Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00614
•
DEVELOPMENT SERVICES DATE ISSUED: 8/22/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S112CA
SITE ADDRESS: 15566 SW 76TH AVE ZONING: R -
SUBDIVISION: RENAISSANCE WOODS NO. 2 LOT : 054 JURISDICTION: TIG
Project Description: Wire AC.
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:
HUTTON, BRIAN D + DEBORAH A WEST SIDE ELECTRIC CO INC
15566 SW 76TH AVE 1834 SE 8TH AVE
TIGARD, OR 97224 PORTLAND, OR 97214
Phone: Phone: 503 - 231 - 1548
FEES Reg #: LIC 13306
SUP 4654S
Description Date Amount ELE 26 - I35c
[ELPRMT] ELC Permit 8/22/2005 $46.85
[TAX] 8% State Surcharge 8/22/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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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: / 3 ,f Permittee Signature: (/ J
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.
APIP
... .. --
Electrical ermitt. A.t 1(��Ilc1..t1onE ® . FOR OFFICE USE ONLY - ..
City of and Received
Tigard t [ , � Permit No /�/
Fs S 2005 p ate/Uy: I / ...1./c7 Lhk Q�('Q � 01�� �
13125 SW Hall Blvd., Tigard, OR )72d : Plan Revie
Phone: 503.639.4171 Fax: 503.59 • x ., �y Datn/fs : Other Permit:
inspection Line; 503.639.4175 CITY OF TIGARD AA ri• _' Hato lcoadytuy: oar;,: �`, ® :ties rev rot
linen/et; www.ci.tig-4rd,ur.us Itli tiP flies DIVISION Noolied/Mct od: —__ T 1 `-'C I Supplemvotal Autormalida
� TYPE OF WORK PLAN REVIEW •
❑ New construction rg Addition/alteration/replacement Please chick all that apply:
['Service over 225 amps, cunun'I ❑l lazarduus location
❑ Delll01tn011 ❑ Utl1Ci t 4erviee over 320 amps • r'aliu Build:* vcr 1
❑. < 1 • E: (.] < x u 0,000 sq- •i„
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new resiik:ruiai
V I 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal writs in one structure
❑ Muni - family ❑ Mass builder El Other:
❑Iluilding over three stories ❑feeders, 400 amps or more
w,.. __Y_....,.__._.�_.._....._ - - - -_ . -. ___ —.. ['Occupant fund over 99 perNons [1Manufacturcd structures or
.1011 Sag INFORMATION AND LOCATION ❑Ligress/Iighting RV park
I ❑Health -care facility
Job no.
:`3. SZw lob site address: 1 ,C 5 / //� /_ �h 1Q
`� - •- --._. 7� tin ... .... _._.... _- •--- -.._.__ : ,..._ Sa hmit. 2 :etsofplanswithanyofthe above.
City /StatclZlP: k t � e.1- .�',t 4 1 — 7 ZZ L. Y The above are sot applicable to temporary cons' action service.
I Suite/bld./at. no.: 1 ro ect name: ��y //+� 1 _. , •.
,FEE SCHEDULE rnuSCHEDULE r' 1 , , !•�' K `� C `-'�� l ' t�l �� Description Qty. Pee. Tow'
Cross street/directions 10 job site: New residential single or multi- family dwelling unit.
— - -- ----- - - - --- - - - -•- includes attached garage.
• 1,000 sq. ft. or less 145.15 4
Subdivision. I - I, no.: Eta. add'l 500 sq. ft. or portion 33.40
- - - - - -- Limited energy, residential 75.00 2
Tax trap /parcel no.: - - - —'
-. �.__ -__. - _, Limited energy, rim-residential 75.00 2
DESCRIPTION OF WORK _ Each manufactured or modular _..__._ ._.., -.-
dwelling. service and /or feeder 90.90 _ 2
......k- /A G. 2/4- t,. t ServiCCS or feeders installation, alteration, andJur rclucetiOt
200 amps ur Iess 1{0.:10 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
�_., -�- 401 amps to 600 amps 160.60 2
Name: 1 -k ce4 k4 P 601 amps to 1,000 amps 240.60 _2
Address: +' M Over 1,000 amps or volts 454.65 2 -
---- l2"•'� - _-- Reconnect only 66.85 2
4
City /State / /Z1P: / / r Terrtporary services or feeders installation, alto - alien, aad/Or'
7� (9Z l'1 7 t l Fax _ relocation S - - 1
Phone: ( ) : ( ) --
200 amps or less 66.8= _
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.:10 2_
intended tnr sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps _ 133.75 _ 2
Owner signature: ___ Dale: BBraneh circuits - new, alteration, or extension, per panel
❑ APPLICANT _.. ❑ CONTA1:T PERSON A. Fee for branch circuits with
service or feeder foe, each 6.65 2
Business name: branch circuit
B. Fee for brunch circuits [
Contact Hartle: without service or feeder fee, 1
46.85 "7 L . ?$ 2
-- - ._.........._.... l
each brunch circrpit _
Address:
__ Each add' branch circuit 6,65 2
City /StareJZlP: Miscellaneous (service or feeder not included)
-- . Pump or irrigation circle 5140 2 —
Phone: ( ) tax:: ( ) ---- -
_,_.. -_. _ -_ __ _ _. _ Sign o r out lighting 53.40 2
—
F, Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
-^-- _ - extension, Describe: Page 2 2
Business name: WEST SIDE ELECTRIC CO. i _ - -- . -
Address: 1834 SE 8 AVE. Each additional inspection over allowable in arty of the above
Per inspection 62,50
City /Start /Z1P: PORTLAND, OR 97214 Investigation per hour (1 lir min) 62.50
Phone: (503) 231-1548 Fax (503) 736. -0677 Industrial plant per hour _ 73,75 1
EI,TC PRICAL PERMIT FEES*
CC13 Lit.: 13306 Electrical L' : 26 -135C Suprv. Li j:�Cg5 ) S y M Suhtotal 44 t2 S
J �/ ! - - Plan review 25% of permit fee)
Suprv. Electrician signature, required: L je 1
p f n l . K r - . -- ��. P - �. -
1 11 / State surcharge (it% of permit fee) -
Frier name: �L�..rn Y c lv,\ 1 , . f � D a t e g l 2/ Tt 5
r i 0 - - ■ ( r TOTAL PERMIT FEE Co .. t 0 _
Authorized signature: This pci•mlt ppplUUAtlon expires if a permit Is not ubliiiacd within 1$O
days utter it hae been accepted PA canplcte
Print name: Duto: • Fce ruethodology set by Tri -Cuway Ovading industryServieo CtoNe0
- —••• - - •• Number of inapecuurts per permit allowed.
h• tfuilding \PermiatELC•PcnnitApp.duc 12/03 410-4613T(' COM/Wttlt
2'd LL90 9EL(EDS) '00 ot.aaoai3 aptS asar e9Et8D SO ZZ 2nd