Permit •
CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 - 00681
COMMUNITY DEVELOPMENT DATE ISSUED: 10/3/2007
TIGARD' 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133DC -14700
SITE ADDRESS: 13269 SW TAMERA LN ZONING: R -
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK LOT : 002 JURISDICTION: TIG
PROJECT: PEDERSON
Project Description: 1 branch circuit to TV.
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: 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:
PEDERSON, RICHARD D + FLORENCE J BROTHERS ELECTRIC INC
13269 SW TAMERA LANE 16670 SW WRIGHT ST
TIGARD, OR 97223 BEAVERTON, OR 97007
Phone: 503 - 524 - 6345 Contact #: PRI 503 - 747 -0805
FAX 503 - 747 -0815
FEES
Description Date Amount Reg #: ELE C297
[ELPRMTI ELC Permit 10/3/2007 $46.85 LIC 176615
(TAX] 8% State Surcharge 10/3/2007 $3.75 SUP 4270S
• Total $50.60 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: 44 44i/e4.4_, .4.-( 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.
t] e �'I ,, 1 of r i '�` rs ^' n: , i i
Electrical Permit Appli • r`� ° t ', , . t �l Y�f ,, ' FOR O USE ONLY 'r r,, ea � n,:
,.
City of Tigard o !15 - *unn:, -`.. 4I h v.' Y Ttl..',; C 1.:F + , ..11 n " ..
' Permit No.: ( Date /B d °�� 1 �4J�
; ° 1 3125 S W Hall Blvd., Ti ard, OR 97223 y _,,z, 621
g Plan Review
ti Phone: 503.639.4171 Fax: 503.598. 1(96 0 3 2007 Date/By: Other Permit:
Inspection Line: 503.639.4175 "�' Date Ready/By:
T I G A S See Page for
t l In
Internet: www.tigard r N S
CI 1 Y (J1 11 CAI ;
g g • A � PLAN REVIEW - -
❑ New construction [. A i t � t lii�ibts/i'e aP `' 1�`N 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 0 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 AND LOCATION A
❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: JYZ C 9 5'i " A ,� 64/ 1 x or more a rest occupancy.
/ i - V ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: - 77G/ -. o Z ❑ Health -care facilities. ❑ Supply voltage for more than
a 2 q 7 L J ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: R /e //4..,2,e, c& 0 .J ❑ Service or feeder 600 amps or more.
- FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I 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
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. 11.) 75.00 2
X1-4.341 Limited energy, multi-family 75.00 2
T //. sc,Z .'C/t/ /fir � ° 77f CL-/C residential (with above sq. 6.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
' ❑ PROPERTY OWNER ❑ TENANT. 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
l / (//,,e., 0 ��� ; S ‹ 601 amps to 1,000 amps 240.60 2
Address:
City /State /ZIP:
Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
relocation
Phone: G C3 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: 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 �/ � g
Contact name: without service or feeder fee, / 46.85 % 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name: / 6 1 fio r -yxf je$ 4'L' '_'"c..:7 energy panel, alteration, or
Address: /667 L✓x /G' ,S7- extension. Describe: Page 2 2
City/State /ZIP: , / ; 9 ✓ pit. , 7v : 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (G , 76/ 7- pg. ,' s— Fax: (S''3) 7x/'7 ., '� 19/5 Investigation per hour (1 hr min) 62.50
CCB Lic. /7 /- Electrical Lic.: G Z.9 7 Suprv. Lic.: 4/2..706 Industrial plant per hour 73.75
ELECTRICAL PERMIT' FEES
Suprv. Electrician signature, required: 1>t. K � /0/f / Subtotal:
Print name: G Plan review (25% of permit fee):
/ . - Date:
/P /` �� ° State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 5Z . 100
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(1 I /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
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL. WORK: ONLY
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
n B • oiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ I nstrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
H N • urse 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 . A . •
BUILDING DIVISION PERMIT #: ELC2007.00 81
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/3/2(107
Phone: (503) 639 -4171 1
Inspection Requests (24 Hrs.): (503) 639 -4175 .�' ''I�
INSPECTION WORKSHEET FOR DATE: 10/4/2007 TIME: 7 :02AM PAGE: 62
SITE ADDRESS: 13269 SW TAMF_RA LN CLASS OF WORK:
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK LOT #: 002 TYPE OF USE:
PROJECT NAME: PEDERSON
DESCRIPTION: 1 branch circuit to TV.
OWNER: PEDERSON, RICHARD D + FLORENCE J, PHONE #: 503 - 574 -6345
CONTRACTOR: BROTHERS ELECTRIC INC PHONE #: 503. 747.0805
Inspection Request Scheduled For: Date: 10/4/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 056938-01 503 -793 -3276 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G- N 0, LE" Date: i Q ii Q 7 Phone #: (503) 718 - 1.-q_q_b_
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