Permit %-'` ELECTRICAL PERMIT
IN A ,,.- P CITY OF TIGARD
PERMIT #: ELC2007 -00703
COMMUNITY DEVELOPMENT DATE ISSUED: 10/11/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S136CA - 07200
SITE ADDRESS: 11015 SW 78TH AVE ZONING: R - 4.5
SUBDIVISION: PP1993 -035 LOT : JURISDICTION: TIG
PROJECT: UNDERWOOD
Project Description: (2) branch circuits for covered porch.
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: 1 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:
SHIRLEY UNDERWOOD CONDUIT ELECTRIC
11015 SW 78TH AVE 19461 SW 89TH AVE
TIGARD, OR 97223 TUALATIN, OR 97062
Phone: Contact #: PRI 503 - 692 - 1428
FAX 503 - 692 -3652
FEES
Description Date Amount Reg #: ELE 26 -905C
[ELPRMT] ELC Permit 10/11/200' $53.50 LIC 109669
[TAX] 8% State Surcharge 10/11/200' $4.28 SUP 45015
Total $57.78 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 • • hese rules or direct questions to OUNC at
503.246.6 or1.8o .332
Issued B : '. . J v I f L % Permittee SignaturAMO. 1�
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: -,'� r■-dar7fl _ter 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.
1 2007 /OCT /11 /THU 02:46 PM Conduit Electric FAX No, 5036923652 P. 001
- r �x Permit Application
. FOR OFFICE USE ONLY
Received
City of Tigard , , • IVED Dato : D i o7 ' X. Permit No_: ime,,7
EA..Cz:Y 7.O5
' 13125 SW Hall Blvd., Tigard; s'_ 3 Pla rlievi e w
gin' fig Other Permit:
Phone: 503.639.4171 Fax: 0 l gS•].' uv i, iii � ` DE16BY •
Inspection Line: 503.639.4175 ' Date•Ready/By rori ec
El SPage2for
OCT 1 1 /'j' !
ternet: WwW.ei,tigard,or -us Notifed/hdethod: f a Supplementallnformation
•
• g . y( ua`r :r.�.- �'s!�nV.'r`r! i ' d;: ': C: ca <,::...,';
.� - ... ,.....,; .., ' er . rib . , ... .. .., � , , z .,. . ,..
•
i y f q .' Please check all that apply:
• 111 New construction B .0:411'''• i fb'r rod replacement
❑Service over 225 amps, comm'1 ❑Hazardous location
❑ Demolition ❑ Other: .. El service over 320 amps -rating DBuildng over 10,000 sq. ft,
,�.,.:. :az.; •:.5 ^ : i ,' C iI? : dwellings 4 or residential ::c: �•�i.r �� ; °- ,,.: - : � ��:� ". `'� . o£1 -and 2- tarni.l g more new res
:c�,.: 'a�.. :f. a �'N §T,Rt7+t'�� �;(I)lv'!. - ,'a�.:; _ ;�k Y
r t :rr S ><1fi�GOR�.'t:nQk:.. Q ,. . , ...�.. -,.;, .. ; , >.. , ,
DS'ystctn over 600 volts nominal units in one structure
� 1- at i- 2- family dwelling p Cammerei dustrial ❑ Accessory building QBuilding over three stories C7 units i s, 400 amps or more
lvjulti- family ❑Master builder ❑Other: DOccupant load over 99 persons DMaau£actured structures or
• .. =; :: °;: essni hint
,,.._ , ..._..' ., '.r; - i ., i n park
, < , .,..' r. .. .:,� °0"AB ;X�?G .. '<.. ....... Egr g gP la
r]Nealth -care facility ,
Job no tog 55 Job site address: 1 101 7$-"1 AU`_ . Submit 2 sets of plans with any of the above.
City/State/ZIP: � � �� 9`'j 3 The above are not applicable to temporary eonstvotion service.
�yN;l *.'� za:i `.` r'•'S'fljf':', M d gt!4. riI) ;`gi....g.f -�:.e;; t;'',t�,,r12.= "!s . . .
Suite/bldg. /apt. no.: . Pro name: nacriptio 1 Qty - 1 Fee_ 1 'Nog 1 . ` M1
•
Cross • to job .
New residential single -or multi- farni.ly dwelling unit.
Includes attached garage.
1,000 sq. S. or less 145.15 4
Lot no.: Ea. add 'I 500 sq. ft or portion 33.40 1
Subdivision: Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, no 75.00 2
: i c : i
non-residential
: ;.; ;; Y ;.i:.: - - "S•, % . " •t.: i t _�r ,i:a:4's x; ' ,, 12t4;.n•, . ', achmanufactured or modular
���sft:K;;� >,�,.:�,. :;fis yi" f. � ';rS,YL'JLAIA.C„+.'IQY�L.,d1? ` 'WO1�K. ^ � .:.. . 1 ``S .-., .. .� .. ....... .... E
✓ dwelling, service and/or feeder 90.90 2
P o' / we - _ • Services or feeders installation, alteration, and /or relocation
( i r 200 amps or less 80.30 2
It
1 s to 400
amps
106.85 2
, : ., ... ;q , : : ;;,,, -...:. ,'.. ..,_:.:.�...- . °ii � ;�7.;;w�.dyC'?.`i' <. �i .ti�n?�1 ;��;y�; % i >A` '!i ?;f}�tr
;, :; .: .' :4 It g; '`� 1� ":,, :. ; r.'. _r..,:. N;,,,, ,: e t a s. r:.4%,1;,; "'. +,- S=, . .,..a°,,-, ,!,,,,,:h�.r:.1 401 s
:,;, - amp p
,'Y'; `" Kz, <,, , .:r,;.,.., � -� trips to 600 amps 160.60 2
, N . a Name: 4"] P 1 4. CA t
Name: � 1 .;; - �`1�2._�a� � 601 artapsto 1,000 amps ,240.60 2
_Over 1,000 amps or volts 454.65 2
Addr Reconnect Daly 66.85 - 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or
- .relocation • • Phone: (, ) - I Fax: ( ) 200 amps or less 66,85 1
Owner installation: This installation is being made on property that 1 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 600 amps • 133.75 2
Owner signature: Date r , Branch circuits - new, alteration, or extension,. per panel
,,,4,.. ,+ : ';,;1>,, :r ;�„' A F for branch circu with
4,,: >av, :: n, ":'ir"s. : 5;i' %i''' ^a '" +:- ot.sO ` , .. ;•; ,:‘�,;I
e. �. „, Ja�,9,: FiQ e)G C`''t` ^,' pt . / ;.;ek'! .t'F:: .,N ... !d., service feeder fee, each •
`���'” � 6,65 • 2
:`.,::... ' :` ....,: • . .. ... .......: ' . ..., . ... a or f
Business name: cb circuit
13. Fee for branch circuits
Contact name: wtrhour service or feeder fee
- • - _ each branch circuit • • 46.85 4/Iw 2
„
_-- .-Address: • — Each•addllbranch .circuit -- x,65 - -(.0. - -. • •
City/State/ZIP: Miscellaneous (service or feeder not included)
. Pump or irrigation circle 53.40 2
Phone: ( ) • I Fax: : ( ) Sign or outline lighting 53.40 - 2
E -mail: . . Signal circuit(s) or limited-
., : •_�., energy panel, alteration, or
• 2V0'12�,C�I'O
R
p• .
, ��K:.,. x . ... ... . ... ...... .. .. .. .:- extension. Describe: 'Page 2 2
Business name: N % _
- - Each additional inspection over allowable hi any of the above
Address: 1 �q./..../ f n / ,.... '= ( J ) ` A (Jr , Per inspection . • 62.50
City /State/ZIP: , • I Or. / / '� • Investigation ,cr hour (1 hr min) • 62.50
Industrial plant per hour 73.75
Phone: Z • Fax: gab ICAL .• :,•t,i ";r; =:::,
Pkto (� ) ' ♦ / . _' �/� o �� ��.. - . :''. : EI:EG'�i 1R7►�':'JEtrF;S ,-, ..''; ..'...
CCB Lic.:. f r lechical Lic:: a AW •rv. Lic.: 4 . Subtotal
•
/ /0 , d . . Plan review (25% of permit fee)
Suprv. Electrician Signature, required: •
�, ' / • State surcharge (8% of permit fee)
Print name: • Date: () / l D 7
- - I .
TOTAL PERMIT.1'F;E .. 71, '
Authorized signature: • mis permit appricntinn expires if a permit is not obtained within 180
days after it has been accepted 9s complete • '
Print name:. .Date: • Fee methodology set byTii County Building Industry Service Board
• •• Number of inspections per pemvtallowed_ -
t; OBuitding ■Pconii PcnoiWpp.doc 12/03 440- 4615T(10/02/COIvWJEB 0 .
CITY OF TIGARD ter
I
BUILDING DIVISION � ! PERMIT #: ELC2007.00703
13125 SW Hall Blvd., Tigard, OR 97223 E DATE ISSUED: 10/1112007
Phone: (503) 639 -4171 IV /1 A. 4N,Ail
Inspection Requests (24 Hrs.): (503) 639 -4175 :_.:.
INSPECTION WORKSHEET FOR DATE: /0117/2007 TIME: 7:02AM PAGE: 64 ,
SITE ADDRESS: 11015 SW 70TH AVE CLASS OF WORK:
SUBDIVISION: PP1993 - 035 LOT #: TYPE OF USE:
PROJECT NAME: I,JNDERWOOD
DESCRIPTION: (2) branch circuits for covered porch.
OWNER: UNDERWOOD, SHIRLEY PHONE #:
CONTRACTOR: CONDUIT ELECTRIC PHONE #: 503.692 -1428
Inspection Request Scheduled For: Date: 10/17/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 06'7636 -01 503 -615 -3493 N
Corrections /Comments /Instructions:
r
q ilk ; Rini& CIAIOMVJ '191/ ` 2 a. e 'll ;AAA< cP7' (11,/ 0 rcit
•
1
e . : ,, j
•
x PASS PARTIAL APPROVAL n CANCEL I I NO ACCESS
n FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
I /4q
Ins ector: Date: / ob I /v7 Phone #: (503) 718 - L / 11 0
p