Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT # ELC2007 -00289
COMMUNITY DEVELOPMENT DATE ISSUED 4/30/2007
TIGARD 13125 SW Hall Blvd , Tigard, OR 97223 503 639 4171
PARCEL 2S103DC -00817
SITE ADDRESS 11225 SW FAIRHAVEN ST ZONING R -3 5
SUBDIVISION VIRGINIA ACRES NO 2 LOT 019 JURISDICTION TIG
PROJECT BURMAN
Project Description Replace electrical box
RESIDENTIAL UNIT TEMP SRVCIFEEOERS 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 CRC 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:
RAYMOND & JUDY BURMAN OWNER
11225 SW FAIRHAVEN ST
TIGARD, OR 97223
Phone• 503 - 639 -0134 Contact #
FEES
Description Date Amount Reg #
[ELPRMT] ELC Pei ma 4/30/2007 $80 30
[TAX] 8% State Suichaise 4/30/2007 $6 42
Total $86.72 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. Permittee Signature' / f `°' U
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent ' /
OWNER'S SIGNATURE r DATE• / 7
/
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 Applicat FOR OFFICE USE`
City of Tigard CEIVED
Datelbv Pen" No
• 13125 SW Flail Blvd. I'Igard,OR R7 2�
/'�� 7 ���aoo� — ooa
• : d Phone 503 639 4171 Fax 5035WF196ty Recened
0 2007
Date/Plan BReview
y Other Permit
Inspection Line 503 639 4175 Date Ready /By pan: fd See Page 2 for
TIGARD: Internet www tigard -or gov CIT TIGARD Notified/Method Supplemental Information
BUt tj ` DIVISION
TYPE'5OF PLAN REVIEW
❑ New construction 0 Addition /alteration /replacement Please check all that apply (submit 2 sets of plans whtems checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other where the available fault current ❑ Matins and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings
d dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I - and 2-family g ❑ 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 ❑ Emergency system larger separately demised system
�•
❑ Addmonofnewmotorloadof ❑`A ",`E ", I- 2 ", % -3 ",
Job no Job stte address r( 5,,,3 ('N
t gAJtt. S .) opooree occupancy
❑ Six Six or more e residential units ❑ Recreational vehicle parks
/
City /State /ZIP ( .t4 I c . 4� 4'11'.3 0 Health-care facilities ❑ Supply voltage for more than
❑ 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 Desenpmn I Qty. I Fee I Total I •
�/, New residential single - or multi -family dwelling unit.
US "l Includes attached garage.
Subdivision Lot no 1,000 sq f t or less 1 4 5 1 5 4
Tax map /parcel no Ea add'I 500 sq ft or portion 33 40 I
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
/J
h tZLtt, /� .� x30K• Limndentia gy, multi-family bove 0) 7500 2
T IG residential (with above sq R
Services or feeders installation, alteration, and/or relocation
200 amps or less I 80 30 2
t ericOPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
Name QAp ws Io /3gie,y4A,/ 401 amps to 600 amps 160 60 2
(( //' 601 amps to 1,000 amps 240 60 2
Address' / I ZZ) 4 5,,.....j /4 , oa It qv eat , t Over 1,000 amps or volts 454 65 2
City/State /ZIP %�L L� / O 9 7 ZL Temporary services or feeders installation, alteration, and/or
�7 relocation
Phone (9)3) 43c; _ 0 13 4 Fax ( ) S a 200 amps or less 66 85 1
Owner installation: Ills 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 7 1 401 amps to 599 amps 133 75 2
g //, ,4LZ - Branch circuits - new, alteration, or extension, I er panel
Owner signature / `t6�OOr 1.--54-4-1-441-0--s. // Date Y A Fee for branch circuits vi irh
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6 65 2
each branch circuit
Business name 544th As /) .f� r � ( Fee for branch circuits
Contact name / ' f, � - � 7i without service or feeder fee, 46 85 2
first branch circuit
Address Each add'l branch circuit 6 65 2
Miscellaneous (service or feeder not Included)
City /State/ZIP Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Phone ( ) Fax ( ) Reconnect only 66 85 2
E Pump or irrigation circle 53 40 2
CONTRACTOR / Sign or outline lighting 53 40 2
Business name S_/✓1t /)AO�� Signal panel circuit(s) limited -
L � 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 (I hr mm) 62 50
CCB Lie Electrical Lie Supry Lic Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Supry Electrician signature, required Subtotal
/ Q0, 3a
Print name //////!! //�) L . ! Date 4 / 1_ / 7 Plan review (25% of permit fee)
f—!a yj 14p i °'iy � JVI r 7�/ State surcharge (8% of permit fee) ( ' ye.
Authorized signature 45 101 AL PERMIT FEE /1 !n r ?a_
Print name Date This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit
I \Budding \Permns\ELC-PermitApp doe 05/23/06 440- 4615TO I /o5 /COWAEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined........ $75.00
Check Type of Work Involved:
7 Audio and Stereo Systems*
❑ Burglar Alarm
n G • arage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n 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 F • ire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control*
n M • edical
n Nurse Calls
n O utdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems
*No licenses are required. Licenses are required
for all other installations
1 .auddin g Aermus/LLC- PermiApp doc 01/23/06
CITY OF TIGARD
BUILDING DIVISION - PERMIT # ELC2007- 00209
13125 SW Hall Blvd , Tigard, OR 97223 DATE ISSUED 4(30/2007
Phone' (503) 639 -4171 _ ICI
Inspection Requests (24 Hrs) (503) 639 -4175 „I
INSPECTION WORKSHEET FOR DATE 5/10/2007 TIME 7:02AM PAGE 66
SITE ADDRESS. 11225 SW FAIRHAVEN ST CLASS OF WORK
SUBDIVISION. VIRGINIA ACRES NO 2 LOT # 019 TYPE OF USE
PROJECT NAME BURMAN
DESCRIPTION Replace electrical box.
OWNER BURMAN, RAYMOND & JUDY PHONE # 503-639-0134
CONTRACTOR OWNER PHONE #
Inspection Request Scheduled For Date: 5/10/2007 Pour Time
Code # Inspection Descnption (7 .Conflfm - #, Contact # Message
193 Electrical final 047949 -01 503. 639.0134 \ Y
Corrections /Comments /Instructions. //\
l
$.PASS ❑ PARTIAL APPROVAL n CANCEL n NO ACCESS
FAIL I AAC``ALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: Cr I 1 1�1&) ( Date. %.S b ' Phone #: (503) 718 -2 1''