Permit CITYCITY TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00152
l DEVELOPMENT SERVICES DATE ISSUED: 2/23/2006
''�" `� II ``' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 112 BD -00700
SITE ADDRESS: 14655 SW 76TH AVE 4 ZONING: R -12
SUBDIVISION: MARCIENE II APARTMENTS LOT : JURISDICTION: TIG
Project Description: (4) branch circuits for washer, dryer and heaters. Job No. 257
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:
MICHAEL O'GORMAN ABC ELECTRIC
PO BOX 1574 135 NE 9TH AVE
HOOD RIVER, OR 97031 PORTLAND, OR 97232
Phone: Contact #: PRI 503 - 233 - 7551
FAX 503 - 233 -7552
FEES
Description Date Amount Reg #: LIC 26 - 1226C
[ELPRMT] ELC Permit 2/23/2006 $66.80 SUP 5096S
[TAX] 8% State Surcharge 2/23/2006 $5.34 ELE 161501
Total $72.14 REQUIRED ITEMS AND REPORTS
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 f than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are t forth in O' - • - - !01 -0010 through OAR 952 - 001 -0100. You may obtain copies of thes- . '-s or direct que *ors to OUNC at
503 -2 6699 or 1 -800- '
- `_
Issu B / %� 4 Permittee Signa''� .,1 ?i
By: _ /
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:' _ %=-- thr%ff /• DATE: 23 D
LICENSE NO: 0 • 5
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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le t Permit A � ' ... A ,, el l f 1 C I . l t .. 1' 14 x ' ,.
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City of Tigard Received X41 Permit No.: i �Q /
q a 20 Q6 DatelB : 3 0 r' f G Q a
13125 SW Hall Blvd., Tigard, OR 97223 , t r (.f Plan Review Othar Permit
Phone: 503.639.4171 Fax: 503.598.1960 �`�+d" +iti Datc/B
htspection Line: 503.639.4175 � ' : "'-- I Date Ready Jurili E1 See Page 2 for
Internet: www.ci.tigard.or.us CITY OF TIGAA� ° Notified/Method: ./ /(s•• Supplemental Information
ni NG DIVISION
7 g WORK PLAN REVIEW .
Please check all that apply:
❑ New construction ]. t lddition /alteration/replacement ❑Service over 225 amps, cotnm'1 ❑Hazardous location
❑ Demolition ❑ Other ❑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
❑System over 600 volts nominal units in one structure
❑ 1 -and 2- family dwellingB Commercial /industrial 0 Accessory building °Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ❑ Master builder 0 Other: ❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE ;INFORMATION, AND LOCATION ❑ Egress/lighting plan RV park
-7 > _ ❑ Health care facility [
Job no.:
r J Job site address: �J �� L fJ Submit L 2 sets of plans with any of the above.
City /State/ZIP: r "/� F �•v The above are not applicable to temporary construction service.
l./ �} , � + • -,. FEE* SCHEDULE . .•
Suite/bldg. /apt. no.: ]� l Project name: i.� - 4
•, 1 Description Qty Fee. Total 1
Cross s to job site: V Mai (r0 fAJG 0* I9/P15, New residential single- ur tnultl- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or Tess 145.15 4
Subdivision: I Lot no.: Ea. add'I 500 sq. it. 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
� n n /n dwelling, service and/or feeder 90.90 2
A � t o L,S j LA )Gu) ( /� q- Services or feeders installation, alteration, and/or relocation
d ' 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
❑ PROPERTY. OWNER I ❑ TENANT 401 amps to 600 amps 160.60 2
Name: l' I C.I.4 -A-� L_ 0 1 00 L -4 4 13 601 amps to 1,000 amps 240.60 2
Address: Over I -D x 157 q Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: \D<'Th R. E. L) f a2.. OP-.... q 70 3 / Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) I 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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
13 APPLICANT _ 1 ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: Nb4 _ `� - -- c w branch circuit
B. Fee for branch circuits
Contact name: by x M›.--) without service or feeder fee ' 46.65 /' 2
each branch circuit 7U��
Address: _
Each add'I branch circuit . 3 6.65 f 9,q'S 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) I Fax: : ( )
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR :.. energy panel, alteration, or
J � extension. Describe: Paget 2
Business name: ` ` � .i( .
Address: 155 K.1 CM. �k� -� Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/Z1P: ..: m'\' \z - (` Q r ,,, Investigation per hour (1 lv min) 62.50
Phone: ( ) c. . ; 95 I Fax: (6t,. 19 5 3 7� -5_„ Industrial plant per hour 73.75
J / ELECTRICAL PERMIT 'FEES*
CCB Lic.: /l /SD ) Electrical Lic.696) _ / 0 7 = ? 4 , 5 , 1 Suprv. Lic. 9 ( Subtotal fgt. AT )
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ��,-)
Print name:�ha t ) DI., & /9 Date: #aG (P
• TOTAL PERMIT FEE 7� ,
Authorized signature: This permit application expires If a permit is not obtained within 180
days after It has been accepted as complete
Print name: 19.-1'1 N,),. n Date: 4,Z5it 0 ' Fee methodology set by To - County Building Industry Service Board
*• Number of inspections per permit allowed.
I:\ Building \Pennits\ELC- PetmitApp.doc 12/03 440-4615T( /trvcomJWEa
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02/23/2006 12:30 FAX 5035981960 CITY OF TIGARD 21001
Building Dion
, , �'j Request for Permit Action or Refund
City o'nkard - ECENE.
—
TO: CITY OF TIGARD FEB 2 4 2006
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223 CITY OF TIGARD
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard or.gov BUILDING DIVISION
FROM: J Owner 0 Applicant Contractor ❑ City Staff
(check one)
Name: �m (Business or Individual)
k. , 'i 8 J
Mailing Address: 1� �/ G q--/L
7 0,- J ' 7 t ` City /State /Zip: /Q,n d I Q 1?- . 7
/ze/e Phone No.: 57) 3 c 3,3 ,> 15 5
PLEASE TAKE ACTION FOR THE ITEM(S) CHFA D (d):
CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES.
REMOVE CONTRACTOR FROM PERMIT (do riot cancel permit).
Permit #: £ LC ,2(v,1 ( - - (0 ce - -,
Site Address or Parcel #: / '/(5 5 c $ J / ' - Z. , 41- iii
Project Name: _1440 IS a
Subdivision Name: Lot #:
EXPLANATION: 1. .. !I ,:, , , , / lI sQe_ E/C�OO_S - `'
L
/Or -ean.t i )- 5�S /AQ /' pr— M �.e , 'l o 6 B 170
- - '
Signature: i_I // Date: --9 y /(�
Print Name: ` /7/'1 L r6 01-e n
Belted Poliov
1. The Building OfBaIai may authorize the reflmd of
t o any tee width vita erroneously paid or collected.
b) not more then 80 percent ofthe permit fec for issued permits prior to any inspection requests.
c) not more than 80 percent ofplan review fee wbea an application is canceled before any plan review effort bee been expended
2. ltefbods will be returned to the cogged Payer in therms method to which paym was received.
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Rte to S Adtnin: e , ° O. 1:. Rte to B1d l,dmin: Date B
Refund Processed: Date -- )rek --)r B 441 Invoice Processed: Date B
Permit Canceled: Date 2...■ "o6 B • areal Tag Date B
Receipt Nob - of Date ' .23 /B‘ Method (_r e. _ Amount $ 'a , i y /fit- i iii.- '
I.- 1BuildinglFormsVtegPerrnitAaion -Bl dedoc 0120/06
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