Permit `4.,.y . ' CITY OF TIGARD
ELECTRICAL PERMIT
e " PERMIT #: ELC2007 -00624
COMMUNITY DEVELOPMENT DATE ISSUED: 9/6/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102C D -02608
SITE ADDRESS: 09800 SW O'MARA ST ZONING: R -4.5
SUBDIVISION: TWALITY HILL LOT : 008 JURISDICTION: TIG
• PROJECT: NIELSON
Project Description: Install (2) branch circuits for a /c.
RESIDENTIAL UNIT TEMP SRVCIFEEDERS 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: 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:
KEN NIELSON
9800 SW O'MARA ST.
TIGARD, OR 97223 .
Phone: 503 - 781 - 8092 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 9/6/2007 $53.50
[TAX] 8% State Surcharge 9/6/2007 $4.28
Total $57.78 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 appli •ble 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, • 'f w• fs suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notificat•• ' =nter •s =les are set forth in
OAR 952-001-00 • hrough OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OU/ 03 ;•9 / /or 1.800.332.2344.
Issued = 4�� � �� // Per mittee Signature: i� ` �• /I
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 Tigard 1, � �� ��r �
III e ' � Permit Z,
•
13125 SW Hall Blvd., Tigard, FLCE1 Plan Review
C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: lulls: ® See Page 2 for
Internet: www.tigard- or.gov J�� 0 1UU1 Notified/Method: - G - Supplemental Information
TYPE @NOV 01 1 Ai ARD PLAN REVIEW
❑ New construction igAdd1 9l /' , j � � �'q°.a tff 3 'z �+ 11.��1 {�� Please check all that apply (submit 2 sets of plans w /items checked below):
V l ly1 }�� F" ✓i ❑ 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
- 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: -1 gob 503 o lulu 100HP or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City/State /ZIP: '11��( (� O y l � ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: P roject n e:
0 Service or feeder 600 amps or more.
J C � � ! A 3 FEE SCHEDULE
Cross street/directions to job site: n ( C�1Ma(Q 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 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
( L- J 1 t � ` \o r &A On r 1rc -s 'F Limited energy, multi - family 75.00 2
\ °t residential (with above sq. ft.
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: tJ�l
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 4 2-in
W -`,W 5 �i"j Owto Over 1,000 amps or volts 454.65 2
City/State /ZIP: T; Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5 0 , ) 7g I G rp� V •� q /� ? 2 2 % )9 Z F 14 St' - / l � 3 i ) q 1 1 200 amps or less 66.85 1
Owner installation: This i v . Ilation is being ma.. on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sal:�, rent, r exchan_: a . to ORS 447, 449, 670, an 7 401 amps to 599 amps 133.75 2
, � ( Branch circuits — new, alteration, or extension, per panel
Owner signature: i��L / �C l� D ate: 7 A. Fee for branch circuits with
[CANT ' ❑ CONTACT P Oi above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee, I 46.85 is 2
Contact name: first branch circuit
Address: Each add'I branch circuit I 6.65 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: ( ) 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 -
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: ( ) Fax: ( ) Investigation per hour (I hr min) 62.50
CCB Lie.: Electrical Lic.: Suprv. Lie.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 6 5D
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 4.28
Authorized signature: TOTAL PERMIT FEE:
Print name: Date: This permit application expires if a permit is not obtaine3 within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 4615T(II /05 /COM/WEB
Electrical Permit Application - City of Tigard •.- '�-
Page 2 - ,.Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
r 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 ti ,% •
❑ Fire Alarm Installation
❑ t HVAC
•
,Instrumentation
❑ 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
1:\Building\Permits\ELC- PermitApp.doc 03/23/06
r F
CITY OF TIGARD
BUILDING DIVISION A .. PERMIT #: ELC2007- 00624
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/6/2007
Phone: (503) 639 -4171 lit�'�
Inspection Requests (24 Hrs.): (503) 639 -4175 1L.
INSPECTION WORKSHEET FOR DATE: 10/16/2007 ;'' TIME: 7:01AM PAGE: Q9
SITE ADDRESS: 09900 SW O'MARA ST CLASS OF WORK:
SUBDIVISION: 1WAL ITY HILL LOT #: 008 TYPE OF USE:
PROJECT NAME: NIELSON
DESCRIPTION: Install (2) branch circuits for a/c.
OWNER: NIELSON, KEN PHONE #: 503-781 -8092
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 10/16/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
145 NC or heating unit circuit 057673-01 503-781-8092 N
Corrections /Comments /Instructions:
e t7i t L� o .q-x-1 a' /0 A-LAz ;-
e- _ co o�(n�G�C�[ �O!e{ -Ma � SC`:5
VA o #4
0 P„1•-0" ■ " ARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
11 FAIL /4 'ALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: L ` J Date: l / d7 Phone #: (503) 718- Z‘37