Permit , Q1 /r5 /OS Ll:
Er `-� ELECTRICAL PERMIT
CITY O F TIGARD PERMIT #:
7 E / L i
COMMUNITY DEVELOPMENT DATE ISSUED: 7/2007 7 -0
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 136CA -02009
SITE ADDRESS: 10900 SW 78TH AVE ZONING: R -4.5
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: RONNIE
Project Description: Alter /add (1) branch circuit for bathroom addition. 2/13/08, added (1) feeder and (10) additional branch circuits.
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: 11 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 0 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:
SCOTT & JULIE RONNIE OWNER
10900 SW 78TH AVE
TIGARD, OR 97223
Phone: 503 - 341 -5695 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMTI ELC Permit 7/17/2007 $46.85
[FAX] 8% State Surcharge 7/17/2007 $3.75
[ELPRMT] ELC Permit 2/13/2008 $106.60
(additional fees not listed here) REQUIRED ITEMS AND REPORTS
Total $318.66
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes a 2 all of er 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 i uan• - .r if work is suspended for
more than Udays A-TTTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notificati Ce• e / hose rules are set forth in
OAR 95 001 -0010 throug • 0 • ' • .2 +1 -0100. You may obtain copies of these rules or direct questions to OU r• - ' • 0.e 6.6699 or 1.800.332.2344.
I /
Issued B ` ` Permittee Signature: .41%
OWNER INSTALLATION ONLY
The installation is being made on property ',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.
E-1ectrica1 Permit A 1 , lication F OR OFFICE USE ONLY'
• ' Received �} /i Q
City of Tigard Date/By: r / Pennit No.:. ELe ! O
1 011 ic
- q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 Date /By: Other Permit:
T 1 GA RD Inspection Line: 503.639.4175 Date Ready /By: lnr. ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: //a1 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 CONSTRUCTION • 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.
A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: p 100HP or more. occupancy.
, a✓ [ 0' S(..J ,N,--174— ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 1 6. AD / oY ` T , . ❑ Health -care facilities. r) i ❑Hazardous locations.
El voltage for more than
600 volts nominal.
Suite /bldg. /apt. no.: Project name: NI ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 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
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
n Limited energy, multi - family 75.00 2
AD DI�d 4- b a'I�f -, M A -J / J' - y residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
•
a PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: /� 401 amps to 600 amps 160.60 2
C ,, ; lie 12° ^i ^t (e , 601 amps to 1,000 amps 240.60 2
Address: /0 ci op c w 1)- Over 1,000 amps or volts 454.65 2
! 2 �� Temporary services or feeders installation, alteration, and/or
City /State /ZIP:
`r 1 Er, 441,0 I V T relocation
Phone: (51) 3) 3 e I c o s -- Fax: ( ) 200 amps or less 66.85 1
Owner installation: This install. to i icing made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, o e , . ge, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
/ Branch circuits — new, alteration, or extension, Qer panel
Owner signature: �// Date: 7'f i .f/a 7- A. Fee for branch circuits with
❑ AP' CANT ❑ 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 � e 2
first branch circuit l
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
Business name: 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 (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES / • rr'/
Suprv. Electrician signature, required: Subtotal: ]`" o • b
Print name: Date: Plan review (25% of permit fee): 7777
State surcharge (8% of permit fee): 3. 7.3
Authorized signature: TOTAL PERMIT FEE: , 05 — el .
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.
L\ BuildinglPermits \ELC- PermitApp.doc 05/23/06 440- 4615T( I 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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System* .
❑ Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918 260 - 260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ 13uilding \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00408
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/17121)07
Phone: (503) 639-4171 /0 �
I Requests (24 Hrs.): (503) 639 -4175 �. ..
INSPECTION WORKSHEET FOR DATE: 2/2512008 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 10900 SW 78TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RONNIE
DESCRIPTION: Alter /add (1) branch circuit for bathroom addition. 2J 13108, added (1) feeder and (10) additional
branch circuits.
OWNER: RONNIE, SCOTT & JULIE PHONE #: 503-341-6695
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2125/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Messa•e
199 Electrical final 065579-01 206-818-3252 tgp
Corrections /Comments /Instructions:
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15 PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ti514 Date: VW' v, Phone #: (503) 718 - Dk •
CITY OF TIGARD
BUILDING DIVISION . - PERMIT #: ELC2007 -004 0
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/17/7007
Phone: (503) 639 -4171 AollImvied�I
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2113/2008 TIME: 7 :01AM PAGE: 20
SITE ADDRESS: 10900 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: RONNIE
DESCRIPTION: Alter /add (1) branch circuit for bathroom addition.
OWNER: RONNIE, SCOTT & JULIE PHONE #: 503.341 -5695
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/13/2003 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'188 Electrical final 064954-02 503 -341 -5696 N
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.
Corrections /Comme s /Instructions:
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PAS • M P: RTIAL APPROVAL Il CANCEL 1 1 NO ACCESS
/LW E CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: 21 ' G>6 Phone #: (503) 718- 2g�j