Permit CITY OF TIGARD v# ELECTRICAL PERMIT
" PERMIT #: ELC2007 -00489
COMMUNITY DEVELOPMENT DATE ISSUED: 7/17/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S134CB-15200
SITE ADDRESS: 12261 SW ANTON DR ZONING: R -
SUBDIVISION: ANTON PARK NO. 2 LOT : 079 JURISDICTION: TIG
PROJECT: LOGAN
Project Description: 2 branch circuits AC and furnace.
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:
JENNIFER LOGAN ANDERSONS INTEGRITY ELECTRIC
12261 SW ANTON DRIVE 18435 SW PACIFIC HWY
TIGARD, OR 97223 STE D
TUALATIN, OR 97062
Phone: 503 - 590 - 5665 Contact #: PRI 320 - 1968 CELL
PRI 524 -4681
FEES
Description Date Amount Reg #: 'F 34 -363C
[ELPRMT] ELC Permit 7/17/2007 $53.50 LIC 91410
[TAX] 8% State Surcharge 7/17/2007 $4.28 SUP 37705
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 of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: �,lifj— �/..vL 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 AppliZ ENE `> E t FOR OFFICE USE ONLY
City of T i g a r d R e e � b7 f � j I � Pennit N L C�cav7 —190 V S'19
II . n 13125 SW Hall Blvd., Tigard, OR X7223 1 J 1001 Plan Review
.: • Phone: 503.639.4171 Fax: 503.598.1 Date /By: Other Permit:
-
TIGARD Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: turfs: .1 ,-- See Page 2 for
Internet: www.tigard - or.gov BUILDING D DIVISION Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 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
S. 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JO& SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
100HP or more. occupancy
Job no.: Job site address:
ZZ X01 Sw 1�.,..x ate Dv-- ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: ` CI Health-care facilities. ❑ Supply voltage for more than
VA �/'r> n ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
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
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
_ d Limited energy, multi - famil 75.00 2
p lA ,�
f...._. t V' (�,,,� A f tr . e--A - , e Ar-- residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
aJV:N.L+r__._ 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
-
Phone: ( ) 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, 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 ' ❑ CONTACT PERSON' • above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 2
first branch circuit
Address: Each add'I branch circuit E 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
CONTRACTOR Sign or outline lighting 53.40 2
Business name: r Signal circuit(s) or limited -
v �A �/` s't ..1S 2 c ��C��1 n k st energy panel, alteration, or
Address: \ extension. Describe: Page 2 2 j.
ri Cit y y /State /ZIP.c:,l5 v � � � 0� Each additional inspection over allowable in any of the above
t4C. tfat a� ( Per inspection 62.50
Phone: (s � I _ L 01 Fax: (S03) C9— �,-t Investigation per hour (1 hr min) 62.50
L_- CCB Lic.: ! 1 y k -0 Elee. ' al Lic.: ` Suprv. Lic.:.3 -/-1 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required , � Subtotal: e~
Print name: l - Date: Plan review (25% of permit fee):
�v �. �►` °-V �jcs C� St ate surcharge (8% of permit fee): zi, Ej
Authorized signature: TOTAL PERMIT FEE: S i s
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.
I \Building \Permits\ELC - PermitApp doc 05/23/06 440- 46t5T(11 /05 /COM/VEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
I RESIDENTIAL WORK ONLY •
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
Ti Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
n Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1: \Building\Permits \ELC- PermitApp doe 03/23/06
f ,
CITY OF TIGARD
BUILDING DIVISION •
PERMIT #: ELC2007-00489
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/17/2007
Phone: (503) 639 -4171 u �0,it
� �
Inspection Requests (24 Hrs.): (503) 639 -4175 I_ l I
INSPECTION WORKSHEET FOR DATE: 7/20/2007 TIME: 7 :03AM PAGE: 81
SITE ADDRESS: 12261 SW ANTON DR CLASS OF WORK:
SUBDIVISION: ANTON PARK NO. 2 LOT #: 079 TYPE OF USE:
PROJECT NAME: LOGAN
DESCRIPTION: 2 branch circuits AC and furnace.
OWNER: LOGAN, JENNIFER PHONE #: 503 -590 -5555
CONTRACTOR: ANDERSONS INTEGRITY ELECTRIC NN e. PHONE #: 320-1968 CELL
Inspection Request Scheduled For: Date: 7/20/2007 Pour Time:
Code # Inspection Description Contact # Message
11 A/C or heating unit circuit 052312 -01 503 -307 -3885 Y
rot 9 F- I t e a , ` . 13) 9 1 .5104 .
Corrections /Comments /Instructions: Qti fl-
/V ■
62 PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL [ I CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: V • e v 06L-E
Date: 1 0 Phone #: (503) 718- L 1