Permit CITY O F TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2009 -00065
COMMUNITY DEVELOPMENT DATE ISSUED: 2/18/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102DC -01900
SITE ADDRESS: 09300 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT : 015 JURISDICTION: TIG
PROJECT: SIMMONS
Project Description: Install new meter base.
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: 1 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: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CRAIG SIMMONS OWNER
9300 SW EDGEWOOD ST
TIGARD, OR 97223
Phone: 503 - 524 -3488 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 2/18/2009 $80.30
[TAX] 12% State Surchar 2/18/2009 $9.64
Total $89.94 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 UN at 503.246.6699 or 1.800.332.2344.
� e
Issued By: Qi_cpas1 kY� Q �Q (� 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.
Electrical Permit Applicati °'li l FOR . USE ONLY
City of Tigard 1 8 2009 Date/By: el / 6 � Permit No.: E LC A
-
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review •
Phone: 503.639.4171 Fax: 503.598 Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 C MOFTIGA RO Date Ready/By: Jun ® See Page 2for
Internet: www.tigard- or.gov BUILDING MASI Notified /Method: / t(f0. Supplemental Information
TYPE OF WORK - . ' 'PLAN REVIEW .
❑ New construction ❑ 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 C ONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- - . less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 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 ", "I -2 ", "1 -3 ",
/ Job no.: /Job site address: 7 00 � 6e ewe r,j S 1— 100HP or more occupancy.
l J �/ 0 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ( a, /tom O` ❑ Health -care facilities. ❑ Supply voltage for more than
2 ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
' FEE SCHEDULE .` . _
Cross street/directions to job site: Description p I Qtr. I Fee. I Total 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
‘0 � . gy -
1 Q ` p , e-1 bLQ • residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less i 80.30 C /0. 2
' . ;,.a`PROPERTY OWNER , ❑ TENANT - . . 201 amps to 400 amps 106.85 2
•
Name: ( 7
401 amps to 600 amps 160.60 2
„Cxt . i v� v„,_ -n S 601 amps to 1,000 amps 240.60 2
Address: CSC) .5c4., C ( t�tX7e� S Jt- Over 1,000 amps or volts 454.65 2
City /State /ZIP: � ` �,I � � � 9 7 �� S Temporary services or feeders installation, alteration, and/or
7 relocation
Phone: (Spy) s--?#1: 1t i�� F ax: ( ) 200 amps or less 66.85 1
Owner installation: This in all ion is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, ren r change, according to ORS 447, 449, 670, nd 701. 401 amps to 599 amps 133.75 2
"
Owner signature: ( Date:42. / ` Branch circuits— new, alteration, or extension, per panel
y D� A. Fee for branch circuits with
' . ❑ APPLICANT ' ❑ CONTACT. PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 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
Signal circuit(s) or limited -
Business name: O` ,J \ A '4--C. energy panel, alteration, or
Address: extension Describe: Page 2 2
City/State /ZIP: Each additional ins 1 ection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL _PERMIT FEES -
Suprv. Electrician signature, required: Subtotal: 3Q, - c . )
Print name: Date: Plan review (25% of permit fee): - 6 1--
State surcharge (12% of permit fee): 6?' 1Q
Authorized signature: TOTAL PERMIT FEE: g q , 9.4f
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
1'\Building\Permits\ELC- PermitApp doe 05/23/06 440- 4615T(1 I /05 /COMAVEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL '
Fee for all residential systems combined $75.00
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
El Heating, Ventilation and Air Conditioning System* •
El Vacuum Systems*
n Other:
. COMMERCIAL WORK ONLY:; 7' - , • _,
Fee for each commercial $75.00
system
(SEE OAR 918 309 - 0000)
Check Type of Work Involved:
• Audio and Stereo Systems
O Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
O Instrumentation
Intercom and Paging Systems
O Landscape Irrigation Control*
n Medical
n Nurse Calls
z
O Outdoor Landscape Lighting* �/
1
n Protective Signaling
O 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
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Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued: (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
r I own, reside in, or will reside in the completed structure and my general contractor is:
t" Si' iv.. N., 0 A- S
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
Ja _
�A, I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit. •
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
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J 1 ec `t( C. -ACA, ✓H.Yv∎.c..•4 1,5
Print Nam of Permit Appl a e nt
li ( 6 / 6
Signature of Permit Applicant Date
Permit #: NEST Zd0 4 - 0007 9
•
Address: Q3 9c u XY5 S-1 • 44:7;;.1 --- , S
Tl Gcl +r0 t C')1(2 Q `7 2 2 ,7.f0'
Issued by: Date: (- 4. \ e - (A
This Copy for Permit Offices
PITY OF TIGARD A .
BUILDING DIVISION 4 t - PERMIT #: ELC2009.00065
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/18/2009
Phone: (503) 639 -4171 !�w�,, it t
Inspection Requests (24 Hrs.): (503) 639 -4175 81L I
INSPECTION WORKSHEET FOR DATE: 2/27/2(109 TIME: 7:01AM PAGE: 4
SITE ADDRESS: tyc 3300 SW EDGEWOOD ST CLASS OF WORK:
SUBDIVISION: EDGEWOOL) LOT #: 015 TYPE OF USE:
PROJECT NAME: SIMMONS
DESCRIPTION: In iall new meter base.
OWNER: SIMMONS, CRAIG PHONE #: 503 - 524 -34918
• CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 212712009 Pour Time:
Code # Inspection Description •Confirm_# Contact # Message
199 Electrical final 610909-01 6603- 700.8433 N
Corrections /Comments /Instructions: \ •
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❑ PASS • ' RTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: C r - ' . 'v 6e L Date: 2'1•1 '1 Phone #: (503) 718- �1 I'Q
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City of Tigard, Oregon Page 1 of 2
City of Tigard, Oregon- 1 C� - ��':. •
,n, r,< .,t't•
TIGARD ;•i
Place to Coll 1li,,,,e `
1 Search T1 Property 1 Planning 1 1 Crimes 1 Transportation 1 Utilities 1 Aerials 1 EOC 1 Street View 1 Print 1
1 Summary 1 Permit Summary 1 Community 1 Hazards 1 Explorer,
9300 SW EDGEWOOD ST
Property Summary
OMARA ST $
1.440p*
•
MCDONALD Si (((
EDGEWOOD ST
6
HILL VIEW ST
2
MCDONALDST
Property Owner Info
Tax ID Number: 2S1.02DCQ.1_900
Tax Account Number: R468871
Site Address: 9300 SW EDGEWOOD ST
Site City:
Site ZIP: 97223
Owner: SIMMONS, STEVEN CRAIG &
Owner 2: JOELLE LOUISE
Owner 3: 9300 SW EDGEWOOD ST
Owner Address:
Owner City: TIGARD
Owner State: OR
Owner ZIP: 97223
Acres: 0.94
Sq Ft: 40,946.4
Bldg SF: 1,690.00
Bldg Value: $ 94,210
Land Value: $ 385,200
Total Value: $ 479,410
Taxable Ass'd Value: $ 124,630
Sale Price: $ 250,000
Sale Date: 05/28/03
Year Built: 1930
District & Community Info
Municipality: Tigard
Tigard Urban Sery Bndry: YES
Tigard Neighborhoods:
L Name Link to Website
Area 6 Area 6 Neighborhood News
School Attendance Areas:
http: / /tiggisiw /mox52_multimap/ index. cfm? fuseaction = property. summary &CFID = 104535 &CFTOKEN =... 2/19/2009
CITY OF TIGARD
;BUILDING DIVISION PERMIT #: FLT 2003 OO4;t +a
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 211812009
Phone: (503) 639 -4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/19/7009 TIME: 7:01AM PAGE: 22
SITE ADDRESS: 09300 SW EDGE 0OD ST CLASS OF WORK:
SUBDIVISION: FDG[ LOT #: 015 TYPE OF USE:
PROJECT NAME: SI MMONS
DESCRIPTION: Install new meler base.
OWNER: SIMMONS, CRAIG PHONE #: 503 - 524 - 34(313
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/1912009 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0130637 -01 503701.8433 N
Corrections /Comments/ Instructions:
14T7 R-QP4t
❑ PASS — PARTIAL APPROVAL 111 CANCEL ❑ NO ACCESS
M( FAIL XCALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G • 00a Date: 2 t c t. • 1 Phone #: (503) 718- 244