Permit CITY OF T TIGARD ELECTRICAL PERMIT
P ERMIT #: ELC2000 -00703
IA DEVELOPMENT SERVICES DATE ISSUED: 12/19/00
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 2S112BD -00700
SITE ADDRESS: 14655 SW 76TH AVE 033
SUBDIVISION: MARCIENE II ZONING: R -12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit for new bathroom fan.
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 AREAISPEC OCC:
Owner: Contractor:
BRENDA REILLY ELECTRO WIRE INC
7524 SW ELMWOOD 18857 SE SUNNYSIDE RD
TIGARD, OR 97223 BORING, OR 97009 -9271
Phone: 503 - 246 -7908 Phone: 658 -8136
Reg #: ELE 26 -667C
LIC 67879
SUP 2717S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/19/00 $46.85 2720000000( Elect'l Final
5PCT CTR 12/19/00 $3.75 2720000000(
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Muniapal 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 -0080. You may obtain copies of rules or direct questions to OUNC at (503)
246 -1987. '
PERMITTEE'S SIGNATURE ' , / / ISSUED Y: •
OWNER INST LLATION 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: -
U ' ( mil �D-�ti DATE:
LICENSE NO: 6 f 7 S
Call 639 -4175 by 7:OOpm for an inspection the next business day
✓ ! ")/ .� - ¢- C -C �a ✓ J . �1 �!1� a_ ! er c-t - /_ _ a..ii-! 11. t-c -�l.1 ,..
\ E- t' ejt fir /h, ,.....4144-4 f �Q .b'- s
A E lectrical Per Application
Date received: /P.-/- Permit no.: C cez1O od 70.3
1J1t :,111 City of Tigard Project/appl -no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 97223 Date issued: By: Receiptno.: -
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
r
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory ❑ Commercial/industrial ! Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration /replacement ❑ Other: ❑ Partial
.. r ;:JOB SITE INFORMATION >: -
Job address: , 55 , ,) t 7 s ,: 03 Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises:
Estimated date of completion/inspection: .
. '. CONTRACTOR APPLICATION .., -' FEE SCHEDULE
Job no: Fee Max
Business name: Description Qty. (ea.) Total no. insp
/' _-� New residential - single or multi- family per
Address: E _ _' _ _ _
f ,j , , �� , � _ - - dwelling unit Includes attached garage.
EEC __ State: p ZIP: - A r Service included
Phone: . 5 , - 1,Fax: E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof -_
CCB no.: - Elec. bus. lie. no: Z (o - (A Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non- residential _M_ 2
=' j ,. i i , 1 C a) Each manufactured home or modular dwelling ■■
. Signature of supervising electrician (required) 4 Date Service and/or feeder 2
�/
Services e installation,
111
Sup elect. name (print) Z 7 i e i ,! icense no: alteration ation or r relocation:
"r- •:,` " PROPERTY OWNER " <° 200 amps or less 2
. q 1 201 amps to 400 amps ___ 2
Name (print): �. �� 9j 401 amps to 600 amps ___ 2
Mailing � ; � address: 5 t•' : ice. / 601 amps to 1000 amps ___ 2
7 �M VIN J � /J ZIP: '. 7' A Over 1000 amps or volts ___ 2
Phone: •, A� , ,
i ! 1I3i1 E -mail: Reconnect only IIIIIMI _ i
Owner installation: e installation is being made on property I own Temporary services or feeders - -
which is not intended for sale, lease, rent, or exchange according to instatlatitxt ,alteration, orrelocation:
2 00 amps or less 2
ORS 447, 455, 479, 70, 7(4. • , ___ 2
7,r 201 amps to 400 amps
Owner's signature _ /,,, , __ _____ _ __ �'i // /mss; e: 401 to 600 amps ___ 2
-
ENGI ?�, EEIt " Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit ..,,,:
-
City: State: " ZIP: B. Fee for branch circuits without purchase p
of service or feeder fee, first branch circuit: ' ° 2
Phone: Fax: E -mail: Each additional branch circuit: iE__-
❑ Servtce over225amps- commercial 0 Health all that apply') .° Misc. (Service or feeder not indaded): e.
PLAN REVIEW (Please check
-care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1 &2 0 Hazardous location Each sign or outline lighting MU__ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, ■■■
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories 0 Feeders, 400 amps or more •Descri • lion:
O Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan ❑ Other: Per inspection _ii♦
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other E
Not all jurisdictions accept credit cards, please call jurisdiction for more information. - Notice: This permit application Permit fee $
O Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $ 1
Credit card number / / within 180 days after it has been State surcharge (8 %) .... $ ✓'/
Expires accepted as complete. TOTAL $ .' `)d
Name of cardholder as shown on credit card -
$
Cardholder signature Amount 440 -4615 (6f)0/COM)