Permit IN CITY OF TIGARD -1 ELECTRICAL PERMIT
OF V PERMIT #: ELC2007-00251
COMMUNITY DEVELOPMENT DATE ISSUED: 4/19/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102AC - 01704
SITE ADDRESS: 12720 SW PACIFIC HWY ZONING: CBD
SUBDIVISION: LOT : JURISDICTION: TIG
PROJECT: BRAEM
Project Description: Reconnect
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:
RICHARD BRAEM OWNER
9895 SW KILLARNEY
TUALATIN, OR 97062
Phone: 503 - 819 -0443 Contact #: -
FEES
Description Date Amount Reg #: .
[ELPRMT] ELC Permit 4/19/2007 $66.85
[TAX] 8% State Surcharge 4/19/2007 $5.35 .
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 3.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: �l� __Zr
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 Applies °it FOR OFFICE USE ONLY
CE LVL - Re ceived Clt of Ti and Permit No.:
III
° 13125 SW Hall Blvd., Tigard, OR 97223 Pam R / q / G 3 J'/ 0 100 � / UU/ZS I
■ C . Phone: 503.639.4171 Fax: 503.598. ��R '1 9 2001 Date/By: / Other Permit:
TI G A K D Inspection Line: 503.639.4175 ' Date Ready/By: runs l® See Page 2 for
Internet: www.tigard-or.gov e 1 j _• Ut 1 � 7 „ ■ •y o Notified/Method: / Supplemental Information
V Q) �9`
TYP Tr IMIT�f4`T�1 PLAN REVIEW
T� Please check all that a I
❑ New construction ❑ lli 9 9 pp y (submit 2 sets of plans w /items checked below):
❑ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
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' eg 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: / , 7 2.0 S� 74 1! Six or or more re s. R occupancy. Recreational Co C) r_ /JL[.Y ❑ Six or more residential units. ❑Recreation al vehicle parks.
City /State /ZIP: ,A_0 /�j �/ - ❑ Health -care facilities. ❑ Supply voltage for more than
T�`'J Q (/ / / 2 Z 3 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no. : ✓✓ -i Project name: . ❑ Service or feeder 600 amps or more.
. u J � � /Q z� FEE SCHEDULE
Cross street/directions to site: Description I Qty. I Fee. I Total I •
/ / , r New residential single - -or multi- family dwelling unit.
cif /� n tZ5 C44., 6l
l a yS' Includes attached garage:
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 • 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.) •
Limited energy, multi - family - 75.00 2
E. ` /G A ! / if Z °G v UeoG 44//fl 7 ' residential (with above sq. ft.)
. 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
401 amps to 600 amps 160.60 2
Name: Q -
e, �l�
°` ~�'� ��t>�il 601 amps to 1,000 amps 240.60 2
Address: - f �. S S'�, ei, j 7 z ��, L�44...., y Over.1,000 amps or volts 454.65 2
�
City/State /ZIP: 4Lv /a / /� , 0 X 9712‘ Temporary services or feeders installation, alteration, and/or
relocation
•
Phone: 9G3 ) V7 _ ,e,! 9 3 Fax: 603) 61i_ /5 9 200 amps or.less 66.85 1
Owner installation: This installation its being made on property that I own which is not 201 amps to 400 amps 100.30 2
' intended for sale, lease, r X/ ch.. g : ccording to ORS 447, 449, 670, d 701. 401 amps to 599 amps 133.75 _ 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: - !, _ 0 ��_ Date: /9D� A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT P RS / above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
. first branch circuit
Address: Each add'l branch circuit 6.65 - 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 I 66.85 / G 342
E -mail: • , Pump or irrigation circle 53.40 t� 2
CONTRACTOR Sign or outline lighting, - 53.40 2
Business name: Signal circuit(s) or limited
/e16 J Qr , ,(9f QL' /'Y) energy panel, alteration, or •
Address: ,r ,� / /� 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 (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: • Industrial plant per hour . 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature,. required: Subtotal:
Print-name: Date: Plan review (25% of permit fee)::
State surcharge (8% of permit fee): , 7.
Authorized signature: TOTAL PERMIT FEE: .791. �
d
Print name: I Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
• ' • Number of inspections allowed per permit.
I :\ Building \Permits\E1.C- PermitApp.doc 05 /23/06 440- 4615T(11 /05 /COM/WEB
Electrical Permi.t.Application - City of Tigard { -
Page '2 = Supplemental Information •
•
LIMITED ENERGY PERMIT FEES:
• j 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
❑ 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 -00251
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/19/2007
Phone: (503) 639 -4171 / Olt
Inspection Requests (24 Hrs.): (503) 639 -4175 _
• INSPECTION WORKSHEET FOR DATE: 4/20/2007 TIME: 7:00AM PAGE: 89
SITE ADDRESS: 12720 SW PACIFIC HWY CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: BRAEN
DESCRIPTION: Reconnect
OWNER: RICHARD BRAEM, PHONE #: 503
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: -Date: 4/20/2007 Pour Time:
. Code # Inspection Description (r # Contact # Message
199 Electrical final 046824 -01 503.8190443 N
Corrections /Comments /Instructions:
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❑ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
. FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
. Inspector: G ' IV � L Date: 2� a 1 Phone #: (503) 718- 2914