Permit I
CITY OF TIGARD ELECTRICAL PERMIT • PERMIT #: ELC2008 -00382
COMMUNITY DEVELO DATE ISSUED: 7/3/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 103AD - 05900
SITE ADDRESS: 12660 SW 111TH PL ZONING: R -4.5
SUBDIVISION: WILDERNESS LOT : 005 JURISDICTION: TIG
PROJECT: AMENT
Project Description: Replacing circuit breaker panel.
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: 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:
JEFFREY AMENT OWNER
12660 SW 111TH PL
TIGARD, OR 97223
Phone: 503 -620 -9182 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 7/3/2008 $80.30
[TAX] 12% State Surchar 7/3/2008 $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 ma obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
4.10 Issued By: e Permittee Signature: 4q
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 0 FOR OFFICE USE ONLY':
•
Eew �Y Permit No.: Er
13125 SW f tall Bvd, Tigard, 5° ?I 1 Qd �� CP
Phone: 503.639.4171 Fax: 50 .9'•. " 60 - ` ` Other Permit
` ` Date /By:
- -
TIGARD Inspection Line: 503.639.4175 ,�� . �` P► , gate Ready /By: luris• 0 See Page 2 for
Internet: www.tigard- Or.gov o G \ �`(, � Notified/Method:
71T-67, Supplemental Information
"
try ^?
..::. ..::.. .. ..... ... = ..u.., ,_ - P YPE : �'VO � ':u P[:AN �KEVIE�V: >; ° t a'�:.
❑ New construction ❑ Addition /alteratjgt � Ncement Please check all that apply (submit 2 sets of plans w /items checked below):
`�Q��'+ ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
���t '�� ��`< "?•". � � "�' ° t 9� 'a?t�;��:_ -:r, ex ceeds 10,000 amps 150 volts or ❑ Floating < ` :.;
"Mt ® GO ,,, , ,, IGTL _ „ '.'- �- p g buildings.
-o ,.e+.., , �-`.`wb2 + v4•i 3 • >,i. ;6i,,,,, .. ..... .._ s.<?b r xi `9Aif et.,T'T .. ,,,,.:: ,;,iS.::":c��?2 �..
' e - � ' `' � _ " less to ground, or exceeds 14,000 ❑Commercial -use agricultural
❑ I- and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
1m � . •,<:_R,- en. system.
.., _ .. x. , :;�: �s'�� °, , �..�� i cyst derived s st
»,.,tom =: ,`:., =; .;.�` ° � separately d
;. -.- me t larger at en
s , - gal.: ,: - JO B: •7, "1N A .IYD . liOCAT . .. ` ° ;.
?: - c,.�� .::" ;.: -':��:; �a- ...��_: ^,.__ _sf �h�tr.; )
..,;i1ia� ['Addition of new motor load of ❑ . ,• «1.2., ,.1-3 ",
Job no.: Job site address: I a& bp 501 iii f'I'` 1001- IPorntore. occupancy.
PL ❑ Six or more residential units. ❑ Recreational vehicle parks.
tate
Cit /S/ZIP: �p� 7 ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: �' Ili / `� ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
`' < ;<rC , EEa Z FDULE ° r ° sue
Cross street/directions to job site: N / l o_� P; ., •• — . , . e Total � *
r
� I P(<e � Description �tl� I Qh•. I Fee. I Total ,x �
New residential single- or multi-family dwelling unit.
99 w — VV' A IN HT — FoN N2/" — 111 P Lfa• L E 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
Mar .,\ :;e� v.�'. -..,,= � vy „ r ,� a j�� ? " ,,;,,,,,,,,,;,, ,..,; a.. 75.00 2
•ms s •'DESCRIPTION: OE`..WORK +:; >�rt � ::.= ': r ::' :,:t,:a:: ;;: ,` (with above s ft.
�: W�
...... �:.:�.,= z.::.� • �...... �'..'.:......_.. t... t•: t;<, ° �, y". i•; �rr� §:;,: »<sx ( 9• )
4 Limited energy, multi- family
R epkSG a r CI rc K, BIZEA k e-- PAN eL- (ZOO AMP) residential (with above sq. ft.)
75.00 2
J 4 Services or feeders installation, alteration, and/or relocation
_ 200 amps or less / 80.30 ''..() 2
1 .
-s:
� < `1' R ° L' R T�'�:: WNE72• 'Il
:�- � O lw , Q •, ; � ` ENt\NT' °
. �`�_'� 201 amps to 400 amps 106.85 2
Name: , 1"- IZ--/ M - AID r 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: I Z ' & Q 6% A 1%1 t K Pi_ Over 1,000 amps or volts 454.65 2
City /State /ZIP: Ti &NO / OR \ 9 -22-2- 3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 62_0 — 9i L 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, ore ange, according ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: /14/1 7
Date: o , / p Branch circuits - new, alteration, or extension, per panel
I - , A. Fee for branch circuits with
h :t' s. •, ,p� , [CAN ,,; . >:: CON- ACT1`I'ER '- "`'_ >::; above aove servi feeder f
service or eeer ee,
: "s. ^...�..:,:... T" ,; ��-= ,'..y... Off_;,;,., t,. 6.65 2
each branch circuit
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 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
Jr: - 0107RA (TOR ,,p - ` "`'Nt2 m Sign or outline lighting 53.40 2
Business name: �� ,1 ) r Signal circuit(s) 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 (] hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
,...., EI'EG.TR_1C_ 't,T /:, PERI7 5 , -" :
Suprv. Electrician signature, required: _ Subtotal: • SU, 3 O
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 9. CO L i
Authorized signature: TOTAL PERMIT FEE: ( l "l
• 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.
tr 1.\ Building \ Permits \ELC- PermitApp doc 05/23/06 440- 4615T(11/05/COM /WEB
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BUILDING DUV8SUON ^ ~ �.� �I� PERMIT #: ELC2D0�O0882
13125 SW Hall Blvd., Tigard, OR 97223 � DATE ISSUED: 7/3/2008
' Phone: (503) 639-4171
Inspection Requea�C24Hmj:�Q3)83Q4�175 . .��� e �
INSPECTION WORKSHEET FOR DATE: 7/23/2008 TIME: 7 : 0 2AM PAGE: 26
SITE ADDRESS: 12660 SW 111TH PL CLASS OF WORK:
SUBDIVISION: ‘AW|'DERWESS LOT #: 006 TYPE OF USE:
PROJECT NAME: AMENT
DESCRIPTION: fe breaker panel.
OWNER: ANENT, JEFFREY pHONB#: 603'820F9182
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled . For: Date: 7/23/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073076'01 503-620-9182 /�~ ��
Corrections/Comments/Instructions:
~~
•
M0 PASS � PARTIAL APPROVAL �� CANCEL � NO ACCESS
. / �� ' /
I | FAIL FOR INSPECTION ri ADDITIONAL FEES ASSESSED
m �
Inspector: Date: (:5 Oa1e: ' i�(� � Phone #: (5O8) 718-
�