Permit �.N , CITY O F TIGARD' ,. ELECTRICAL PERMIT
14
PERMIT #: ELC2007 -00684
COMMUNITY DEVELOPMENT DATE ISSUED: 10/4/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104CA - 03500
SITE ADDRESS: 13672 SW LAUREN LN ZONING: R -
SUBDIVISION: HILLSHIRE LOT : 035 JURISDICTION: TIG
PROJECT: HANSEN
Project Description: 1 branch circuit, floor heat in bathroom.
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: SIGNAUPANEL:
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:
BARBARA HANSEN WASHOUGAL ELECTRIC & SHEET METAL
13672 SW LAUREN LN 4702 NE 199TH ST.
TIGARD, OR 97223 RIDGEFIELD, WA 98642
Phone: NA . Contact #: PRI 360- 571 -2277
FAX 360-57141
FEES 5"
Description Date Amount Reg #: ELE 37 -1047C
[ELPRMT] ELC Permit 10/4/2007 $46.85 LIC 161564
[TAX] 8% State Surcharge 10/4/2007 $3.75 SUP 4276S
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 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: q(,),e4 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- 503.639.41 -75 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.
Oct 04 07 12:42p Jennie Black 3505712277 p.2
A
el Permit Application
FOR OFFICE I. SE ONL1'
City of Tigard Received 0 / D7 -rqD 6 If
- _� ;.v B : ' Perm;t N
13125 SW Hall Blvd_, Tig. .tab({ ,;
Date
a3 Phone: 503.639.4171 Fax: ' t' .' •' :.` • 0 Date Plan Review
By: Other Permit:
Ti GA RD Inspection Line: 503.639.4175 0 c T 4 ZUI) i Date R /B
Internet: www.tigard ar.gov I Notified had: }°"'' 1 Page 2 for
PE � 7'1 4 1 Supplemental Information
❑ New construction t D1lMON PLAN RENTEW
Additi tlo replacement Please check all that apply (submit 2 sets of plans w/items dlecked below):
❑ Demolition Other: Service or feeder 400 amps or more CI Building over three stories.
where the available fault current ❑ Marinas and boatyards,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
Tr l- and 2- family dwelling ❑ ComrnerciaUindustrial ❑ Accessory building less io ground or exceeds 14,000 ❑ Commercial - nse agricultural
❑ Multi family ❑ Master builder amps for all other installations. buildings.
❑ Other: 0 Fire pump. Q Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system, larger separately derived system.
C] Addition of new motor load of ❑ "A ", E ", "1 1', "l - °,
Job no.: I Job site address: k n y 1 more occupant
�� ' �'�^^"rP 1 L ❑Six 1001i? or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: - G .., . �1Ci-rl a 0 n C^ -l a D.3 ❑ Heal - care facilities. Q Supply
t� " voltage for more than
❑ Hasardous locations, 600 volts nominal.
Suite/bldgJapt no.: J Project name: L J ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description I Ory. I Pee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 1 145.15 4
Tax mapiparcel no.: Ea. add'l 500 sq. it or portion 33.40 • 1
DESCRIPTION OF WORK (with energy, residential 1
(with above sq. $.) 75.90 2
t 5 11 l t rC.J._C 1 4� Limited energy, multi - family
residential (with above sq. L) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PR PERTY OWNER ❑ TENANT 201 amps to 400 amps 106"85 2
Name: / —` �� k • _� ` - 401 amps to 600 amps 160.60 2
Address: I fit- A , 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts • 454.65 2
City/State/ZIP: 1 7a.)- 2) Temporary services or feeders installation, alteration, and/or
I relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that 1 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 i 2
Owner signature: Date: Branch circuits – new, alteration, or extension, r panel
A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee,
\ W + . �, each branch circuit 6.65 2
Business name: t t.�cx)e; ca �'aCG` t _� C_.... B. Fee for branch circuits
Contact name: V without service or feeder fee, 1 46.85 IOt
•
first branch circuit 2
Address :. .1...v Nye__ let c-- - - 5fi • Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: ' ', a t° P t-e. 1d, ti-- rs- r; Riv 3- - Each manufactured or modular
� dwelling, service and/or feeder 90.90 2
Phone:
(3j) %---/ 1 0a a.1 — Fax: : (3t) 5--)t 5 t ia I Reconnect only 66.85 2
OC
E -mail: 7_, P - 1"N tr cis T,, Sv\ 1 Y\ 1 Q 01 , C.Zyyl Pump or irrigation circle 53.40 2
Q CONTRXCTOR Signor outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
V energy panel, alteration, or
4 Address: i�,0a N i qQ +h - - extension. Describe: Page 2 2
"City /Slate/ZIP: R d, e ?i e Loft q 6( _ 1 , - Each additional inspection over allowable in any of the above
I Phone: (� 5' 1 , ,D, ..' -\ I Fax: ( lcD) ." 51 Lo Per inspection 62.50
Investigation per hour (I br min) 62.50
CCB Lie.: Lkii`C (,14 Electrical L 3. i o. { ') ( r Suprv. Lie.: ._ • Industrial plant per hour 73.75 •
Suprv. Electrician signature, required: 7 ' i - °" ELECTRaCAL PERMIT FEES t , .. ,o• I . I Subtotal: 4 (ct Print name: ate: 113/310=7 Plan review (25 % of permit fee):
— — State surcharge (8% of •'
(} arg ( permit fee):
..ki
Authorized signatur: r TOTAL PERMIT FEE: Lenr‘t o
�� L y���� Date: lO f f� This permit application expires if a permit is not obtained within 180
Print name
"� t ��t�� / / LJ� days after it has been accepted as complete.
• Number of inspections allowed per permit. D
' 1 Bni ldinglPrralits\FJ.C- PermitApp.dce 05'3/06 4404615TOIt05/CO,waTh
CITY OF TIGARD < r
BUILDING DIVISION L PERMIT #: ELC2007_0(0684
13125 SW Hall Blvd. Tigard, OR 97223 DATE ISSUED: I {44807
Phone: (503) 639 -4171 /0 '' ' Wypiipll���l�
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 11/2/2001 TIME: 7 :01AM PAGE: 34
SITE ADDRESS: 13672 SW LAUREN i_N CLASS OF WORK:
SUBDIVISION: HI1.LSHIRE LOT #: (335 TYPE OF US •
PROJECT NAME: HANSEN
DESCRIPTION: 1 branch circuit, floor heat in bathroom.
OWNER: HANSEN, BARE3ARA PHONE #: NA
CONTRACTOR: WASHOUGAL ELECTRIC & SHEET METAL PHONE #: 350.571 -2277
Inspection Request Scheduled For: Date: 1112/ 107 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 058915 -01 503.309-4040 N
Corrections /Comments /Instructions:
G
._ ,Ita —6'c ,L �f_��PAA7 'O 7X7
e ir,./7 - 220 / . v ,i
ASS n PART A L APPROV _ CANCEL _ n_NO ACCESS _. _
n FAIL ! ,. FoR �J ' TION n ADDITIONAL FEE ASSESSED
Inspector: ,,
A • Date. )7---- Phone #. (503) 71
,
0,,,... .
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-00694
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/4/2007
Phone: (503) 639-4171 enYAMIAI#
Inspection Requests (24 Hrs.): (503) 639-4175 Ai2.
INSPECTION WORKSHEET FOR DATE: 10/9/2007 TIME: 7:00AM PAGE:
SITE ADDRESS: 13672 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 035 TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION: 1 branch circuit, floor heat in bathroom.
OWNER: HANSEN, BARBARA PHONE #: NA
CONTRACTOR: WASHOUGAL ELECTRIC & SHEET METAL PHONE #: 360-571-2277
Inspection Request Scheduled For: Date: 1019/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
125 Wall cover 067184-01 360-772-2763 N
Corrections/Comments/Instructions:
'T ilik.,\) - A 1 2,0 v. Crf
.
•
,•
PASS TIPARTIALAPPROVAL • 1 CANCEL _ . _ __EI NO. ACCESS
I I FAIL I I CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: G N6e l._.. Date: i 019'lq Phone #: (503) 718-140
, ,
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007-0064
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/412007
Phone: (503) 639-4171 ,4111
Inspection Requests (24 Hrs.): (503) 639-4175 4 IJ.
INSPECTION WORKSHEET FOR DATE: 10/8/2007 TIME: 7:00AM PAGE: 90
SITE ADDRESS: 13672 SW LAUREN LW CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 035 TYPE OF USE:
PROJECT NAME: HANSEN
DESCRIPTION: 1 branch circuit, floor heat in bathroom.
OWNER: HANSEN, BARBARA PHONE #: NA
CONTRACTOR: WASHOUGAL ELECTRIC & SHEET METAL PHONE #: 360-571-2277
Inspection Request Scheduled For: Date: 10/8/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
195 Misc. inspection 057091-01 360172-2753
Corrections/Comments/Instructions:
Co CkA) 61U4ot ptft_
os pr& pal \ 3.•bp
I I PASS ri _PARTIALAPPROVAL p_,CANCEL ACCESS -
S FAIL ,CALL FOR INSPECTION . 0 ADDITIONAL FEES ASSESSED
Inspector: • N6b1--E Date: 101 10 1 Phone #: (503) 718- V*