Permit CITY OF Tn.. ELECTRICAL PERMIT
11 " PERMIT #: ELC2007 - 00318
COMMUNITY DEVELOPMENT DATE ISSUED: 5/9/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2 S 109 D B -04900
SITE ADDRESS: 13263 SW SUMMIT RIDGE ST ZONING: R -7
SUBDIVISION: SUMMIT RIDGE NO. 3 LOT : 128 JURISDICTION: TIG
PROJECT: SAMPSON
Project Description: (1) Branch circuit for a/c connection. Job NO. 07 - 493
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:
STEVE SAMPSON BOB'S ACTION ELECTRIC INC
13263 SW SUMMIT RIDGE ST. 2700. NE BURTON ROAD #A
TIGARD, OR 97224 VANCOUVER, WA 98662
Phone: 503 - 828 -1076 • Contact #: PRI 360- 254 -7200
FAX 360- 254 -8219
FEES
Description Date Amount Reg #: ELE 37 -43 I C
[ELPRMT] ELC Permit 5/9/2007 $46.85 LIC 53136
[TAX] 8% State Surcharge 5/9/2007 $3.75 SUP 4322S
•
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: g Permittee Signature: pp /t c,af jo
vv OWNER INSTALLATION ONLY f'
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
C ity of Tigard EG I e' Received anima Per No. ..,
LLL ddd DateB : tt i -,..
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Ip - (p' DateB Other Permit: : G _ -- 12
Inspection Line: 503.639.4175 I, - :•d i y /� „44 „�,ii, Date Ready/By: fa See Page 2 for
Internet: www.ci.tigard.or.us CITY Notified/Method: , / Supplemental Information
CITY OF TIC /l�D PLAN REVIEW
: :TYPE OFg lygl�lr - .
❑ New construction ❑ Addition/alteration/replacement Pl e a se chec all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
. CATEGORY OF CONSTRUCTION - of 1- and 2- family dwellings 4 or more new residential
E 1 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 stones ['Feeders, 400 amps or more
❑Occupant load over 99 persons ['Manufactured structures or
- , IN
; JOB SITE FORMATION A ND LOCATION ,. ❑Egress/lighting plan RV park
❑Health -care facility ['Other:
Job no.: 07 -493 Job site address: 13263 SW Summit Ridge St . Submit 2 sets of plans with any of the above.
City/State /ZIP: Tigard, OR 97224 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: /� ,� FEE* SCHEDULE
S lM f IOSO� Description I Qty. Fee. I Total
Cross street/directions to job site: 1 New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: 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
A/C connection. 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
401 amps to 600 amps 160.60 2
Name: Steve Sampson 601 amps to 1,000 amps 240.60 2
Address: 13263 SW Summit Ridge St. Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
503 828 -1076 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 600 amps 133.75 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
:1 :APPLICANT ' .® CONTACT•PERSON : ' A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee,
each branch circuit 1 46.85 46.85 2
Address: Each add'l branch circuit 6.65 I 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: Signal circuit(s) or limited-
. , - . CONTRACTOR - . . energy panel, alteration, or
extension. Describe: Page 2 2
Business name: Bob's Action Electric
Address: t , tt Each additional inspection over allowable in any of the above
2700 NE Burton Rd. "A” Per inspection 62.50
City /State /ZIP: Investigation per hour (I hr min) 62.50
Vancouver, W 98662
Phone: ( 360) 254 -7200 I Fax: (360) 254 -8219 Industrialplantperhour 73.75
ELECTRICAL PERMIT FEES*
CCBLic.: 53136 Electrical Lic.: 37 4311C Suprv. Lic.: 4322S Subtotal 46.85
Suprv. Electrician signature, required�/ Plan review (25% of permit fee)
Print name: D a t e: State surcharge (8% of permit fee) 3.75
Kevin Brose 5/8/07 TOTAL PERMIT FEE 50.60
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri•County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Perrnits\ELC- PermitApp.doc 12/03 440
CITY OF TIGARD
BUILDING DIVISION PERMIT #: ELC2007 -00318
13125 SW Hall Blvd., Tigard, OR 97223 ' DATE ISSUED: 5/9/2007
Phone: (503) 639 -4171 P 1111
Inspection Requests (24 Hrs.): (503) 639 -4175 -_..
INSPECTION WORKSHEET FOR DATE: 5125/2007 TIME: 7:17AM PAGE: 78
SITE ADDRESS: 13263 SW SUMMIT RIDGE ST CLASS OF WORK:
SUBDIVISION: SUMMIT RIDGE NO. 3 LOT #: 128 TYPE OF USE:
PROJECT NAME: SAMPSON
DESCRIPTION: (1) Branch circuit for a/c connection. Job NO. 07-493
OWNER: SAMPSON, STEVE PHONE #: 503- 828 -1076
CONTRACTOR: BOB'S ACTION ELECTRIC INC PHONE #: 360.254 - 7200
Inspection Request Scheduled For: Date: 5/26/2007 Pour Time:
Code # Inspection Description - . • - Contact # Message
145 NC or heating unit circuit 048851 -01 51' :28-1076 N
kq c"
Corrections /Comments /Instructions:
1g , PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: N 3 $ Lc Date: 612,6101 Phone #: (503) 718-131100