Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2008 -00107
' COMMUNITY DEVELOPMENT DATE ISSUED: 2/26/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 104CA -02100
SITE ADDRESS: 13687 SW LAUREN LN ZONING: R -7
SUBDIVISION: HILLSHIRE LOT : 021 JURISDICTION: TIG
PROJECT: PRESJAK
Project Description: Moving switches in bathroom and adding circuit for floor heat system.
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:
MATTHEW & CATHI PRESJAK HARVEY ROSE ELECTRIC SERVICES
13687 LAUREN LN PO BOX 128
TIGARD, OR 97223 NORTH PLAINS, OR 97133
Phone: Contact #: FAX 503 - 648 - 8254
PRI 503 - 789 -3284
FEES
Description Date Amount Reg #: ELE 34 -130C
IELPRMT] ELC Permit 2/26/2008 $53.50 LIC 43084
'TAX] 12% State Surchar 2/26/2008 $6.42 SUP 2767S
Total $59.92 REQUIRED ITEMS AND REPORTS
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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 Notifi.:tion Center. Those rules are set forth in
OAR 952 - 001 -0010 through OAR 952 -001 -0 so. may obtain copies of these rules or direct questions to"
/ NC at 503.246.6699 or 1.800.332.2344.
Issued By * ` i" �I/ • Permittee Signature: � r •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or re t.
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 ` s = 4 , ,°. `. I
. , FOR OFFICE USE ONLY
e of Tigard Received
a'., ;'. ' ' City J g Date /By: / a /g77 Permit No.: �LG � (0
13125 SW Hall Blvd., Tigard, OR 97223 °
Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 DateBy: Other Permit. ,,,;? 2((''_O/t) 60
T I GA R D Inspection Line: 503.639.4175 Date Ready /By: hurls: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
• E OF WORK • PLAN' REVIEW' . •'. :V xx51:11
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current 0 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 ❑Emergence system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "l -2 ", "I -3 ",
Job no.: Job site address:/ 2 S 7 Siv 1 Six or or snore. occupancy.
J fit/ rQ/� ❑ Six or mote residential units. ❑ Recreational vehicle parks.
City/State /ZIP: `j^ 7 � ❑ Haz u facilities ❑ Supply voltage for more than
� � / co l/ `�1 ❑Hazardordous locations. . 600 volts volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1 -LS A %,/ t.. Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
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
DESCRIPTION OF WORK ,, (with above sq. ft.) 75.00 2
,�A W +' J t 4_D- Limited energy, multi- family 75.00 2
1 r 1,02 -- 5 ; .� 0 n 'PGA VV. 'K- 0... CA .) residential (with above sq. ft.)
CJei; ( c` Services or feeders installation, alteration, and/or relocation
-o 'OpC ,t7 sI/S'f ` /L 200 amps or less 80.30 2
ROPERTY 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON ' ., ' above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service o r feeder fee, 1 46.85 a� 2
Contact name: first branch circuit
Address: Each add'l branch circuit 1 6.65 4 cc 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: '' - Signal circun(s) or limited -
/ 3 7 /. /i�G eG . .......c.-e-- - Z6--C energy panel, alteration, or
Address: / /? .. 67 ` j �?/ y C� extension. Describe. Page 2 2
City /State /ZIP: 4 ,LA / � j _ O ff ' j ? 3 Each additional inspection over allowable in any of the above
� � /� Per inspection 62.50
�
Phone: J 7/0?--,7)-172 Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lie.:L Electrical Lie.:3 —,3 Suprv. Lie.:, 7675 Industrial plant per hour 73.75
/ ELECTRICAL PERMIT FEES • '
Suprv. Electrician signature, requir /�� t-- ./t6.:__ Subtotal: 53. SO
Print.name:. — _ - Date: _— t Plan review (25% of permit fee):
�Ct t/ C y� '` r� � - o��� _ \PQ State surcharge�(%‹permit fee): t
Authorized signature: TOTAL PERMIT FEE: - �� _ q 1 ` q'�
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 \Permns\ELC -PermitApp.doc 05 /23/06 440 - 46151(11 /05 /COM/WEB
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CITY OF TIGARD
BUILDING DIVISION ._ _.___ PERMIT #: ELC2008-00107
13125 SW Hall Blvd., Tigard, OR 97223 . DATE ISSUED: 212612008
Phone: (503) 639-4171 'oi lInspection Requests (24 Hrs.): (503) 639-4175 .,/..4-1 't.....
INSPECTION WORKSHEET FOR DATE: 3126/2008 TIME: 7:00AM PAGE: 18
SITE ADDRESS: 13687 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 021 TYPE OF USE:
PROJECT NAME: PRESJAK
DESCRIPTION: Moving switches in bathroom and adding circuit for floor heat system.
OWNER: PRESJAK, MATTHEW & CATHI PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503-789-3284
Inspection Request Scheduled For: Date: 312612008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
159 Electrical final .067363-01 603.709-3284 N
Corrections/Comments/Instructions:
/ 7 ------ 7.7
/
/ (
X PASS _ _______PARTIALAPPROVAL n_CANCEL _ 0 NO_AC_CESS
I FAIL El CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: ) Date: Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC200800107
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/2&2008
Phone: (503) 639-4171 J
Inspection Requests (24 Hrs.): (503) 639-4175 IL
INSPECTION WORKSHEET FOR DATE: 3/25/2008 TIME: 7:01AM PAGE: la
SITE ADDRESS: '13687 SW LAUREN LN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 021 TYPE OF USE:
PROJECT NAME: PRESJAK
DESCRIPTION: Moving switches in bathroom and adding circuit floor heat wstem.
OWNER: PRESJAK, MATTHEW & CATHI PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503-789-328e1
Inspection Request Scheduled For: Date: 3/2512008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 067291-01 503-789-3204
Corrections/Comments/Instructions:
f kbV4 7 tia 47) t 444
AtA 44,0 , " e.014.4 APe .e.4111e 2 / try r--e#
E PASS 0 PARTIAL APPROVAL ri CANCEL H NO ACCESS_
FAIL Y•c ALL FOR INSPEC ION n ADDITIONAL FEES ASSESSED
Inspector: N 6e LE ":41r Date: 4 45 - '4 Phone #: (503) 718-
1-0
•- .• . .
•
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.......______. _ . 7 /
CITY OF TIGARD . ,. < •-- -
BUILDING DIVISION . PERMIT #: ELC2008-00107
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/26/2008 .
Phone: (503) 639-4171 0911 t
Inspection Requests (24 Hrs.): (503) 639-4175 . -....
INSPECTION WORKSHEET FOR DATE: 3/14/2008 TIME: 7:00AM PAGE: 1
SITE ADDRESS: 13687 SW LAUREN LW • CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 021 TYPE OF USE:
PROJECT NAME: PRESJAK
DESCRIPTION: Moving switches in bathroom and adding circuitfor floor heat system.
OWNER: PRESJAK, MATTHEW & CATHI PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 5CO3789-3284
---
Inspection Request Scheduled For: Date: 3/14/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
195 Misc. inspection 066740-01 503-703284 'N Y
Corrections/Comments/Instructions: .
6 iLlk 'FA.,366 il-E\tcp
. / A 0 14
, .
i .
PASS _g PARTIAL APPROVAL 111-CANCEL 17 NO ACCESS
,
ri FAIL 0 CALL FOR INSP TION [1] ADDITIONAL FEES ASSESSED
II -
.„(
Inspector: ''''',----WelierCle I . ' Date: 04 'O Phone #: (503) 718-
CITY OF TIGARD . _ .... I .
BUILDING DIVISION ■ .1!
PERMIT #: ELC2008-00107
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 2/26/2008
Phone: (503) 639-4171 .in 14, - givl i ff
._.,_
Inspection Requests (24 Hrs.): (503) 639-4175 ,.1.
INSPECTION WORKSHEET FOR DATE: 2/2712008 TIME: 7:00AM PAGE: 15
SITE ADDRESS: 13687 SW LAUREN IN CLASS OF WORK:
SUBDIVISION: HILLSHIRE LOT #: 021 TYPE OF USE:
PROJECT NAME: PRESJAK
DESCRIPTION: Moving switches in bathroom and adding circuit for floor heat system.
OWNER: PRESJAK, MATTHEW & CATHI PHONE #:
CONTRACTOR: HARVEY ROSE ELECTRIC SERVICES PHONE #: 503-789-3284
Inspection Request Scheduled For: Date: 2/27/2008 Pour Time:
Code # Inspection Description CoM —:. iii -----. m # Contact # Message
125 Wall cover 065738-01 503-803-1814 Y
Corrections/Comments/Instructions:
C
ittki (A. rya67 2
-- -i:-- frxze Ti les oaRAyab •
PASS D PARTIAL APPROVAL D_CANCEL_ .171-1\10-.ACCESS
0 FAIL 0 CALL FOR INSPECTION fl ADDITIONAL FEES ASSESSED
Inspector: C- 7.--- NW 1 f Date: 211'C% Phone #: (503) 718- Itilli