Permit Tv OF ELECTRICAL PERMIT
' 1 ' , I�r OI� TIGARD PERMIT #: ELC2006 -00621
IJI DEVELOPMENT SEIVICES
s• DATE ISSUED: 10/31/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111 CC 07100
SITE ADDRESS: 15885 SW GREENS WAY ZONING: R -12
SUBDIVISION: SUMMERFIELD NO.2 LOT : 098 JURISDICTION: TIG
Project Description: (2) branch circuits for bath remodel.
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:
VICTOR STURGEON DICKINSONS ELECTRIC
15885 SW GREENS WAY 8449 SW BARBUR BLVD
TIGARD, OR 97224 PORTLAND, OR 97217
Phone: Contact #: PRI 503 - 246 -3550
FAX 503 - 213 -6049
FEES
Description Date Amount Reg #: ELE 26 -140C
[TAX] 8% State Surcharge 10/31/200( $4.28 LIC 65534
[ELPRMT] ELC Permit 10/31/200( $53.50 SUP 3100S
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 OA' ' . 011-0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC•at "503 - 246 -6699 or
1- 800 -3. -2344.
t:
Issue. By: C math) _ U4Y Permittee Signature: k,,e
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:
CONTRACT.OR 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.
Electtical'Perrnit Application FOR OFFICE USE ()NIX / Receiv
City of Tigard f Daz 10 D Permit No.: t L exe.)6i " et)b) -1
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' C ' Phone: 503.639.4171 Fax: 503.598.1960 Date/B . Other Permit:
Tl C A kll Inspection Line: 503.639.4175 Date Ready/By: Juris: El See Page 2 for
' Internet: www.tigard - or.gov Notified/Method: 4 v Supplemental Information
TYPE OF WORK PLAN REVIEW
CI New construction ®' Add ition /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
! Er and 2- family dwelling CI Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
Job no.: Job site address: /5455 Six or more e more. occupancy.
��� C� tag ❑ Six or more residential units. ❑ Recreational vehicle parks.
f / ❑ Health -care facilities. ❑ Supply voltage for more than
City/State/ZIP: �� 1 1/ ❑ 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: _c.> 1 1 � ,� �/ 1 - „ //' Description I Qty. I Fee. I Total I •
c r /! V c a New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTIO OF WORK
1 (with above sq. ft.)
•
�1 Limited energy, multi - family 75.00 2
(l �/l� residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: .' 1I 1 1 ,,,,Q & S 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: ( '.0.1 Wt7 i ` / 7 C5 � 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
• Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
� A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2 • Di c I' ,� B. each branch circuit
Business name: DJ j - L- ,ry �� _ d Fee for branch circuits /
Contact name: without service or feeder fee, j� 46.85 4 b"�S
2
first branch circuit /
•
• Address: p y r' t? ,i2 z/L Each add'l branch circuit / 6.65 b 44 2
' / , i Cc7 "{ ' f� Miscellaneous (service or feeder not included)
City / State/ZIP: ” / /��" ,, , 2 „. /9 Each manufactured or modular
90.90 2
/ i " 1 1 dwelling, service and/or feeder
Phone: ( S�/.� / S Z9 2-2 Fax: : ( 2 3 Eby 5 Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR f Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
energy panel, alteration, or
Business name �y �C �- �
Address: C `''L 5 z J a 1 t b�_ �
extension. Describe: Page 2 2
City / State/ZIP: 62„." e 9 7 7---/, Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: V37 5/,5 — `% 2 L.Fax:gf.'�j) 3 (3 __60L19 Investigation per hour (1 hr min) 62.50
CCB Lic.: L Electrical Lie.: 4' v. Lic.: 349e2S Industrial plant per hour 73.75
ELECTR PERMIT FEES
Suprv. Electrician signature, required: ' .z� — , Subtotal:
Print name,( ) (2. Lam. Date: /C4,,/7 Plan review (25% of permit fee):
�/ 7 State surcharge (8% of permit fee): 2f dg
Authorized signature.' TOTAL PERMIT FEE: 57 , 78
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 \Pemuts\ELC- PermitApp.doc 05/23/06 440- 4615T(I 1/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
FI SIDENTIAL-'WC RICONLY: _ .
• Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY: - 1
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
•
❑ HVAC
❑ Instrumentation
❑
•
Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other •
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PerrnitApp.doc 03/23/06
Community Development
Building Division
13500 SW Hall Blvd.
Tigard, OR 97223
Phone: 503 - 639 -4171 T I G A R D
FAX TRANSMITTAL
NOTICE OF EXPIRED PERMIT
Date: 3/12/08
Contractor: Dickinson's Electric
Permit Number: ELC2006 -00621
Owner: Sturgeon, Victor
Site Address: 15885 SW Greens Way
This notice informs you that per OAR 918- 309 -0000 (7) and TMC 14.04.065 the
above permit has expired by limitation. A notice informing you of outstanding
correction(s) written to this permit was faxed to you on 7/20/07, a copy of which is
attached. These corrections shall be completed under a reinstated permit within (20)
twenty calendar days of the date of this notice per OAR 918- 309 -0000 (8).
Reinstatement of this permit will require payment of a fee of $70.00 authorizing (1)
one inspection. Additional inspections, if required, will be charged $70.00 each.
Failure to reinstate the permit may result in the issuance of a summons and complaint
for violation of OAR 918- 309 -0000 (8) per TMC 14.04.090, which constitutes a Class
I Civil Infraction with penalties of up to $250.00 per day per violation.
You are urged to reinstate the pettnut or provide cause as to why you cannot make the
required correction(s) within (20) twenty days of the date of this letter. My desk phone
is 503 - 718 -2446. Please leave a voice mail if I am out of the office.
Gary Noble
Senior Electrical Inspector
503 - 718 -2446
Fax: 503 - 624 -3681
Email: garynntigard- or.gov
f \ENO \FAX DOT
CITY OF TIGARD
BUILDING DIVISION •..
PERMIT #: ELC2006-00621
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2006
Phone: (503) 639-4171
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 11/1/2006 TIME: 7:03AM PAGE: 31
18 -.Sven/ma Fe-a-
SITE ADDRESS: 15886 SW GREENS WAY CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.2 LOT #: 098 TYPE OF USE:
PROJECT NAME: STURGEON
DESCRIPTION: (2) branch circuits for bath remodel.
OWNER: STURGEON, VICTOR PHONE #:
CONTRACTOR: DICKINSONS ELECTRIC PHONE #: 503
Inspection Request Scheduled For: Date: 11/1/2006 Pour Time:
Code # Inspection Description Confirm # Contact #
120 Electrical rough-in 039131-01 503-61Er 2922
Corrections/Comments/Instructions: S 3 -
775
Nis 44
Fiwa_ tipRoofk■--
The electrical installation defects noted
on this report snail be corrected and
an inspection request made within 20
calendar days per OAR 918
ii 'O7
4
•
•
I6 PASS fl PARTIAL APPROVAL El CANCEL El NO ACCESS
FAIL CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: C/PC Date: 0 6 Phone #: (503) 718-
. . .
CITY OF TIGARD
BUILDING DIVISION A:. • PERMIT #: ELC2006.00621
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/31/2006
Phone: (503) 639-4171 11"141111,
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 4/2/1 08 TIME: 7:00AM PAGE: 52
SITE ADDRESS: 15085 SW GREENS WAY CLASS OF WORK:
SUBDIVISION: SUMMERFIELD NO.2 LOT #: 098 TYPE OF USE:
PROJECT NAME: STURGEON
DESCRIPTION: (2) branch CirCUILS for bath remodel. 3/31/08, reinstated for 20 days for final inspertion.
OWNER: STURGEON, VICTOR PHONE #:
•
CONTRACTOR: DICKINSONS ELECTRIC PHONE #: 503-246-3550
Inspection Request Scheduled For: Date: 4/2/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067677-01 503-515-2922
Corrections/Comments/Instructions:
•
174' PAS "I PARTIAL APPROVAL El CANCEL fl NO ACCESS
fl FAIL CALL FOR INSPECTION I I ADDITI NAL FEES ASSESSED
Inspector: Date: Phone #: (503) 718- Z-6
Nb.
_ . .• ,