Permit CITY OF TIGARD ELECTRICAL PERMIT
-� s ; ° P ERMIT SSUED: #: ELC2007 -00481
COMMUNITY DEVELOPMENT
D ATE I 7/16/2007
TIGARD 13125 SW Hail Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 111 AB -02000
SITE ADDRESS: 09265 SW MOUNTAIN VIEW LN ZONING: R -4.5
SUBDIVISION: ELROSE TERRACE LOT : 016 JURISDICTION: TIG
PROJECT: ALLEE
Project Description: Install ground rods.
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:
JACK C. ALLEE OWNER
9265 SW MTN VIEW LN
TIGARD, OR 97223
Phone: 503 - 574 -2586 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 7/16/2007 $46.85
[TAX] 8% State Surcharge 7/16/2007 $3.75
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 B • / // 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 503.639.4175 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 FOR OFFICE USE ONLY
City of Ti and Received A Permit No.: E(� Z �j c)
• `J g Date/By: 1 & SC.iv ? - 0Q OJ
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Date Ready /By: m el See Page 2 for
Internet: www.tigard - or.gov Notified/Method: i' IT Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New 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 ❑ Commercial -use agricultural
X 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
s� eyr� / /�/f �t �� J Six oP or more residential Recreational
Job no.: Job site addre-! /a s J C ! /�( /1'I f 1. 1n09 ❑ Six or more residential units. 0 vehicle parks.
City/State /ZIP:
e-----; /, Q , d or 9 2 2 ❑ Health -care facilities. ❑ Supply voltage for more than
�9 1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.:i I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I tom. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'! 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
Limited energy, multi - family 75.00 2
4+ r a o 5? I44 � 1\ o --0 residential (with above sq. fl.)
�l V ` Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ( , ,�/ /' / 401 amps to 600 amps 160.60 2
cl C L • . - 6 601 amps to 1,000 amps 240.60 2
Address: i J
A1.1 / Over 1,000 amps or volts 454.65 2
City/State /ZIP: y e rk' d ly 7 7 , a L.. Temporary services or feeders installation, alteration, and/or
v relocation
Phone: ( _ Fax: ( ) 200 amps or less 66.85 1
�� ' 7 / ( / � 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, ent, or xc nge idi9.4 t o 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
PLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, , 46.85 4 j 2
first branch circuit
Address: Each add'! branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I 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 circuit(s) or limited -
v j I) n p r' 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: ( ) I Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lic.: I Electrical Lic.: I Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 4/ , ss
Print name: I Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 3 .
Authorized signature: TOTAL PERMIT FEE: So. (
Print name: ��a�,� /# Date: This permit application expires if a permit is not obtained ithin 180
days after fter it has been accepted as complete.
— — — — • Number of inspections allowed per permit.
I:\Building\Pe t LC- PemiitApp.doc 05/23/06 440.4615T(11/05/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
1 RESIDENTIAL WORK ONLY:
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:
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
El 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- PermitApp.doc 03/23/06
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00451
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16 /2007
Phone: (503) 639 -4171 , u; I I
Inspection Requests (24 Hrs.): (503) 639 -4175 I ..
INSPECTION WORKSHEET FOR DATE: 2/25/2008 TIME: 7:00AM PAGE: 32
SITE ADDRESS: 08265 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: LLROSE TERRACE LOT #: 016 TYPE OF USE:
PROJECT NAME: ALLELE
DESCRIPTION: Install ground rods.
OWNER: ALLEE, JACK PHONE #: 503 - 5742586
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final Q65548 -06 503 5742586 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ik(
Date 7/ Phone #: (503) 718-
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00481
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2007
Phone: (503) 639- 4171
Inspection Requests (24 Hrs.): (503) 639 -4175 . 40. I � �
INSPECTION WORKSHEET FOR DATE: 2/25/2008 TIME: 7:00AM PAGE: 34
SITE ADDRESS: 09265 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 016 TYPE OF USE:
PROJECT NAME: ALLELE
DESCRIPTION: Install ground rods.
OWNER: ALLEE, JACK PHONE #: 503674 -2686
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
105 Underground/slab cover 065548 -04 503. 574-2506 N
Corrections /Comments /Instructions:
�] PASS El PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
, ❑ \ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: € v 4 Phone #: (503) 718-
CITY OF TIGARD '
BUILDING DIVISION PERMIT #: ELC2007 -0fY81
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 7/16/2007
Phone: (503) 639 -4171 larei . , ,t 1
Inspection Requests (24 Hrs.): (503) 639 -4175 -
INSPECTION WORKSHEET FOR DATE: 2/25/2008 TIME: 7:00AM PAGE: 33
SITE ADDRESS: 09265 SW MOUNTAIN VIEW LN CLASS OF WORK:
SUBDIVISION: ELROSE TERRACE LOT #: 016 TYPE OF USE:
PROJECT NAME: ALLEE
DESCRIPTION: Install ground rods.
OWNER: ALLEE, JACK PHONE #: 503 - 574 -2586
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 2/25/2008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough-in 065548-05 503.574 -2586 N
Corrections /Comments/ Instructions:
[IX I PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1l, Date: Phone #: (503) 718-