Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00741
DEVELOPMENT I r SERVICES DATE ISSUED: 10/4/2005
13125 503 - 639 -4171
PARCEL: 2S109CD -00600
SITE ADDRESS: 15729 SW COLYER WAY ZONING: R -7
SUBDIVISION: BEEF BEND HEIGHTS LOT : 006 JURISDICTION: URB
Project Description: 3 branch circuits in garage.
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: 2 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:
CHARLES F. RADLEY ACE ELECTRIC CO
15729 SW COLYER WAY 9210 SW 28TH AVE.
TIGARD, OR 97224 PORTLAND, OR 97219
Phone: 503 - 579 -4686 Phone: 244 -0078
FEES Reg #: LIC 70628
SUP 3597S
Description Date Amount ELE 26 - 798C
[UELPMT] ELC Permit 10/3/2005 $60.15
[UTAX] 8% State 10/3/2005 $4.81 REQUIRED ITEMS AND REPORTS
Total $64.96
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 -88e- 332 -2j 4.
Issued By: AP � _ i Permittee Signature: C ` � •�
OWNER INSTALLATION ONLY
The installation is being made on property l 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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Electrical Permit A ],�,� d o OFFICE FOR OF USE ONLY
• pp 4 2005
,J
City of Tigard DateRecei/Bved y:(o /7 05, be Permit No. t, 6 iZif
13125 SW Hall Blvd., Tigard,049 ' Plan Review
Phone: 503.639.4171 Fax: 5 3.39 V� �' A " ' l '� Date/By: Other Permit.
Inspection Line: 503.639.417 DJVJS .J el I Date Ready/By: Iup� per. ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: WV' Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'1 ['Hazardous location
❑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
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
El Multi- family ❑Master builder ❑ Other: ❑Building over three stories ['Feeders, 400 amps or more
['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
29 S W Co( tar ❑Health -care facility ['Other:
Job no.: Job site address: 1 5 7
Wei) Submit 2 sets of plans with any of the above.
City/State /ZIP: ` z a rd t CI 12 1 9 72. 2. z- The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. 1 Total I *"
Cross street/directions to job site: h G. ...c Be Q. S Be.r. 4 R . q o1 New residential single- or multi - family dwelling unit.
dif ;.e. i'e l CO3- 401 -3 60' -- 4.. 5d 3-- 32-4 Includes attached garage.
f� / �.o 1 3 5 Z� 1,000 sq. ft. or less 145.15 4
Subdivision: Be. a Bev,. A H e i� F5 Lot no.: 6 Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Z 5 09 ( 0 0 6 OO Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Q cur0. ¢ C. oe O `` leis mat d ' ¢e9 Services or feeders installation, alteration, and/or relocation
J 200 amps or less 80.30 2
VI PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
1 401 amps to 600 amps 160.60 2
Name: CA z 1 f e T . K.1.4 )Q'1 601 amps to 1,000 amps 240.60 2
Address: 15 /2. 9 5 WY • C . 1 1 QC J UU •..) Over 1,000 amps or volts 454.65 2
�
Reconnect only 66.85 2
t
City /State /ZIP: 1 i q o.. f 0 (Z .972 2- ek Temporary services or feeders installation, alteration, and /or
Phone: (5a)) Jr 79 - 4 6 8 6 Fax: (5 C 3) 579 - 4 6 8 relocation
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 cording to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: C- 12.-.W F - '� ( Date: 1 of / 0 5 Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each Z 6.65 /3, 30 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, aa¢¢
each branch circuit 46.85 45 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: A GQ E J a ej'r i e Ce r r
Address: 92 1 0 5 . 1.1 A v @ Each additional inspection over allowable in any of the above
.5 Per inspection 62.50
City /State /ZIP: Po r t I a N d / 0 R 9 72. .9 Investigation per hour (I hr min) 62.50
Phone: (5O 3) 2. 4 4 - 0 0 7 it Fax: (5 ) 2 if 4-- 0 0 9 I Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: 70 6 2 Electrical Lic.: Z6 -- 4 8 Sup . Lic.:' ,S Subtotal 60, / 5 9
/ N e' �� 0
Suprv. Electrician signature, required: �` �W'j� 3 / S Plan review (25% of permit fee)
. VV/� /v ( '/ State surcharge (8% of permit fee) 4, I
Print name: g i f- /(,1 L u 7 Date: Z o v r- 05
TOTAL PERMIT FEE 4 1104* /,
Authorized signature: d� /� This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: pe b kI 6'0 N Date: L O L ( 0 5 * Fee methodology set by Tri- County Building Industry Service Board
** Number of inspections per permit allowed.
is\ Building \'ermits\ELC- PermitApp.doc 12/03 440.4615T(10/02/COM/WEB