Permit C ITY OF TIOARD ELECTRICAL PERMIT
° PERMIT #: ELC2007 - 00066
COMMUNITY DEVELOPMENT DATE ISSUED: 1/26/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AB -00501
SITE ADDRESS: 12115 SW LINCOLN AVE ZONING: R -4.5
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT : 063 JURISDICTION: TIG
Project Description: Install new mast from meter to front corner. Job # R -07 -102.
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JD SCOGIN ABC ELECTRIC
12115 SW LINCOLN DR 135 NE 9TH AVE
TIGARD, OR 97223 PORTLAND, OR 97232
Phone: 503 - 913 - 6983 Contact #: PRI 503 - 233 - 7551
FAX 503 - 233 -7552
FEES
Description Date Amount Reg #: ELE 161501
[ELPRMT] ELC Permit 1/26/2007 $66.85 LIC 26 -1226C
[TAX] 8% State Surcharge 1/26/2007 $5.35 SUP 5096S
Total $72.20 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: Q .P - Tc
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.
JAN-25.-2007 02: 23P FROM: TO: 81P5035981960 P.1
. •,.,
Electrical Permit Appijcaljoj,. FOR OFFICE USE °NIA
13125
City SW Hall B of Tigard lvd.. Tigard. OR 97223 Ei 11 Received •
Date/11 . —..._ Permit No.: . .,,e . , ,.,/i 7
Phone: 503.639.4171 Fax: 503.598.1960 JAN 2 5 200 or ■ A Plan Review
Other Penult:
Inspection Line: 503.639.4175 . a - I -11,,■ 1 Dat : :
j . - .m. L. Date Ready/By: Jurb: 65 See Page 2 for
Internet: www,ci.tigard.or.us CITY (Jr i i0I-1 Notified/Method: Supplemental Information
81.111231NC) DIVICAOP:
... , .. :•-:: -•..- - . - ' : --., ; „' : .
TYPE. OF WORK .;: - . . . .
: .. ... - • PLAN REVIEW •
0 New construction '6.Addition/alteration/replacement Please check all that apply:
0 Demolition 0 Other: ['Service over 225 amps, comml ['Hazardous location
: . ['Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
; - ' !•CATEGORY OF CONSTRU4TION • of I- and 2-family dwellings 4 or more new residential
S 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building 0System over 600 volts nominal units in one structure
0 Multi-family 0 Master builder 0 other OBuilding over three stories OFeeders. 400 amps or more
• .• . .. • • • .. - . - pOccupant load over 99 persons ['Manufactured structures or
AOR.SITE INFORMATION : AND LOCATION " . • . ., , DEgress/lIghting plan RV park
Job no.F. bri , 10Q1 Job site address: i i / S si L .„ A " ) OHeatth-care facility 00ther:
v t L., i r) ay Submit .2,_ sets of plans with any of the above.
City/State/ZIP: 7 ,' Nea cV, bc? . The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: I Pro)cci name:
S t n ,,..,.. :':-• ....::,::'.:.:.!. :.:! ! VIM* SCHIMBIA,' . :' ,.• .•.: ' ;'' h •:: :',.:*
Description I QIY• I Yee I Total I ..
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
. Limited energy, non-residential 75.00 2
,....„. .. . . ,. , .. ,
,,T,kr, i: • :::::- i',„ : : . : : • . •DESCRIptION OP, WORK ' • • • • • Each manufactured or modular
. dwelling, service antVor feeder 90.90 2
.D 04 rilvt Services or feeders Installation, alteration, and/or relocation
. ' , 200 amps or less 80.30
:: %„':::30 : ':'... ' • 1 '...• : ..• ::••• : ' a 'TENANT . • . . . . 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: ti 0
----) 3 , r,
■./,( j 601 amps to 1,000 amps 240.60 2
Address: I 1 1..s.: \. ‘N. 411 - 4 V \ Over 1,000 amps or volts
• a
Reconnect only i 66.85 4 2
City/State/Z1P:
. Temporary services or feeders installation, alteration, and/or
Phone: ( ) (1 \ - 5- 1 c) 0 1 :> tKl. " ( " - I S 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 600 amps 133.75 2
Owner signature:
• ,, ... :; ..: I r : . : Date: Branch circuits - new, alteration, or extension, per panel
a'
::'..: ' '' •:-.• ' ' ,'''' APPLICANT .- .: I:1 CON PERSON : . A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: Nbc - ',s ( branch circuit
B. Fee for branch circuits
Contact name:
......**)1(NA.v...._1 without service or feeder fee.
46.85 2
each branch circuit
Address: Each addl branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E-mail: Signal circuit(s) or limited-
, .;:•:' ',::, : ' ." i'..i --: • ' - ; ,-: • - " , CONTRACTOR •-. ' • i• • : . - energy panel, alteration, or
_
extension. Describe: Page 2 2
Business name: it( k. k Q A T
Each additional Inspection over allowable in any of the above
Address: 1 55 m E clx\-■,, _Sisk nvk. c) Per inspection 62.50
City/State/ZIP: - m-\ \ . t?Ne qr)0 .., D... Investigation per hour (1 hr min) , 62.50
(
Phone: t, cg5 '.5 i Fax: ( Industrial plant per hour 6)3 c p 5 3 75 -5 0 , _.......
73.75
ELECTIiICAI:i PERMIT FEES* . • ' . ' ' ."
CCB Lic.: /( /3 ) Electrical Lic.V(6, _/ I Suprv. Lic.:MQ ( ., Subtotal I / 06) i 6.
Suprv. Electrician signature, required: .... e§.. 4„..,---:. , Plan review (25% of permit fee)
-
State surcharge (8% of permit fee) 5
Print name/7� totkp D iLcii 1 a / 0 I
Date: /A (7 7
TOTAL PERMIT FEE
• Authorized signature: __4f:....--\,) 7).•-f----- This permit application eapires Ira permit It not obtained within 180
days after It has been accepted as complete
Print name: 1/4.._. n ivic N ■s.,. r I Date: //.. ci 7 • " Fee methodology set by Tri-County Building Industry Service Board
Number of inspections per permit allowed.
1:43ulldineermiunELC-PermhApp.doe 12/03 440-46 IST(lognicommsa
CITY OF TIGARD Q,
BUILDING DIVISION L.,n tot, I PERMIT #: ELC2007 -00066
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 1/26/2007
Phone: (503) 639 -4171 wd '411‘
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 2/23/2007 TIME: 7 :01AM PAGE: 70
SITE ADDRESS: 12115 SW LINCOLN AVE CLASS OF WORK:
SUBDIVISION: NO. TIGARDVILLE ADDITION AMEND LOT #: 063 TYPE OF USE:
PROJECT NAME: SCOGIN
DESCRIPTION: Install new mast from meter to front. corner. Job # R -07 -102.
OWNER: SCOGIN, JD PHONE #: 503- 913 -6983
CONTRACTOR: ABC ELECTRIC PHONE #: 503 -233 -7551
Inspection Request Scheduled For: Date: 2/ ?3/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 043779 -01 503.233 -7551 N
Corrections/Comments/Instructions:
/0
X PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CAL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: I q , Date: 0/W 0 7 Phone #: (503) 718 -