Permit " t � ® CIT OF TIGARD ELECTRICAL PERMIT
COMMUNITY PERMIT #: ELC2007-00210
OMMUNITY DEVELOPMENT DATE ISSUED: 4/6/2007
T,IGAR'D 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S136CB -09200
SITE ADDRESS: 11190 SW 81ST AVE ZONING: R - 4.5
SUBDIVISION: HERB + PEGGY'S PLACE LOT : 022 JURISDICTION: TIG
PROJECT: HARTE
Project Description: 1 branch circuit to furnace.
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: 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:
DORIS HARTE OREGON ELECTRIC GROUP
11190 SW 81ST 1010 SE 11TH AVE
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: 503 - 620 - 7976 Contact #: FAX 503 - 535 -2763
PRI 503 - 234 -9900
FEES
Description Date Amount Reg #: ELE 26 -95C
[ELPRMT] ELC Permit 4/6/2007 $46.85 LIC 203
[TAX] 8% State Surcharge 4/6/2007 $3.75 SUP 4460S
Total $50.60 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 Si �`n � , e n .��
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.
ks:=A 0 09:04AM FROM -OR ELECTRIC SVC 5035352763 T - 317 P.001/002 F -368
.cat Permit A itcauuu t: pa. f.: « �iwa � r. _,,.,..,.... ---
�� Received / 6 i� Permit City of Tigard l l , Dare._ f � /J (/`
13125 SW Hall Blvd., Tigard, OR't .} • .� � r Plan Rovicw
Phone: 503. 639.4171 Fax: 503. 9:. Other Permit
l • •0 i? ) ({{'�= ua
I I Date Re nd y /B y Ian Fa See Page 2 for
Inspection Line: 503.639.4175 APR — 4 2007 �"'- Supptemcnttd iaformadaa_�
Notified/Method
Internet: www.ci_tigrrd.or.ua
C It, (:.r t4®, PLAN REVIEW •
'� f 1 - c
❑ New construction 1;4 'Mon/alteration/replacement 'Mon/alteration/replacement ement
please ase all that apply:
ase check heck over amps, comm'1 ❑HoTardous 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 dwelling ❑ Commercial/industrial ❑ Accessory building ['Building over three stories ❑Fcedes, 400 amps or more
❑ Multi- family ❑ Master builder ❑ Other. ['occupant load over 99 parsons ❑Manufactmrd structures or
ess/li l
JOB SITE INFORMATION AND LOCATION E htin 0 g' 8 6P an RV park
❑Health - rue facility -
Job no.: 21215 I Job site address: 11190 SW 81 AVE Submit 2 sets of plans with any oft o above.
— City /Statc/ZIP: TIGARD, OR 97223 _ The above are not applicable to temporary Construction service.
FEE* SCHEDULE
Suite/bldg. /apt no.: , Project name: DORIS HARTE - -F,..—
j Qty. I F. 1 Taal -F,..—
Cross street/directions to job site: New residential single- or multldamily dwelling unit.
— Includes attached garage.
1,000 sq. R or lts _ 145.15 4
_Ea. add'( 500 sq. ft. or Portion 33- 1
Subdivision: l Lot no.: - -
Limited energy, residential 75.00 _ 2
Tax map/parcel no_: Limited energy, non-residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
•
- dwelling, service and/or feeder 90.90 2
RECONNECT FURNACE Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 _ 2
201 amps to 400 amps 106.85 2
• ❑ PROPERTY OWNER J 0 TENANT 401 amps to 600 amps 160.60 2
Name: DORIS HARTE 601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2 -
Address: SAME AS ABOVE Reconnect Daly 66.85_ 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) IF": ( ) 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 600 amps , 133.75. 2
Owner signature: Date: Branch circuits - new, alteration. or extension, per panel
0 APPLICANT I ❑ CONTACf 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, 1 46.85 4-1015 2
Bich branch circuit w
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: ( ) 1Fax: = ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
energy panel. alteration, or
CONTRACTOR extension Describe: Page 2 2
Business name: Oregon Electric Group -
Each additional inspection over allowable in any of the above
Address: 1010 SE 11th Ave Per inspection 62.50
City /State/ZIP: Portland, OR 97214 Investigation per hour (1 hr min) 62.50
Industrial plant per hour 73.75
Phone: (503) 234-9900 I Fax: (503) 535 -2763 ELECTRICAL PERMIT FEES'
CCB Lie.: 203 I Electrical Lic.: 26 - 95C I Suprv. Lic.: 4549s Subtotal X40 .S 5
°
Suprv. Electrician signature, 1eq v S. -
, plan review (25% of permit fee)
State surcharge (8% of permit fee) 3 ,1 5
Print name: R % G � a ti QA l " ' c. e 1) j Q .I-- Date: 04/05/07
TOTAL PERMIT FEE Sir, 1p 0
Authorized sign= ° ° 'This permlr appileatioe expires Ira permit Is not Obtained width' 190
�m. aa‘ days after it bus been accepted as complete
�► G l
Print name: Q �ci G ` I t . L '^ 11 p. t - . 1 • /05/07 • Fee methodology set by Tri- County Building Industry Service : •
� — •• Number of inspections per permit afowoa
is \euitdin8\rerttits \0.C- Pe+r•1u1PP.e 12111 4404615T(10r02/COM/wE13