Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00203
li DEVELOPMENT SERVICES DATE ISSUED: 4/14/2006
� I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1 S136AD -04700
SITE ADDRESS: 06611 SW PINE ST ZONING: R-4.5
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: (2) branch circuits for bathroom conversion.
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 FOR: 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:
HAYLEY & R HULTENGREN OWNER
6611 SW PINE
TIGARD, OR 97223
Phone: 503 - 347 -9963 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/14/2006 $53.50
[TAX] 8% State Surcharge 4/14/2006 $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 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 a re set f. • - OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503-246-6.= 9 or 1 -8
Issued : y: , I _ I ,, Permittee Signature 1C ( ey oktr/j".---
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent. /
OWNER'S SIGNATURE: .*Jel____He90.—____ DATE: / Qk
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 IiSE ONLY
City of Tigard H `d 117° � ,Iii . ��.
13125 SW Hall Blvd., Tigard, OR 97223 plan Review
' C Phone: 503.639.4171 Fax: 503.598.1960 ) D . Other Permit:
- Fl G A It D Ins Line: 503.639.4175 : . Date Ready/By. Erni fb See Page 2 for • Internet: www.tigard- or.gov Notified/Method Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply: •
❑Service over 225 amps, comm'I ❑Hazardous location
❑ Demolition ❑Other:
['Service over 320 amps -rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I - and 2 - family dwellings . 4 or more new 01 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure '
❑ Multi - family ❑Master builder ❑ Other: ['Building over three stories :Weeders, 400'amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park -
❑ Health-care facility ❑ Other;
Job no.: Job site address: 6 6 f (� p r1 S t Submit 2 sets of plans with any of the above.
City / State/ZIP: Pori.ltr►d r OR R 9 7 2 Z The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: 17 a,3roo al Description
(� LL `,) I Qty. I Fee. I Total . I •• •
Cross street/directions to job site: Pac i CC ITS vv eb 1 R n (� w Ne residential single - or multi- family dwelling unit.
1 / Includes attached garage.
( v I" , Q • , a k i o P i n e • 1,000 sq. ft. or less 145.15 4
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or. portion 33.40 1
•
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2 .
DESCRIPTION OF WORK Each manufactured or modular
�, dwelling, service and/or feeder 90.90 ' 2
l�c r Cl a bd71u 't rOOrn i+'1lo aft e?4 s `� Services or feeders installation, alteration, and/or relocation
r e oof • 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: H (p -1 v f � eLe a 1 � � 601 amps to 1,000 amps 240.60 2
c0 10 _ (�
Address: s P n e tt . ` 1 5.1-- Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: or tl a/✓l d 09, . a 7 2 2 3 Temporary services or feeders installation, alteration, and/or
Phone: ( 503)34 7 -q ci 4 3 Fax: ( 563 5i g - 3 q86 relocation -
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, I =: - rent, or exc Ian e, according to ORS 447, 449, 670; and 401 amps to 600 amps 133.75 2
Owner signature: ti it Date: if' I � `"' la Branch circuits - new, alteration, or extension, per panel
❑ AP ' f r C I ❑ CONTACT PERSON A. Fee for branch' circuits with
service or feeder fee, each 6.65 2
Business name: • branch circuit •
Contact name: B. Fee for branch circuits - aa C
without service or feeder fee, 1 46.85 4/6, :LI JL
Address: first branch circuit
Each add'l branch circuit 1, ' 6.65 6 • ( 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40. 2
Phone: ( ) Fax:: ( )
Sign or outline lighting 53.40 2
E - mail: Signalcircuit(s) or limited -
NTRACTOR energy panel, alteration, or
extension. Describe: • Page 2 2
Business name: .
Address: Each additional inspection over allowable in any of the above
.. i> Per inspection 62.50
City/ State/ZIP: • Investigation per hour (1 hr min) 62.50
Phone: ( ) ax; ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: I Electrical Lic.. Suprv. Lic.: Subtotal: 53 ; sa
Suprv. Electrician signature; required: Plan review (25% of permit fee):
Print name: Date: State surcharge (8% of permit fee): - it 'on ,
TOTAL PERMIT FEE 5'7 73.
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board .
•• Number of inspections per permit allowed
I:\ Building \Pamits\ELC- PemtitApp.doc 0323/06 • 4404615T(1I/05/COM/WEB -
Electrical Permit Application - City of Tigard
Page 2 o 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* ;• _ ' 9 1 , t •. °
r•.
❑ Heating, Ventilation and Air Conditioning System* f '
❑ Vacuum Systems* ; . , j j • °
El Other • , � ; o z . •
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system ,• . + ; 1 e' . • t,' . a
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
, • • o • , , •
❑ Audio and Stereo Systems '
„ + ra
❑ 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\pemits\ELC- PamitApp.doc 03f23/06
CITY OF TIGARD ()°`e,
BUILDING DIVISION %' PERMIT #: ELC2006- 00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2006
Phone: (503) 639-4171 a ��- : 11
Inspection Requests (24 Hrs.): (503) 639 -4175 `:_..
INSPECTION WORKSHEET FOR DATE: 4/27/2006 TIME: 7:04AM PAGE: 4
SITE ADDRESS: 06611 SW PINE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HULTENGREN
DESCRIPTION: (2) branch circuits for bathroom conversion.
OWNER: HULTENCaREN, HAYLEY & REECE PHONE #: 503 -347 -9963
CONTRACTOR: OWNER PHONE #:
Inspection Request Scheduled For: Date: 4/27/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
120 Electrical rough -in 026859 -01 503-347.9963 N
•
Corrections/Comments/Instructions:
/ 1
1
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL il ALL FO P •TION ❑ ADDITION . FEES SESSED
Inspector: / V 4 Date: - Phone #: (503) 71 -
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2006 00203
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/14/2006
Phone: (503) 639 - 4171
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: 21 12/2007 TIME: 7:05AM PAGE: 60
SITE ADDRESS: 06611 SW PINE ST CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME: HULTENGREN
DESCRIPTION: (2) branch circuits for bathroom conversion.
OWNER: HULTENGREN, HAYLEY & REECE PHONE #: 503347 -9963
CONTRACTOR: OWNER PHONE #:
Inspection' Request Scheduled For: Date: 2/12/2007 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 0432160/ 503347 -9963 N
Corrections/Comments/Instructions:
illuAllezeibkor6( frikk, t A/0 11,(ivti I
p - I
PASS 0 PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: 4 10\ I vI P hone #: (503) 718 V
( )