Permit , CITY OF TIGARD , ELECTRICAL PERMIT
PERMIT #: ELC2007 -00667
COMMUNITY DEVELOPMENT DATE ISSUED: 9/26/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 PARCEL: 1S133CD
SrfE ADDRESS: 11674 SW WILTON AVE ZONING: R -
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT : 140 JURISDICTION: TIG
PROJECT: GERDES
Project Description: (4) circuits. Job No. A9450
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: 3 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:
DON GERDES MCCOY ELECTRIC CO INC
11674 SW WILTON 2014 SE 9TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Contact #: PRI 503 - 234 - 7521
FAX 503 - 234 -9473
FEES
Description Date Amount Reg #: ELE 26 - 82C
[ELPRMT] ELC Permit 9/26/2007 $66.80 LIC 8277
[TAX] 8% State Surcharge 9/26/2007 $5.34 SUP 21755
Total $72.14 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 • - • • • - in accordance with approved plans This permit will expire if work is not started within 180 days of issuance, or if work is
suspe = - d for more tha 180 • = s. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center.
Tho• - rules are set forth in • • R 952 -0 0010 through OAR 952 -001 -0100 You may obtain copies of these rules or direct questions to OUNC at
503 246.6699 • r 1.800.33. 2344.
Issu - • B : kb, / r Permittee Signature: e J r r
t
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:
C • TRACTOR INSTALLATION ONLY
� SIGNATURE OF SUPR. ELEC'N: _�•i % , � �% ore- 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.
Eleekical Permit Application FOR OFFICE USE ONLY
- City of Tigard Date/ Received By: 9 /4 47 Permit No. 6,4,
III ° 1 3125 S W H all Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639 4171 Fax: 503.598.1960 Date/By- Other Permit
TI GARD Inspection Line: 503 639 Date Ready/By. Jun ® See Page 2 for
Internet: www tigard or.gov Notified/Method / CG Supplemental Information
TYPE OF WORK - . -- PLAN REVIEW
❑ New construction NQ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below)
J` ❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ 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
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
❑ Emergency system larger separately denved system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I - ", "1 -
Job site address: I � �`� 100HP or more occupancy.
Job no.: POISO I ) 6-74 5 c , 3 W ' I Dr r"" ` ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 1 3aY. n , qi ,Q a ❑ Health -care facilities 0 Supply voltage for more than
❑Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: t_ C / cI c Service Sece or feeder 600 amps or more.
�� FEE SCHEDULE
Cross street/directions to job site: Desuiption I Qty. I Pet. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq ft.) 75.00 2
T Ce Limited energy, ft 75 00 2
residential (with th above sq sq. ft )
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
Name: el ex&-e / c 1 (V I ) 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: CAmQ Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT [Iv CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: A-/l C B. Fee for branch circuits 9 I tO 85
Contact name: 1 without service or feeder fee, 1
( first branch circuit 46 85 ` 2
Address: Ea add'I branch circuit 3 6.65 1 5,95 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (Sc ) 3( -7 I 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: r J1 c(.0 � Signal circuit(s) or limited -
A �`= (-1- ( energy panel, alteration, or
Address: an `LA �S q fih w•Q extension. Describe Page 2 2
City/State/ZIP: p, �/'+) H of t � 97 111 Each additional inspection over allowable in any of the above
CJt Per inspection 62.50
Phone: ei.,3) D ?) 7g 21 Fax: ()`9 cQ I qq Investigation per hour (I hr min) 62.50
CCB Lic.' ')7 Electrical Lic.: D6 —82 N Suprv. Lic.: 21 i S s Industrial plant per hour 73 75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: � LA •( ( •S 0
Print name: Date: q Plan review (25% of permit fee)
, o.n�cc $1 7 State surcharge (8% of permit fee). 9 , 3y
Authorized signature: TOTAL PERMIT FEE. — 7 a , (Li
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit
I \ Building \Permits\ELC- PermitApp doc 05/23/06 4404615T(i 1 /05 /COM/'EB
CITY OF TIGARD - : ,
-
BUILDING DIVISION PERMIT #: ELC2007 -00667
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/26/2007
Phone: (503) 639 -4171y ' i
Inspection Requests (24 Hrs.): (503) 639 -4175 �' I L. .
INSPECTION WORKSHEET FOR DATE: 10/29/2007 TIME: 7 :01AM PAGE: 47
SITE ADDRESS: 11674 SW W LTON AVE CLASS OF WORK:
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 140 TYPE OF USE:
PROJECT NAME: GERDES
DESCRIPTION: (4) circuits. Job No. A9450
OWNER: GERDES, DON PHONE #:
CONTRACTOR: MCCOY ELECTRIC CO INC PHONE #: 503 - 2347521
Inspection Request Scheduled For: Date: 10/29/2007 Pour Time:
Code # Inspection Description onfirm ' Contact # Message
125 Wall cover 058459 -01 503 - 577 -8009 N
Corrections /Comments /Instructions:
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: cr.' NOES LG Date: iir. Phone #: (503) 718- Y #6
CITY OF TIGARD ,. . -
r
BUILDING DIVISION PERMIT #: ELC2007. 00667
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 9/2612007
Phone: (503) 639 -4171 4ll
Inspection Requests (24 Hrs.): (503) 639 -4175 °_ -..
• INSPECTION WORKSHEET FOR DATE: 1/25/2008 TIME: 7 :O0AM PAGE: 30
SITE ADDRESS: 11674 SW WILTON AVE CLASS OF WORK:
•
SUBDIVISION: COTSWALD MEADOWS NO.3 LOT #: 140 TYPE OF USE:
PROJECT NAME: GERDES
DESCRIPTION: (4) circuits. Job No. A9450
OWNER: GERDES, DON PHONE #:
CONTRACTOR: MCCOY ELECTRIC GO INC PHONE #: 503 -234 -7521
Inspection Request Scheduled For: Date: 1/25/2008 Pour Time:
Code # Inspection Description ,.--Gon irm,# Contact # Message
199 Electrical final 063939 -01 503 572 -3051 Y
Corrections /Comments /Instructions: RII GK
1 & Ri oQ
N,
dV
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6--- N W Date: i 'ir' v 1 Phone #: (503) 718- 3A____