Permit CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT #: ELC2007 -00640
COMMUNITY DEVELOPMENT DATE ISSUED: 9/13/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103BB -10800
SITE ADDRESS: 12105 SW 123RD CT ZONING: R -4.5
SUBDIVISION: YE OLDE WINDMILL LOT : 028 JURISDICTION: TIG
PROJECT: LIANG
Project Description: Reconnect only
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: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
CIMIN LIANG
TUAN LIU
12105 SW 123RD CT
TIGARD, OR 97223
Phone: 503 - 524 -6015 Contact #:
FEES
Description Date Amount Reg #:
IELPRMTI ELC Permit 9/13/2007 $66.85
[FAX! 8% State Surcharge 9/13/2007 $5.35
Total $72.20 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 w se done in a - • rdance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
mor: han 180 days. A • TION o -gon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
O • - 952 - 001 -0010 through •, ' 952 -08 8100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
L P rm' na ur I - ued By: � � �� , e ittee Signature: e - — -
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.
Elf cal Permit Application ' , ,,, , ; '" I : . FOR OFFICE.USE ONLY l `
City of Tigard Date/By: / / A...7 Permit No: ei_ ' �D07 �(�6o </t)
• 13125 SW Hall Blvd., Tigard, OR 97223 y
g Plan Review
C " Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit.
T,I GA RD, Inspection Line: 503.639.4175 Date Ready /By: lur ® See Page 2 for
Internet: www.tigard - or.gov • Notified/Method: ' Col. , Supplemental Information
TYPE OF WORK PLAN REYIEW
❑ New construction ❑ Addition/alteration /replacement Please check all that apply (submit 2 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 - r
exceed 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 : ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: /2/0S Slv /-2 C 6 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 7� O y 2223 ❑ Health -care facilities. ❑Supply voltage for more than
(� ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: I /Cl/s1 j ❑ Service or feeder 600 amps or more.
FEE SCHEDULE •
Cross street/directions to job site: Description 1 Qty. 1 Foe. 1 Total 1
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'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.)
ea 0 i ,J l ,l^ _ -r D I , / L energy, multifamily 75.00 2
( N r residential (with above 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
�l� 401 amps to 600 amps 160.60 2
Name:
G � "1;L 601 amps to 1,000 amps 240.60 2
Address: / :2.10 ,Su...) / 2- 2 (6- Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty // 7 relocation
i
Phone: (S 3 ) f —60/1 Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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 ' ❑ '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, 46.85 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 90.90
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 64,g
e2
E -mail: Pump or irrigation circle 53.40 2
CO OR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /Z1P: 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 a
Suprv. Electrician signature, required: Subtotal: 66, 8-
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): J ' 3
-
Authorized signature: —,......-0 ' —"; TOTAL PERMIT FEE: 70A- AQ
/ This permit application expires if a permit is not obtained within 180
Print name: Gib / _ Date: ay - 1170 days after it has been accepted as complete.
* Number of inspections allowed per permit.
I. \ Building \Permits\ELC- PermitApp.doc 05/23/06 440- 46!5T(II /05 /COMIWEB
Electrical Permit Application - City of Tigard
4 1hk '
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
( °RESID WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK O NLY:
Fee for each commercial $75.00
system
(SEE OAR 918 -260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
H Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
H Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1:\ Building \Permits\ELC- Permi1Aup.doc 03/23/06