Permit A- CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00344
DEVELOPMENT SERVICES DATE ISSUED: 5/23/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 2S110DA 09200
SITE ADDRESS: 15287 SW 107TH TERR ZONING: R -3.5
SUBDIVISION: ERICKSON HEIGHTS LOT : 053 JURISDICTION: TIG
Project Description: (2) branch circuits.
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:
SHERMAN, CONNIE WEBER ELECTRIC INC
15287 SW 107TH TERR PO BOX 231154
TIGARD, OR 97223 TIGARD, OR 97281
Phone: 503 - 624 -2141 Phone: 503 - 620 -1906
FEES Reg #: LIC 44087
SUP 4028S
Description Date Amount ELE 34 - 442c
[ELPRMT] ELC Permit 5/23/2005 $53.50
[TAX] 8% State Surcharge 5/23/2005 $4.28 REQUIRED ITEMS AND REPORTS
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty 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- 2 -2344. ��
Issued By:', Permittee Signature:T l 9, . ,t7,/\
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.
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ctrical Permit App i„ a kiwi � � r ` s ,,,, Fox orFicE sE;o I Y , su Y � 4
���� �� Received /��j�
City of Tigard Date/By: PermitNo.: 6,LC l /r) CU3W
13125 SW Hall Blvd., Tigard, OR 97223 200 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 MM lrl Date/By: Other Permit:
Inspection Line: 503.639.4175 1 lt.?N �' . e 'I'I Date Ready/By: Juris: See Page 2 for
Internet: www.ci.tigard.or.us et t Y n ``t`1 �t/' �� Notified/Method: Supplemental Information
T i [ WO RK M 6 PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply:
111 Demolition ❑ Other: ['Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating DBuildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
0 4- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi- family III Master builder ❑ Other: ❑Buildin over three stories El Feeders, 400 amps or more
['Occupant load over 99 persons ❑ Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: /s,' g'7 5LJ /0 °7 El Health-care facility ['Other: l erre, e� Submit 2 sets of plans with any of the above.
City/State /ZIP: ` tt 5 4. - The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description Qty. I Fee. Total *,
Cross street/directions to job site: 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
Limited energy, residential 75.00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
1 dwelling, service and/or feeder 90.90 2
new C-t`T ( ■. _Z.. � 7� 1 -`a`r co, lc lap Services or feeders installation, alteration, and /or relocation
C�-T / c tf c i. -mot F� / lc l u re... /`ey L 200 amps or less 80.30 2
PROPERTY OWNER El TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: S r vs-...r.. ,., 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: mj 3 6,2_1 _ 2 1 4 1 Fax: ( ) 2 00 m ion
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
❑ 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, 46.85 each branch circuit / 46 461c
61 S 2
Address: Each add'l branch circuit ( 6.65 /, ,( 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: t,iebP ( 6 ,_, x -,,,,_ ,, —
Address: �v 3 Z ' 3 5-1 Per additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: 5 J OR 5'7 Z / Investigation per hour (1 hr min) 62.50
Phone: (5 3 -2_,.. 1 , c)(p Fax: (� 62_0._ 6? ( Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: L i Gi 08 ? Electrical Lic.: 39 — q y1( Suprv. Lic.:.4' o 24 S Subtotal S 3, c--3
Suprv. Electrician signature, required: 7,�/� Plan review (25% of permit fee)
Print name: Date: _ State surcharge (8% of permit fee) y, , 2g
/� c ..tt` /, e. r S" j ' a�
TOTAL PERMIT FEE 5 7, 78
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.
i:\ Building \Permits\ELC- PermitApp.doc 12/03 440- 4615T(10 /02 /COWWEB
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:
1 Audio and Stereo Systems*
❑ Burglar Alarm
1 1 Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
Vacuum Systems*
1 1 Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
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
n Nurse Calls
n Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03