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Permit CITY OF TIGARD ELECTRICAL PERMIT Ilq PERMIT #: ELC2007 -00266 ° COMMUNITY DEVELOPMENT DATE ISSUED: 4/24/2007 TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 2S 105DD - 07600 SITE ADDRESS: 13815 SW SANDRIDGE DR ZONING: R - SUBDIVISION: COSTIUC PART /MLP2001 - 00005 LOT : 003 JURISDICTION: TIG PROJECT: GROSS Project Description: 1 branch cir. to AC 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: 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: MICHAEL GROSS OWNER 13815 SW SANDRIDGE DR. TIGARD, OR 97223 Phone: 503- 524 -3303 Contact #: FEES Description Date Amount Reg #: [ELPRMT] ELC Permit 4/24/2007 $46.85 [TAX] 8 %.State Surcharge 4/24/2007 $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 By: v ��fJ Permittee Signature: ��Ii�� OW NER 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 1;si; ()NIX City of Tigard CEDED Received Date/B : 1� B PermitNo.: r, — Oj1pkoto 13125 SW Hall Blvd., Tigard, OR 9 Plan Revie ' C . Phone: 503.639.4171 Fax: 503.598A fil 2 4 2007 Date/By: Other Permit. - r I G A R D Inspection Line: 503.639.4175 Date Ready :y: ruris Si See Page 2 for Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information TYPE of3W6IiiNG DIVISION PLAN REVIEW ❑ New construction ® Addition/alteration/replacement Please check all that apply (submit a 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 ® 1- 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 ID Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2" "l -3" Job no.: Job site address: 13815 SW SANDRIDGE DRIVE tooliP or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/ State/ZIP: TIGARD, OREGON 97223 ❑ 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 Qty. I Fee. I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 69 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.) EXTENSION OF ELECTRICAL FOR AIR CONDITIONNER Limited energy, multi -family 75.00 2 residential (with above sq. ft.) FROM DISCONNECT TO UNIT 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: MITCHELL J. GROSS AND CORINE GROSS 401 amps to 600 amps 160.60 2 601 amps to 1,000 amps 240.60 2 Address: 13815 SW SANDRIDGE DRIVE Over 1,000 amps or volts 454.65 2 City/State /ZIP: TIGARD, OREGON 97223 Temporary services or feeders installation, alteration, and/or relocation Phone: (503)524 -3303 Fax: ( ) 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2 Owner signature: / i.". d � • ' Date: �"07 Branch circuits — new, alteration, or extension, per panel A. Fee for branch circuits with ❑ APPLICANT ❑ CONTACT PERSON 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, 1 46.85 I 2 first branch circuit Address: Each add'I 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: ( ) 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 - t�"I.tl� 12)1_ 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 (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): 3.75 Authorized signature: TOTAL PERMIT FEE: 50.60 Print name: 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(II/05 /COM/WEB CITY OF TIGARD 1 II - BUILDING DIVISION PERMIT #: ELC2007 -00266 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/24/2007 Phone: (503) 639 - 4171 Inspection Requests (24 Hrs.): (503) 639 -4175 INSPECTION WORKSHEET FOR DATE: 4/30/2007 TIME: 7:00AM PAGE: 19 SITE ADDRESS: 13815 SW SANDRIDGE DR CLASS OF WORK: SUBDIVISION: COSTIUC PART /MLP2001 -00005 LOT #: 003 TYPE OF USE: PROJECT NAME: GROSS DESCRIPTION: 1 branch cif. to AC OWNER: GROSS, MICHAEL PHONE #: 503.524.3303 CONTRACTOR: OWNER PHONE #: Inspection Request Scheduled For: Date: 4/30/2007 Pour Time: Code # Inspection Description Confirm # Contact # Message 199 Electrical final 047349 -01 503- 524 -3303 N Corrections /Comments /Instructions: ( ) ) )tt jt \ PAS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED Inspector: G - 1 � L Date: L AI 3 I 3r) Phone #: (503) 718- 2-44)