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' 1 CITY 1 ,. TIGARD K D ELECTRICAL PERMIT
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V PERMIT #: ELC2007 -00163
COMMUNITY DEVELOPMENT DATE ISSUED: 3/16/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
WO PARCEL: 1S125CA-03800
SITE ADDRESS: 0 7 S W CEDARCREST ST ZONING: R - 4.5
SUBDIVISION: BOULEVARD HEIGHTS LOT : 016 JURISDICTION: TIG
PROJECT: LAWRENCE
Project Description: Temporary power.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 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: 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:
LAWRENCE RESOURCES INC JEROME ELECTRIC
6770 SW ALFRED ST PO BOX 751
TIGARD, OR 97223 HILLSBORO, OR 97123
Phone: 503 - 975 -6560 Contact #: FAX 503 - 648 -9723
PRI 503- 648 -5144
FEES
Description Date Amount Reg #: ELE 34 -1 I9C
[ELPRMT] ELC Permit 3/16/2007 $66.85 LTC 158119
[TAX] 8% State Surcharge 3/16/2007 $5.35 SUP 2877S
Total $72.20 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 at 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: 4k,/ 7 7 "04.6i
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.
/
.5
ci. ical Permit Application __
City of Tiga-rd FOR OFFICE US ONLY •
" ' R Permit N 7 D
° 13125 SW W Hall Blvd., Tigard, OR 97223 /
' 11111
e b D an By: Other Permit:
Ph one: 5 Fax: 503.598:1960 Date /By:
T 4G Inspection Line: 503 639.4175 y n i ZUU I Date Ready/By: .runs El See Page 2 for
. Internet: www.tigard- or.gov �� " `) 1 Notified/Method. Supplemental Information
. TYPE o i', 41011 { J j IA I PLAN: REVIEW •
�. - ` Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ❑,Addit n/alfgrafititl`/ mlaeemelltrg A
r�,rt ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Xl, 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
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
' Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. JOB SITE- INFORMATION AND LOCATION El Emergency system. larger separately derived system.
, ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", "l -3 ",
Job no.: Job site address: d IOOHP or more. occupancy.
7 � Z 4/ • C � -'� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ID Health -care facilities. ❑ Supply voltage for more than
/ / ®�� 97 Z �3 ❑ 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: Z:,,,,-.4// 7 4/'l Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
0 '/ , ..L ,ec Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
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.)
Limited energy, multi - family 75.00 2
7 _,,i / , 4,, ' residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
je._.__ i Td�s sf ,Gu 200 amps or less 80.30 2
A PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
� itLv,deOdreg.-- -- 77 "'°`G "6,-. j d � /v . 601 amps to 1,000 amps 240.60 2
Address: 77 w �,-'0--/7 �� Over 1,000 amps or volts 454.65 2
City/State /ZIP: Gs �l Temporary services or feeders installation, alteration, and/or
rv/ / �/L__ q 77 , -3 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 C ONTACT PERSON above service or feeder fee, 6.65 2
/ each branch circuit
Business name: B. Fee for branch circuits
Contact name: T without service or feeder fee, 46.85 2
%7G�o, „2.4-......- first branch circuit
Address: Each add'l branch circuit 6.65 2
G �� �� Miscellaneous (service or feeder not included)
City/State /ZIP: .�G f= //ill-- ' Z Each manufactured or modular 90.90 2
dwelling, service.and/or feeder
Phone 6.3 ) C7, -;:"...3 GZ- Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump•or irrigation circle 53.40 2
CONTRACTOR . . Signor outline lighting 53.40 2
Business name: ....2.t.,:„. Signal circuit(s) onlimited-
l� cl�- fr-� z /�. _ ' energy panel, alteration, or
Address: ze,_ ---7-/ extension. Describe: Page 2 2
City/State /ZIP: / L ! S g,,,..,0„ z e,"j <,� GJ7j� Each additional inspection over allowable in any of, the above
/ Per inspection 62.50
Phone: (j53. ) „11., j Li p- Fax: ( ) Investigation per hour (l hr min) . 62.50
CCB Lie.: C� . / Electrical Lie.: /t96,.. Suprv. Lie. 2 Industrial plant per hour 73.75
• 7 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (04a , 5
Print name: �'L t y ��� Date:
y Plan review (25% of permit fee):
/ ,7- -/ State surcharge (8% of permit fee): '• 35
Authorized signature: ,A _ �y J- e� y � � TOTAL PERMIT FEE: aNO
"�"� /, V r 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.
(.\Building \Permits \ELC- PermitApp.doc 05/23/06 440- 4615T(1 1/05 /COM /WEB
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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
F1 HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Totafnumber of commercial systems:
*No licenses are required. Licenses are required
for All other installations •
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
- CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC20t17 0 1
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3//612007
Phone: (503) 639 -4171 a 7pllp'�I +*
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE:. 3/28/2007 TIME: 7:00AM PAGE: '49
7�{o g
SITE ADDRESS: /2 SW CEDARCREST ST CLASS OF WORK:
SUBDIVISION: BOULEVARD HEIGHTS LOT #: 016 TYPE OF USE:
PROJECT NAME: LAWRENCE
DESCRIPTION: Temporary power.
OWNER: LAWRENCE RESOURCES INC, PHONE #: 503 - 975 - 6560
CONTRACTOR: JEROME ELECTRIC KA 1 1 PHONE #: 503 - 648 - 5144
Inspection Request Scheduled For: Date: 3/28 /2007 Pour Time:
Code # Inspection Description Confi Contact # Message
110 Temporary electrical service 045567 -01 503-648-5144 Y
1 `'t q � i �L-
Garrect' /In ctions:
64' : rf ROCS 91 51514
•
PASS n PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
I I'" FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
. Inspector: N 66 LC Date:3 . t 0 Phone #: (503) 718 - VI4I