Permit �/ ' ` r riP)i o c � - t L e/( Cc e Q r
n �� ELECTRICAL PERMIT
IN ' 4 l -1 ITY OF IGAR
PERMIT #: ELC2008 -00208
COMMUNITY DEVELOPMENT DATE ISSUED: 4/9/2008
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 110BC -10000
SITE ADDRESS: 12494 SW WINTERVIEW DR ZONING: R -7
SUBDIVISION: THORNWOOD PARTITION LOT : 001 JURISDICTION: TIG
PROJECT: BACKLUND
Project Description: Installing (2) branch circuits for bathroom addition.
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: 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:
ISSAC BACKLUND T & T ELECTRIC
12494 SW WINTERVIEW DR 4120 SE INTERNATIONAL WAY #F
TIGARD, OR 97224 MILWAUKIE, OR 97222
Phone: 408 - 921 -1762 Contact #: PRI 503 - 652 -7610
FAX 503 - 652 -7612
FEES
Description Date Amount Reg #: ELE 3 -605C
[ELPRMT] ELC Permit 4/9/2008 $53.50 L1C 161187
[TAX] 12% State Surchar 4/9/2008 $6.42 SUP 51765
Total $59.92 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' �` / _ �! Permittee Signature: 5,00 c���/
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'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
�- Received
City of Tigard �� Date/By y q v ( „ 372 ---- Permit No. �LC�IU� c��
' 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review ''`� L„,"....
48
: ll Phone: 503.639.4171 Fax. 503.59;i . ‘)()(e Date/By: Other Permit /064.7) ( x. "� / —KJ
TI G A It D Inspection Line. 503.639 ! � • � . Date Ready/By Juns 0 See Page 2 for
Internet. www tigard-or gov r tO` ` , r` ,,p► V u 'tt ified/Method. Supplemental Information
TYPE OF WORKS
C, PLAN REVIEW
❑ New construction ® Addition/alteratio __ _ _ ent Pl check all that apply (submit 2 sets of plans whtems checked below):
❑ 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
RI 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 ❑ Emergency system larger separately denved system. A
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 2z1 9 4 S w 1., , I yj e Di I Six or or more residential occupancy
❑ Six or more residential amts. ❑ Recreational vehicle parks.
City/State /ZIP: e C ' Z Z ❑ Health -care facilities ❑ Supply voltage for more than
7 % J ct tf J / ❑ Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: a k /(1 d) ❑ 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.: 1,000 sq. ft. or less 145 15 4
Tax map /parcel no.: Ea add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75 00 2
DESCRIPTION OF WORK (with above sq ft )
r ,y�, Limited energy, multi- family
I-�(,t 1 Yi 00 v^ J: 1, L' ^ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80 30 2
N PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: 11SSC^ < 1,4 401 amps to 600 amps 160 60 2
601 amps to 1,000 amps 240 60 2
Address: Over 1,000 amps or volts 454.65 2
City/State /ZIP: Temporary services or feeders installation, alteration, and/or I
relocation
Phone: ( yam liz I 1 76 Z 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
a APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 6.65 2
^ '� each branch circuit
Business name: S G1 U t, B. Fee for branch circuits
without service or feeder fee,
Contact name: i r
first branch circuit 46 85 L.(�, 2
Address: Each add'I branch circuit i 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 -
/•tti.2 energy panel, alteration, or
Address: extension. Descnbe: 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 (I hr min) 62 50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: c ? . co_
Print name: Date: Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6, . y a--
Authorized signature: e";,..--- TOTAL PERMIT FEE. , 9 a.
This perm application expires if a permit is not obtained within 180
Print name: s4 q C k �ut� Date: 4/ 5 /� it days after it has been accepted as complete.
• Number of inspections allowed per permit
I \Budding\Pennits\ELC- PemtitApp doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard •
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: I
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ 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
❑ 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\Permns\ELC- PermitApp dot 03/23/06
1
CITY OF TIQARD
BUILDING DIVISION r PERMIT #: ELC2008 -00208
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 4/9/2008
Phone: (503) 639 -4171 kip I�I
Inspection Requests (24 Hrs.): (503) 639 -4175 I .
INSPECTION WORKSHEET FOR DATE: 5/14 /2008 TIME: 7:04AM PAGE: 9
SITE ADDRESS: 12494 SW WINTERVIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: BACKLUND
DESCRIPTION: Installing (2) branch circuits for bathroom addition.
•
OWNER: • = UND. ISSAC PHONE #: 408- 921 -1762
CONTRACTOR PHONE #:
'T t 4- r 'EL. .
Inspection Request Scheduled For: Date: 5/14/2008 Pour Time:
Code # Inspection Description - Contact # Message
120 Electrical rough-in ()fame- 02 408.921 -1762 Y
Corrections/Comments/Instructions:
PR\
ASS El PARTIAL APPROVAL El CANCEL El NO ACCESS
� ❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 1\1%L- Date: ffil Phone #: (503) 718- liti t
. _ - _
CITY OF, TI3ARD
BUILDING DIVISION r PERMIT #
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: ELG2008 OQ2(18
Phone: (503) 639 -4171 I AI91 ?Q08
Inspection Requests (24 Hrs.): (503) 639 -4175 R'I —
INSPECTION WORKSHEET FOR DATE: 7/29/2008 TIME: 7 :01AM PAGE: 3
SITE ADDRESS: 12494 SW WINTERVIEW DR CLASS OF WORK:
SUBDIVISION: THORNWOOD PARTITION LOT #: 001 TYPE OF USE:
PROJECT NAME: BACKLUND
DESCRIPTION: Installing (2) branch circuits for bathroom addition.
OWNER: BACKLUND, ISSAC PHONE #: 408. 921 -1762
CONTRACTOR: T & T ELECTRIC PHONE #: 503-6527610
Inspection Request Scheduled For: Date: 7/79/7008 Pour Time:
Code # Inspection Description Confirm # Contact # Message
199 Electrical final 073395-03 503 -598 -7177 Y
Corrections/Comments/Instructions:
\ P rY\ ON1,11
ii iki l
XPASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 6 ,V OV 1 Date:Ill V'D Phone #: (503) 718- -4%