Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT
PERMIT #: E 7/2008 00258
DATE ISSUED: 5/7/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 AD - 20300
SITE ADDRESS: 14944 SW 89TH CT ZONING: R - 4.5
SUBDIVISION: LADY APPLE LOT : 027 JURISDICTION: TIG
PROJECT: LADY APPLE
Project Description: Installing (1) branch circuit for A/C.
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: 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:
BEACON HOMES NW. INC. CONNECTIONS ELECTRIC
12703 SW 67TH AVE PO BOX 7136
TIGARD, OR 97223 SALEM, OR 97303 -0026
Phone: Contact #: PRI 503 -390 -7914
FAX 503 - 463 -6863
FEES
Description Date Amount Reg #: ELE 24 -248C
[ELPRMT] ELC Permit 5/7/2008 $46.85 LIC 65444
[TAX] 12% State Surchar 5/7/2008 $5.62 SUP 3611S
Total $52.47 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 Ce . 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 c C ate •.246.6699 or 1.800.332.2344.
Issued By:, /! �' 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 Application - - e V 1► FOR OFFICE USE ONLY
o` 'k - Re ceived
' City of Tigard r1 gyp DateB _f A Permit No.: • Ihil 13125 SW Hall Blvd., Tigard, OR 97223 MP� Q 1 2
Plan Review
a . Phone: 503.639.4171 Fax: 503.598.1960 pate/By: Other Permit:
_.
T I G A R. I) Inspection Line: 503.639.4175 ,- .;: ''c` I a Ready /By: tuns: 0 See Page 2 for
Internet: www.tigard - or.gov - 1k i4ied/Method: Supplemental Information •
TYPE OF WORM _1►. PLAN REVIEW
❑ New construction
Please check all that apply (submit 2 sets of plans w /items checked below):
Addition /alteration /replacement
❑ 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
t7:1 I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder El 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 ", "l -2 ",' l -3 ",
Job no.: Job site address: ` ,L G 1'1A- IOOHP or more. occupancy.
11 T / W VI 1-1A- G� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 e p
t i . N> C"(Z 9 - "2:7-5 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: l _A -P y A. p P ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 41,ec k . A 4 S c i- Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
pc D� k P 1,000 sq. ft. or less 145.15 4
Subdivision: l.. �-2 Lot no.: 'Z
Ea. add'I 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.)
2 .e.. /� Limited energy, multi - family 75.0 0 2
t � t Ci �t'ho�V residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 I 2
PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Q . Ar61A,t� 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: C2.1-0 3 S 6 ko,e. Over 1,000 amps or volts 454.65 2
City/State /ZIP: `rj yL 0 12-- V. on 2 2 3 Temporary services or feeders installation, alteration, and/or
l relocation
Phone: (03) 1 .4f 0-4- t c5 9,t, I Fax: ( 503 ) 61-0 $ $ 6 °1. 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 I [CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
p
Business name: �c___/K t 3 4 101xV. , V . w B. Fee for branch circuits
Contact name: t"� 07 G `t <�
without branch circuit or feeder fee, / 46.85 (f (' 2
v u' ` first branch circuit l f `o
Address: \'Z ._ G L0 6 4 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: - 1 , �c�2_17 e •'_ e l'} -Z2c Each manufactured or modular 90.90 2
S dwelling, service and/or feeder
Phone: ( , ) d-S 1 p Fax: : ('' ) b --o 5 S at ' Reconnect only 66.85 2
E -mail: j 1 ,- Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
1 Signal
Business name: //�� / � Q p al e r to limited-
,
t (� Pc v� t �[-2 t � ' �7i 1 energy panel, alteration, or
Address: "7 extension. Describe: Page 2 2
City/State /ZIP: P (_e•-"- Ol(L c 3 3 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (.o3, '3 Q' p -4. e1 I C.f I Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 66 t.( I Electrical Lie.:' j (, f 5 Suprv. Lie.: . .).1,1 s - Industrial plant per hour 73.75
l /' , - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / /I �1 Subtotal: L/ (p ,
�
Print name: LLL/// ��_ ��' Date: ,� ej Plan review (25% of permit fee): 1
State surcharge (12% of permit fee): - G, a.
Authorized signature: TOTAL PERMIT FEE: 5
Print name: Date: This permit application expires if a permit is not obtained within 80
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(I1/05 /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- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
❑ 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
I \ Building \Permits\ELC- PermitApp.doc 03/23/06
May 07 08 11:33a Connections Elec 5034636863 p.1
'i r T vr I nafrusu
• COMMUNITY DEVELOPMENT
TIC- �:�R17
13125 SW Hall BNd., Tigard, OR 97223i 503,639.4179
Electrical Signature Form
IMPORTANT PERMIT NOTICE
CONNECTIONS ELECTRIC
PO BOX 7136
SALEM, OR 97303 -0026
Permit #: ELC2008 -00258
Date Issued
Parcel: 2S111 AD -20300
Site Address: 14944 SW 89111 CT
Subdivision: LADY APPLE
Lot: 027
Jurisdiction: TIG
Zoning: R-4.5
Project Name: LADY APPLE
DesCnption. Installing (1) branch circuit for NC.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature Of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please. mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvid.. Tigard. OR 97223, or you may fax the f .
If you have any Questions please call 503.718.2433,
No electrical inspections will be authorized until this completed form is received
OWNER. ELECTRICAL CONTRACTOR:
BEACON HOMES NW. INC. CONNECTIONS ELECTRIC
12703 SW 67TH AVE I PO BOX 7136
TIGARD, OR 97223 SALEM, OR 97303 -0026
Phone #: Phone #: 503 -390 -7914
Reg #: ELE 24-248C
LIC 65444
SUP 3611S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
X
A.4 A. - 3 6(15
Sign1uro of St,� g Electrician amc (printed) SUP LIC #
z d 8g1 INVOZ 80OZ
CITY OF TIGARD
BUILDING DIVISION • PERMIT #: ELC2008.00258
1 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: f `7 /2008
Phone: (503) 639 -4171 � M�tp pi�p�lil�`I
Inspection Requests (24 Hrs.): (503) 639 -4175 ...'
INSPECTION WORKSHEET FOR DATE: f 1/2008 TIME: 7:00AM PAGE: 42
SITE ADDRESS: 14944 SW 89TH CT CLASS OF WORK:
SUBDIVISION: L ADY APPLE LOT #: 027 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Installing (1) branch circuit for NC.
OWNER: DEACON HOMES NW. INC., AN P 9 PHONE #:
CONTRACTOR: CONNECTIONS ELECTRIC PHONE #: 503- 390 -7914
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
'199 Electrical final 070179-02 503. 407 -0580 Y
AwDL
Corrections /Comments /Instructions: A.
`\ \P � i
PASS _ PARTIAL APPROVAL — CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G ' Iv(:)6L-1( Date: 5 u d Phone #: (503) 7181-4A) I
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2008 00258
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 51712008 /
Phone: (503) 639 - 4171 . 4 .1 11 141041 1
Inspection Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 5/21/2008 TIME: 7:00AM PAGE: 43
SITE ADDRESS: 14944 SW 89TH CT CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 027 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: Installing (1) branch circuit for NC.
OWNER: BEACON HOMES NW. INC., PHONE #:
CONTRACTOR: CONNECTIONS ELECTRIC PHONE #: 503.390.79142
Inspection Request Scheduled For: Date: 5/21/2008 Pour Time:
Code # Inspection Description , Confirm # Contact # Message
120 Electrical rough -in 070179-01 ` 503- 407 -0580 N
Corrections /Comments /Instructions:
IN PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
• FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: G NQL. Date: 4 Phone #: (503) 718- ovi 4