Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00870
$ A111 DEVELOPMENT SERVICES DATE ISSUED: 11/7/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S111 DC -03800
SITE ADDRESS: 15680 SW ALDERBROOK DR ZONING: R -7
SUBDIVISION: SUMMERFIELD NO.7 LOT : 381 JURISDICTION: TIG
Project Description: (3) 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: 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: 2 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:
DEUEL FAMILY REVOCABLE PRECISION ELECTRIC
LIVING TRUST 14842 SE REGNER TERR
15680 SW ALDERBROOK DR BORING, OR 97009
TIGARD, OR 97224
Phone: Phone: 503 - 413 -9870
FEES Reg #: LIC 105851
ELE 26 -892C
Description Date Amount SUP 4155S
[ELPRMT] ELC Permit 11/7/2005 $60.15
[TAX] 8% State Surcharge 11/7/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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 of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature: c
J`v \
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.
Nov 0605 08:05p Precision NW Electrical C 503 521 1637 p.2
• Electrical Permit Application
FOR OFFICE l SE ONLY
City of Tigard R EC E 0 V E r Received // _/, r
Daze /By. // l U ' Permit No: (J � - 0.5" '70
13125 SW Hall Blvd., Tigard, OR 97223 d6 R
Phone: 503.639.4171 Fax 503.548.1960 z~`•, Plan Review
,,rl, �' l . Date/By: Other Pem it
NOV nspection Line: 503.639.4175 7 4 c Read /By Seri"
Internet: www.ci.tigard.or.us tnvvvv ! 2OC El SecPugetfor
Notitied/Method
� Supplemental Information
T EI'PF(YYo#?NARt} PLAN REVIEW
❑ New construction Cit l allerattmnA Went Please check all that apply:
, cotnm
❑ Demolition ❑ 1 Other: ❑Service over 225 amps, p ❑Hazardous location
CATEGORY OF CONSTRUCTION ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
oft and 2 family dwellings 4 or more new residential
and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ System over 600 volts nominal units in one structure
❑Building over three stories ❑Feeders. 46D amps or more
❑ Multi - family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION
❑Egressdighting plan RV park
Job n
Job o.: I Job site a li G� Q '1 �� x � � 1th -rare fac ['Other:
n tatelZ� ..TI address:
/t � e t � � �"� " it 2 sets of with of the above.
^tf , -.- The above are not t appli applicable le to to t temporary construction service.
Suite/btdg. /apt. no. :i Project C).__ FEE* SCHEDULE ) + Description
Cross street/directions to job site: Qty. Pee. Total
New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft or less 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no,: Limited energy, residential 75.00 2
DESCRIPTION OF WORK Limited energy, non - residential 75.00 2
Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and /or relocatio n
200 amps or less 80.30 1 I 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name : c } 401 amps to 600 amps 160.60 2
�J 601 amps to 1,000 amps 240.60 2
Address: i 5 k F Q SW ) } / . c - 1 �• .�r k_-_,s— Over 1,000 amps or volts 454.65 2
City /State/ZIP -- '` ,, � _^ / • a / CY � Reconnect only 66.85 2
~'r1L L LJY_ Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( relocation
Owner installation: This installation is being made on property that 1 own which is not 20 amps to 100 00.30 1
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 20 t amps to 400 amps 100.30 2
Owner signature: 401 amps to 600 amps 133.75 2
Date: Branch circuits —new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
Business name ;' service or feeder fee, each I
i1 Z �-'t 5 'j l� jk�.� te branch circuit 6 111 2
Contact name: �/ �., B. Fee for branch circuits
` d/ 'rj t �f'6 without service or feeder fee,
Address:' r,_ each branch circuit
, 46.85 2
'l � .<;‘,„;,t, " �l`I' � �.- - Each a dd'] branch circuit
City /State/ZIP: ,,r ,t 7 6.65 2
h(` C , eti no Miscellaneous (service or feeder n ncluded)
Phone: (i) Fax: : (3 i Pump or irrigation circle I 53.40 2
�1- ` L- Sign or outline li tm
E - mail - g Sh g 53.40 2
Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or •
Business name. 2, t LA d .,� extension_ Describe: Page 2 2
Address: Each additional inspection over allowable in any of the above
City/ State/ZIP' Per inspection 62.50
' Investigation per hour(! hr min) i l 62.50
Phone: ( ) I Fax: ( ) Industrial plant per hour 73:75
CCB Lie.: � �2 , I Electrical Lie.: �' Suprv. PERMIT FEES*
-_1 I Su rv. Lie.: ZA-)l C
Subtotal I F „r
Suprv. Electrician signature, required: Plan review (25% of permit fee) V tS1
Print name: rrN/�1L� c V�,., „ r) J AA() I Date: State surcharge (8% of permit fee) 4..
' TOTAL PERMIT FEE j .
Authorized signature: %
e w /� ! This permit application expires if a permit is not oboe ed within 180
Print name: i days after it has been accepted as complete
rv - . vie j,0 ja,. Date: + Fee meihodotogy s: by Tn-C ounty Building industry Service Board
" Number of inspections per permit allowed.
is \Dui lding '',Pcmi its \EL.C•PemirApp.d°c 12103 440- 4615T(]0,'01/COM/WEO
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2005 -00870
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: '11/7/2005
Phone: (503) 639 -4171 Ahl
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/21/2005 TIME: 7:13AM PAGE: 87
SITE ADDRESS: 15680 SW ALDERBROOK DR CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.7 LOT #: 381 TYPE OF USE:
PROJECT NAME: DEUEL
DESCRIPTION: gbranch circuits
OWNER: DEUEL, NORMA PHONE #: 503 -684 -3511
CONTRACTOR: PRECISION ELECTRIC PHONE #: 503-413-8870
Inspection Request Scheduled For: Date: 11121/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 021977 -01 503 -684 -3511
Corrections /Comments /Instructions:
rnt - m - 1
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(IN)
I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
n FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: _� ,/. Date: / /// Phone #: (503) 718-