Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00445
lTep. DEVELOPMENT SERVICES DATE ISSUED: 7/20/2004
13125 SW Hall Blvd.. Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1 11 DC 01400
SITE ADDRESS: 15920 SW ALDERBROOK CIR
ZONING: R -
SUBDIVISION: SUMMERFIELD NO.8
BLOCK: LOT : 461 JURISDICTION: TIG
Project Description: Altering receptacles, switches, and lights throughout, garage not included.
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: 4 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:
JAN VANDERPOOL MT HOOD ELECTRIC INC
15920 SWALDERBROOK CIR PO BOX 1270
TIGARD, OR 97224 WELCH ES, OR 97067 -1270
Phone: 503 - 244 -5154 Phone: 503- 622 -1305
Reg #: ELE 3 -517C
LIC 147640
FEES SUP 4828S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/20/2004 $73.45
[TAX] 8% State Surcharge 7/20/2004 $5.88 Rough -in
Elect'I Final
Total $79.33
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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 thes rules or direct questions to OUNC at (503)
246 -6699 or 1 -000 -33 2344.
Issued By: Permit 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:
CONT ACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE: I/ (Wo
LICENSE NO: 4-7/4:2--g-
Call 639 -4175 by 7:00pm for an inspection the next business day
!.FROM Mt. Hood Electric, Inc NI FAX NO. :583 622 13(35 Jul. 19 2004 07:56AM P2/2
Electrical Permit Applica io
1% o D e Receive.o/Hy ! / per nut Ne.:� ¢ — �
1 5
7
City Tigard
SW W Hall Blvd. Tigard, OR 9722 > () Odor Permit.
Phone: 5(13.639.4171 Fax: .503 598,1960 ` 0 �' � ,. .� cj,1 ■ ° 'r Wo' 1 Date/ :
Plan Rev;ey4
I. Da1e Ready /ay' ions la See Page a for
Inspection Line: 503.639.4175 C ` O ' o\ c4r - Notified /M i ediotl: \ [ r I Supplem Information
Internet: www.ci.tiga '� C,
i „.
Please check all that apply:
❑ New construction ® Addition /a.lt. ration /replace mcnl DServicc over 225 amps, comm'1 ❑Hazardous location
Q Demolition ❑ Other: .. DScrvice over 320 amps - rating ❑ Duildng over 10,000 sq. ft.,
. .. .. Y dwellings 4 or more new residential
CA„L :'IC!' ' ' of 1 - and 2
System over 600 volts nominal units in one structure
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
El Building over three stories ❑Feeders, 400 amps or more
0 Multi- family ❑ Master builder ❑ Other; :Occupant load over 99 persons 0Manufactured structures or
t?Ati`ION:::, . 1. _ .,� ❑Fgre /light ng plan Others
:Health-care facility ss i ❑
lob no.: .lob site address; 15920 SW Alderbrouk C ' Submit 2 sets of plans with any of the above.
City /State/ZIP: Tigard, OR 97224? The above are not applicable to temporary construction service.
._. ,GHEA1!ltaE
Suite /bldg- /apt. no,; Project name; Vandepool Descripti gay. Foe. I — Toiei I ”
Cross street/directions to job site: Durham to Alderbrook Dr, to Aiderbrook Cir New residential single - or multi family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Lot no.: Ea. add'! 500 sq, ft, or portion 33.40 1
Subdivision: Limited energy, residential 75.00 2
Tax map /parcel no.: -
Limited energy, non - residential 75,00 2
: .,,,, „t,S . . • . 1,. ,. Each manufactured or modular t
dwelling, service and /or feeder 90.90 2
Add and move receptacles, switches, and lights throughout _ Services or feeders installation, alteration, and /or relocation
200 amps or less 80,30 2
R to 400 amps l
w
,, 106,85 1?lP . r :k.1T., ; ... 160.60 :
,�r;�.'�`�!... ', .:.• , ii 600 amps !
i 401 am to 6 2
Name; c7,q'N iffl " D6.:pcier i, 601 amps to 1,000 amps 240.60 2
Address: /6920 5W Aid 0 4 r-°fc,LC 0,-' Over 1,000 amps or volts 454.65 2
Reconnect only 66,85 2
City /StEAe /Z1P: t^ ‘„,1.. C L Temporary serv or feeders installation, alteration, and/or
l relocation
Phone: ( �/ 3 i ) '2 / f j Fax: ( ) _ 200 amps or less 66.85 I
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 600 amps _ 133,75 2
Owner signature, Date: Branch circuits - new, alteration, or extension, per panel
• ...... ,. ` Kg ranch circuits w ith
o, A Fcc f or b
1:7.1:4440041141k, ii 4:•;., . _y. ........" i :...`' serv or feeder fee. each
Business name: Mt. Hood Electric, inc branch circuit 6.65
-. B, Fcc for branch circuits
Contact name: Maurice Greven without service or feeder tee, i 46,85 2
each branch circuit
Address: PO Box 1270 Each add'I branch circuit A 6.65
City/State /ZIP: Welches, OR 97067 -1270 Miscellaneous (service or feeder not included) _
• Pump or irrigation circle 1 5140 ,
Phone: (503) 622 -1305 Fax: : (503) 296 -5949 Sign or outline lighting 53,40
E -mail: mt.hoodeleetric @verizon.net Signal circuit(s) or limited-
...,.... .. -„,`! ,.... - : :'' : :..... ..
.... ibNTAi OR or
.. :., energy panel, alteration, o
extension, Describe: Page 2
Business name; Mt. Hood Electric, Inc
Each additional inspection over allowable in any of the above
Address: POP Box 1270 Per inspection 62.50
City /State/ZIP: Welches, Or 97067 -1270 Investigation per hour (1 hr min) 62.50
Industrial ,plant per hour 73.75
Phone: (503) 622 -1305 S Fax; (503) 296 -5949 ,. w -
O _ ,'.:; � •.�.::; ,., :'i18;'I<;���G;���li; 11f1T`'P"!�'� k•
C CB I ic.: 141640 y'� Electrical i ic.: - 517C U 'o S uprv. L 48285 D ,- Subtotal -7'. S
Suprv, Electrician signature, require. 10' >;, Plan review (25 70 of permit fee)
— Date: 7/16/2004 State surcharge (8% of permit fee) 5 _ g
Print name: �) TOTAL PERMIT FEE "7 !.3 3
Authorized signature: / This permit application expires if a permit Is not obtained w tb n 1St
14 / day after it hat been accepted a. complete
Print name: y�,, Date: 7/16/2004 • Fcc methodology set by Tri- County Building industry Seevicc Board
rAi/� !!„ t /`L -Q-c - Number of inspections per permit allowed.
i'\euildiesweemlu\ELC -i' .'a,itApp.doc 12/03 440- 40I57(10/42/COM /WED