Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00815
u � �� i� ' DEVELOPMENT SERVICES DATE ISSUED: 10/17/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171 PARCEL: 1 S136DD 03800
SITE ADDRESS: 11675 SW 66TH AVE ZONING: MUE
SUBDIVISION: WEST PORTLAND HEIGHTS LOT : 007 JURISDICTION: TIG
Project Description: 5 branch circuits.
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: 4 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:
CASEY, EDWARD L JR + GEORGE + SONS ELECTRIC CORP
CASEY, PATRICK D PO BOX 339
BY COMMERCIAL REALTY MGMT GRP CLACKAMAS, OR 97015
CLACKAMAS, OR 97015
Phone: Phone: 503 - 654 - 8634
FEES Reg #: LIC 35600
•
ELE 3 -117C
Description Date Amount SUP 3185S
[ELPRMT] ELC Permit 10/17/200: $73.45
[TAX] 8% State Surcharge 10/17/200: $5.88 REQUIRED ITEMS AND REPORTS
Total $79.33
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 -80 32 -2344.
Issued By: u � Z Permittee Signature: In arplat - QZ T1 ) _.
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.
17/2005, 08:13 503- 653 -6886 GEORGE & SONS ELECTR PAGE 01
'Electrical Permit Applica t P '
t .; .. I Pill t,l rlt l 1 NI i.,Ni
City of Tigard ® ' Received
13125 SW Stall Blvd Tigard ei• Datde : � / D� /:_��� CUP • i
Phone; 303..593 96Q r PIMA Review
503.639.4171 Fax 903
Phone: 503. ne: 503.639.4175 1 7 2 005 1 y �' j +J Dote ' Xele : Other Permit:
ed/Metho: See Page 21br
Internet: www.ci.tigard.or.us Notified/Method: ® _ Notified/Method: � Sapplem�t.t taformatloa
•
Inte
0 New construction B'rLi ' • • i on/alteratiott/rt lacement
p Please check all that apply:
❑ Demolition ❑ Other; []Service over 225 amps, comm'1 []Hazardous location
�' ,
i; `' ^'1 "'"'°� �' amps - rating ❑Builds over 10,000 ft.,
, � „I, . ,K OF � E]S tYVioe over 320 am g sq
;a - +'��: Nix' ° N . .. • of 1 -end 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
❑Buildmg over three stories ❑Feeders, 400 amps or more
El Multi El Master builder [] Other:
,�,�,,,� ❑Occupant load over 99 persons ❑Manufactured structures or
Y
i ' O(ATtON ❑Egress/lighting RV park
lob no.: 1185 Job site address: 11675 SW 66 Ave. ❑Health -care facility [Other:
•
Submit" sets of plans with any of the above.
City/State/VP: Tigard, OR 97253 The above are not applicable to temporary construction service.
- Suite/bldg. /apt no.: [ Project name: State National F ^ Iii,L
Description Qty I Fee. 1 Taal I "•
Cross street/directions to job site: New residential single- or multl- family dwelling Unit.
Includes attached garage.
_ 1.000 sq. ft or Tess 145.15 4
Subdivision: Lot no.: Ea addi 500 sq. ft, or portion 33.40 1
Tax map /parcel no.: - Limited energy, residential 75.00 2
>>c� ^! Limited energy, non - residential 75.00 2
Each manufactured or modular
Electrical remodel ineladina receptacles and lighting. dwelling, service and/or feeder 90.90 2
Services or feeders Installation, alteration. and/or reloeaeo
200 atttps or less 80.30 2
it j, IR. ;, ❑ TENANT 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Reconnect only 66.85 2
Temporary servkes or feeders Installation, alteration. and/o
Phone: ( ) F ax: ( ) relocation
or
Owner installation: This installation is being made on property that 1 own which is not 200 amps to less 66.85 1
20 1
intended for sale, )case. rent, or exchange, according to ORS 447. 449. 670, and 701. amps to 4 00 amps 133.75 2
401 amps to 600 amps l 33.75 2
Owner signature: - Date: Branch circuits - new, alteration, or extension, per panel
• .. :IQ ,: • ..I ° • . O •CONTACT PERSON A. Fee for branch circuits with —Y
Business name: service or feeder fee. each
6.65 2
branch circuit
Contact name: B. Fee for branch circuits
without service or feeder fee. 46.85 gr. 2
Address:
each branch circuit / _
Each add•I branch circuit y 6.65 i A 0 2
City /State /ZIP: Miscellaneous (service or feeder not included) -
Phone: ( ) p er: • ( ) Pump or irrigation circle 53,40 2
Sign or outline lighting 53.40 2
E - mail; • Signal circuit(s) or limited-
, . ? `f '1; . !..,Iii; l ' energy panel, alteration, or •
Business e: George and Son's Electric Corp. extension. Describe: Page 2 2
name:
Address: PO Box 339 Each additional Inspection over allowable In any of the above
- Per inspection 62.50
City /State/ZIP: Clackamas Investigation per hour (I hr min) 62.50
Phone: (503)&444634 Fax: (503) 653 - 6886 Industrial plant per hour 73.75
EII TRICA3. SF$ItMIT nES-
CCB Lic.: 35600 Electrical Lic!: 3117 -C Suprv- L 3185 -S �� +Y.�
Subtotal
Suprv. Electrician signature, required: Plan review (25`o of permit fee)
Print name: er 4a ) x Date: 10-17 -05 State surcharge ($" /o ofpermit fee)
TOTAL PERMIT FEE
Authorized signature: _ ?�i '� 3
T6k permit application expires if a Pernik B not obtained within 150
day; after It has been accepted as complete
Print name: I Date: ' Fee methodology set by Tri- County Building Industry Service Board
'• Number of inspections per permit allowed.
i•\ Building \PenoloAEi,C•Permit App. doc 12/03 440 I OM/CO vwee