591 9
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 106.85 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date: 401 amps to 600 amps 160.60 2
❑ APPLICANT 1 ❑ CONTACT PERSON
Business name: C ame: en Cov115++r•uei-lo" RetmodGl 601 amps to 1,000 amps 240.60 2
Contact name: .p....( cj C , f ,, n p m„
C�C+ Over 1,000 amps or volts 454.65 2
Address. 15
3 icr c,� 171
City/State/ZIP: II 9e.ra , Oft.. 91 VL ( relocatrion services or feeders installation, alteration, and/or
Phone: (SOS ) 1 401 5650 Fax:: ( )
200 amps or less 66.85 1
E -mail: IN,AA,1 `tC- Cr °a+e- @ itsO•t•iv+4.t 1. c.e. t
CONTRACTOR
201 amps to 400 amps 100.30 2
Business name: Sa. 0.4 a.400ler..
Address: 401 amps to 599 amps 133.75 2
City/State/ZIP:
Branch circuits — new, alteration, or extension, per panel
Phone: ( ) Fax: ( ) A. Fee for branch circuits with
above service or feeder fee, 6.65 2
CCB Lic.: Electrical Lic.: I Suprv. Lic.: each branch circuit
B. Fee for branch circuits
Suprv. Electrician signature, required: without service or feeder fee, 46.85 2
first branch circuit
Print name: Date:
Each add'I branch circuit 6.65 2
Authorized signature:
Miscellaneous service or feeder not included) /
Print name: I Date: Miscellaneous (service
1 o / _ • '5
5/4 Cif-/ -U, 5
,9 7a -P-0
CITY OF TIGARD
BUILDING DIVISION PERMIT #: IFE0007.00667
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9124/2007
Phone: (503) 639 -4171 , r�
Inspection Requests (24 Hrs.): (503) 639 -4175 �': " ��_�i
INSPECTION WORKSHEET FOR DATE: 12/6/2007 TIME: 7:06AM PAGE: 45
SITE ADDRESS: 1393?. ", SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CICERONE
DESCRIPTION: Reconnect orrly
OWNER: CICERONE_, PAUL PHONE #: 503-407 -5630
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: '12 /f )007 Pour Time:
Code # Inspection Description Confi
----- # - Contact # Message
\
11(i Electrical service /060940.01 \ 503 -407 -6630 N
Corrections /Comments /Instructions:
----- `r N i S es nA ►`T r s F itt ALE,._
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❑ PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
41I► FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES C ASSESSED
� _I
Inspector: , NI i Date: ti_ 4 e') Phone #: (503) 718 - b,. .
• CITY OF TIGARD
BUILDING DIVISION PERMIT #: EL C2007.00662
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/24/2007
Phone: (503) 639 -4171 °`'���
Inspection Requests (24 Hrs.): (503) 639 -4175 . ':� ''' _..
INSPECTION WORKSHEET FOR DATE: 12/5/2007 TIME: 7:04IAM PAGE: 7
SITE ADDRESS: 13935 SW 72ND AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: CICERONE
DESCRIPTION: Reconnect Fairly
OWNER: CICERONE, PAUL PHONE #: 503 407 - 6630
CONTRACTOR: PHONE #:
.Inspection Request Scheduled For: % Date: 1216/2007 Pour Time:
Code # Inspection Description Confirm -# Contact # Message
116 Electrical service \ 06086301 503407 -5630 N
Corrections /Comments /Instructions: \ \
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rAv61' Peszvi Access . at c �c
c - .E---4-c, Fes- 44146 rN - 1 - V. c,tvmQ
111/44 ems
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•
n PASS n PARTIAL APPROVAL ❑ CANCEL y NO ACCESS
N. FAIL 7iALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C N (y) (E Date: 1 ma O) Phone #: (503) 718 - viLik-
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