Permit 1 , CITY OF TIGARD .: I �' ELECTRICAL PERMIT
1
t PERMIT #: ELC2007 -00527
COMMUNITY DEVELOPMENT DATE ISSUED: 7/31/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 25111 AD -18000
SITE ADDRESS: 14840 SW JONAGOLD TERR ZONING: R -4.5
SUBDIVISION: LADY APPLE LOT : 004 JURISDICTION: TIG
PROJECT: LADY APPLE
Project Description: (1) branch circuit to connect a/c unit.
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: 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:
BEACON HOMES NORTHWEST CONNECTIONS ELECTRIC
12703 SW 67TH AVE. PO BOX 7136
TIGARD, OR 97223 SALEM, OR 97303 -0026
Phone: 503 - 407 - 0580 Contact #: PRI 503 - 390 - 7914
FAX 503 - 463 -6863
FEES
Description Date Amount Reg #: ELE 24 -248C
[ELPRMT] ELC Permit 7/31/2007 $46.85 LIC 65444
[TAX] 8% State Surcharge 7/31/2007 $3.75 SUP 3611S
Total $50.60 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 issua7e=,ocr if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notij' iiotp Center. / Those rules are set forth in
OAR 952 - 001 -0010 through OA' •52- 001 -0100. You may obtain copies of these rules or direct questions to'OUNCJ - 03'246.6699 or 1.800.332.2344.
/ /
J
Issued B� / Permittee Signature: / /
II
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 Application 9T, rLf— FOR OFFICE USE ONLY .
Cl of Tigard g L 1 ` " ,: ci j z t . - ` , Received Permit No.:
City g DateBy: �� I� _•...k ' �� 2
- ° 13125 SW Hall Blvd., Tigard, ORJ 197223` 1 )007 Plan Review
Phone: 503.639.4171 Fax: 503 5 L Date/B : Other Permit: M C 0Ar _I
Inspection Line: 503.639.4175 l . : . l Date Ready /By loos: See Page 2 for
TIGARD Internet: www.tigard or.gov s� i " "" f` `: e ® Notified/Method: / / �' Supplemental Information
TYPE OF WORK. PLAN REVIEW
s A
ew 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 El Commercial -use agricultural
and 2- family dwelling ❑ Commercial /industrial El Accessory building amps for all other installations. buildings
E Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. buildings
of 75 KVA or
❑ Emergency system larger separately derived system.
• JOB SITE INFORMATION AND LOCATION 0 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 1 [� % C-(4) 5 c D F , x .� p, Six o or more residential R occupancy. Recreational l J �� ❑ Six or more residential amts. ❑Recreational vehicle parks.
City/State /ZIP: — T - �Z ®''I-- c '- Z23 ❑ 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.
y, FEE SCHEDULE
Cross street/directions to job site: S 1 .e.._ A 1---/VV27 Description I Qty. I Fee. I Total I "
Ai? New residential single- or multi- family dwelling unit.
Ai? } 1 . _ 1 .--'r , - - Includes attached garage.
Subdivision: L_ p A-i p (_42._ Lot no.: `T. 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
DESCRIPTION OF WORK (with above sq ft.) 75.00 2
//��
V�� U Limited energy, multi - family
A+C:. - 1/� residential (with above sq. ft.)
75.00 2
T 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: 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
- , .g, APPLICANT ? CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: CR ,Pll,c,„ er B. Fee for branch circuits
p without service or feeder fee, I 46.85 4p . is 2
Contact name:
Q>. Ct` ( ( ‘ 3 V&F\- first branch circuit
Address: (2.: 9 >-k.D 69- AA) _e____ Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: 7_%0 ® q'r4 -223 Each manufactured or modular
90.90 2
dwelling, service and/or, feeder
Phone: (5 Lt pY o S g O Fax: : ( 5 7 - p SS t! Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR , _ .. Sign or outline lighting 53.40 2
�e
- Signal circuit(s) or limited -
Business name: Co w -G- - 1 -3} e��r 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: ( 3010 (A ( --f- Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: $ - 7-1 Electrical Lie.: 2 ;% ?' Suprv. Lie.: ,36// S Industrial plant per hour 73.75
1 ELECTRIC AL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 46. t,5
Print name: 417 Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 3
Authorized signatu 0 ' TOTAL PERMIT FEE: c 0 . (� D
This permit application expires if a permit is not obtain within 180
p
Print name: -�9�• t ( t,wD 1A,<1^.._ Date -- —3 ( l" days after it has been accepted as complete.
! * Number of inspections allowed per permit.
1' \Building \Permits \ELC - Permit pp doe 05/23/06 440- 461ST(1 t /OS /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - .Supplemental Information `
LIMITED ENERGY PERMIT FEES:
RESID 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*
• 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
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
n Intercom and Paging Systems
• 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
I: \ Building \Permits\ELC- PermitApp.doc 03/23/06
CITY OF TIGARD
COMMUNITY DEVELOPMENT
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
t� X0 01 •
Electrical Signature Form t '
IMPORTANT PERMIT NOTICE
CONNECTIONS ELECTRIC •
PO BOX 7136
SALEM, OR 97303 -0026
Permit #: ELC2007 -00527
Date Issued:
Parcel: 2S111 AD -18000
Site Address: 14840 SW JONAGOLD TERR
Subdivision: LADY APPLE
Lot: 004
Jurisdiction: TIG
Zoning: R -4.5
Project Name: LADY APPLE
Description: (1) branch circuit to connect a/c unit.
Your company has been indicated as the electrical contractor for the permit referenced above. In order for the electrical
permit to be valid, the signature of the supervising electrician is required. Please have the appropriate individual from
your company sign below and return this Electrical Signature Form prior to the start of the work. Please mail the form to:
City of Tigard, Building Division, 13125 SW Hall Blvd., Tigard, OR 97223, or you may fax the form to: 503.624.3681.
If you have any questions please call 503.718.2433.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
BEACON HOMES NORTHWEST CONNECTIONS ELECTRIC
12703 SW 67TH AVE. PO BOX 7136
TIGARD, OR 97223 SALEM, OR 97303 -0026
Phone #: 503 - 407 -0580 Phone #: 503 - 390 -7914
Reg #: ELE 24 -248C
LIC 65444
SUP 3611S
AN INK SIGNATURE IS REQUIRED ON THIS FORM
3/
Signature of Supervisi4g Electrician Name (printed) SUP LIC #
CITY OF TIGARD .
BUILDING DIVISION PERMIT #: ELC2007-00527
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/3112007
Phone: (503) 639 -4171 a �Npvi "Iil
Inspection Requests (24 Hrs.): (503) 639 -4175 �. ' W
INSPECTION WORKSHEET FOR DATE: 8/9/2007 TIME: 7:00AM PAGE: 30
SITE ADDRESS: 14840 SW JONAGOLD TERR CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 004 TYPE OF USE:
PROJECT NAME: LADY APPLE • •
DESCRIPTION: (1) branch circuit to connect a/c unit.
OWNER: BEACON HOMES NORTHWEST. PHONE #: 503.407.0580
CONTRACTOR: CONNECTIONS ELECTRIC PHONE #: 503 - 390 -7914
Inspection Request Scheduled For: Date: 8/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
145 NC or heating unit circuit 053700 -01 503- 407 -0580 N
Corrections /Comments /Instructions:
i
1
PASS n PARTIAL APPROVAL ❑ CANCEL NO ACCESS
I I FAIL n CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: � Date: sC 6 9 I Phone #: (503) 718 -
CITY ������N��������
��mn n OF mm���mnn�� ' • ,
BUILDING DIVISION PERMIT #: ELC2007c00627
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/31/2007
Phone: (503) 639-4171 1 /
4.41 Inspection Requests (24Hmj:(6O3)63Q'4175 a4�� �W..
INSPECTION WORKSHEET FOR DATE: 8/9/2007 TIME: 7:00AM PAGE: 29
SITE ADDRESS: 14840 SW JONAGOLD TERR CLASS OF WORK:
SUBDIVISION: LADY APPLE LOT #: 004 TYPE OF USE:
PROJECT NAME: LADY APPLE
DESCRIPTION: (1) branch circuit to connect a/c unit.
OWNER: BEACON HOMES NORTHWEST, PHONE #: 503-407-0680
CONTRACTOR: CONNECTIONS ELECTRIC PHONE #: 503-390'7914
Inspection Request Scheduled For: Date: 8/9/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 05370002 603407-8580 N
Corrections/Comments/Instructions:
X ,pAss | I PARTIAL APPROVAL 0 CANCEL I j NO ACCESS
| I FAIL 7 CA FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector: . ' Date: 011 ~/ Phone #: (503) 718-
-- ` . ` .