Permit CITY OF TIGARD j ELECTRICAL PERMIT
I: COMMUNITY DEVELOPMENT �� Permit #: ELC2012 -00367
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 1S136DCO2701
Jurisdiction: Tigard
Site address: 7040 SW BAYLOR ST
Project: Ledridge Subdivision: ELNOLA HEIGHTS Lot: 2
Project Description: This permit is to complete expired permit ELC2009- 00237. 7/10/12, reprinted to add (21) branch circuits.
Contractor: OWNER Owner: JAMES A. LEDRIDGE
1141 ENGLEWOOD DR
LAKE OSWEGO, OR 97034
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PHONE: PHONE: 503 - 244 -0011
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/13/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/13/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT 21 crt Branch Circuits w /Purchase 07/10/2012 $155.82
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 07/10/2012 $18.70
Occupancy Grp: Electrical
Total $287.30
Required Items and Reports (Conditions)
This permit is ' subject • se regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ccordance with approv- • • . This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A NTION: Oregon law • ;res y• • o follow the rules adopted by the Oregon lit". •o ^:'% - • e ter. Those rules are set forth in OAR
952 -001- 10 thro !h OAR 952 -0 • -009 % maobtain a copy of the les or direct questions to OU by calling 503.23 . or 1.800.332.23n.
Issue By: �� / Permittee Signat :.• D--te
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' Date:
LICENSE NO. •
Call 503.639.4176 by 7:00 a.m. for the next available Inspection date.
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.
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CITY OF TIGARD ELECTRICAL PERMIT
1111 *; .. COMMUNITY DEVELOPMENT Permit #: ELC2012 00367
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 1 S136DCO2701
Jurisdiction: Tigard
Site address: 7040 SW BAYLOR ST
Project: Ledridge Subdivision: ELNOLA HEIGHTS Lot: 2
Project Description: This permit is to complete expired permit ELC2009- 00237.
Contractor: OWNER Owner: JAMES A. LEDRIDGE
1141 ENGLEWOOD DR
LAKE OSWEGO, OR 97034
PHONE: PHONE: 503 - 244 -0011
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/13/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/13/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is ' . • -• . to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i• accordance with ap• oved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • ENTION: Oregon law re. - = • u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 0010 thro h OAR 952 -001 % r 90. Y • ay obtain a copy of the rules or direct questions to OUNC by calling 503. .1987 or 1.800.34
Issue. B : l � Pe rmitteeSi nature: .ii / r' 1ff )w /'�. ✓i ■ ''
Y 9
OWNER INSTALLATION ONLY /
The installation is being made on prope • which is not intended •r :le, le- _ Ot.
OWNER'S SIGNATURE A. . / /._ _ _ ._ / A., - -i _ Date: CP�, 9-.
/ CONTRACTOR INSTALLATI • N ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4175 by 7:00 a.m, for the next available Inspection date.
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 Folz ui iici usi.: owl.\
City of Tigard Received D Permit No.: EGC / o l *41 ", 7
114 ° 13125 SW Hall Blvd., Tigard,OR .97223 Plan Review
C Phone: 503.718.2439 Fax: 503.598.1960 Date/Ely:
Permit:
Tic A It D Inspection Line: 503.639.4175 Date Ready/By: lusts: la See Page 2 for
i t
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
El New construction ❑ A ddition/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.
El 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
❑ 1- and 2- family dwelling ❑ Commercial/industrial 0 Accessory building a mps 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 ", "I -3 ",
Job no.: Job site address: tootle or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qtr. 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 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
7l ^� ' �^ 1
Limited energy, multi-family i 75.00 2
/i 1
f`�/ l:ts_ pl t residential (with above sq. q. ft.)
S Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Ci /State /ZIP: Temporary services or feeders installation, alteration, and/or
�' relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without ' '
service or feeder fee, first 56.18 ; 2
Contact name: branch circuit _
Each add'l branch circuit 7.42 , 2
Address: Miscellaneous (service or feeder aul included)
Each City /State /ZIP: dwe service�and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name:
panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES__ _ . . . - . _ _ _ e n , . . ,
Suprv. Electrician signature, required: Subtotal_ 1 S r�� -
_ Plan review (25% of permit fee): _
Print name: Date: State surcharge (12% of permit fee): i ?r70
TOTAL PERMIT FEE:
Authorized signature: / � 5
T permit application expires if a permit is not obtain t hin 180
Print name: • Date: days after it has been accepted as complete.
Number o inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 07/01 /10 440.4615T(11/05/COM/WEB
Electrical Permit A licati 1'O1t ctrl ICI: use (NI.)
Received /,, ,
City of Tigard Date/By: 0 / /� I Permit No.: j/-.- DO 36 7
13125 SW Hall Blvd., Tigard, OR 97223) UN 1 3 2012 Plan Review
In Phone: 503.718.2439 Fax: 503.598.1960 Date/By: Other Permit:
TI G n It D Inspection Line: 503.639 CITY OF TIGARD Date Ready/By: Sufis: la See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
BUILDING DIVISION PLAN REVIEW
TYPE OF WORK
Please check all that apply (submit 2 sets of plans w /items checked below):
New construction ❑ ❑ Addition/alteration /replacement
❑ 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
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 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 ", "l -3 ",
Job no.: Job site address: 7,0 I/ Q 6 '1) 0, i 9 ❑ Six or or more residential Recreational parks.
or more residential units. ❑Rr vehicle arks.
City/State/ZIP: �y�. 9 7 x ❑ Health-care facilities. ❑ Supply voltage for more than
/� Q " rT D� ` / 2 L / ❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 72 '. _ 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 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
n Limited energy, multi- family 75.00 2
i �� .-.-t7/ 9F' .�3 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 00.0 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: t) - ii e 5 %.z, e �J e 401 amps to 600 amps 200 2 _
,�'t r� t� 601 amps to 1,000 amps 301.04 2
Address: / /% u iZ_ o d Over 1,000 amps or volts 552.26 2
Ci City/State/ZIP: / Temporary services or feeders installation, alteration, and/or
ty ,4(t•° f / / ? 7 0 relocation
Phone: Orly) 7.-14 q U o o /, Fax: ( ) 200 amps or less 59.36 1
7 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, le. rent, or exchange, ac rdi`g to ORS 447, 449, 670, and 701.
rr ` Branch circuits — new, alteration, or extension, per panel
Owner signature: ' / , , , 1 . _ _ _ Date: //_,3 A. Fee for branch circuits with
IB APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
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Address: Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
-
Phone: ( ) Fax: : ( ) Reconnect only _ 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: O r ) A) E panel, alteration, or extension. _ Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (V2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Subtotal: /00.74
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): /e2.04'
Authorized signature:
TOTAL PERMIT FEE: if A - ?c<
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Num o inspections allowed per permit.
I: \ Building \Permits\ELC- PermitApp.doc 07/01 /10 440- 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*
El Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved: •
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
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❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
• ❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
El _ Other
Total number of commercial systems:
*No_licenses are required. Licenses are required
for all other installations
1:\ Building \Pennib\ELC- PermiIApp.doc 07/01/10
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box: •
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
/ Afe, A le); 6125 e_
Print Name of Permit Applicant
ignature of Permit Applicant Date
Permit #: � / 9-- oo 362 7
`74 1/6) i * --625� •
Address
A R o2 q - 72-2-3 •
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Issued Ic - Date: cisie V/9--
tai
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This Copy for Permit Offices