Permit .7 ®F TIGAR ELECTRICAL PERMIT
PERMIT #: ELC2004 -00027
DEVELOPMENT SERVICES DATE ISSUED: v21 /o4
el 13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639 - 4171
PARCEL: 25101 BD -00105
SITE ADDRESS: 12805 SW 77TH PL
ZONING: I -
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install (6) branch circuits for 11 radiant heaters.
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: 5 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:
B R + G CO LLC BROADWAY ELECTRIC - COCHRAN INC
PO BOX 23009 626 SE MAIN
TIGARD, OR 97223 PORTLAND, OR 97214
Phone: Phone: 503 - 234 - 6564
Reg #: LIC 72942
SUP 3447S
FEES ELE 37 -546C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/21/04 $80.10
[TAX] 8% State Surcharge 1/21/04 $6.41 Rough -in
Elect'I Final
Total $86.51
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. /
/O J J / r U i C
Issued By: � �� Permit Signature:
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:
CaII 639 -4175 by 7:OOpm for an inspection the next business day
lip
ti
., -- . , ' 1 cctrical PermitApplication - , • , -
Date received: '. -p Permit no.: _ L,,,100..../ 09 > 04
k H "" • `''jy' C ity of Tigard Project/appl.no.: t Pro ect/a 1 -no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By3 Receipt no.:
' Phone: (503) 639 -4171
' Fax: (503) 598 -1960 Case file no.:. Payment type:
•
Land use approval:
cat , : - -,,f,; - ,,. , a Ti'PE OF PERINIIT _ ` ' f ' : `€ "
❑ 1 8.2 family dwelling or accessory ❑ Commercial/industrial ❑ Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
2 " , , JOB SITE
Job address: 2 O ,,,0 '11'` " / P -[0,4„ I Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: r, Subdivision: r
Project name: 'Pa Cl`ti t✓ tt I I t J 1 Description and location of work on premises: - TU ►_
ak- (, p 11 d ,.?„, th' itr"
t
Estimated date of completion/inspection: r
b ONT ,C r ., a � .� ,� TEE SC A ' '
. =`� , . C APPLICATIO w
... . .._. - -- -� � -- - -. _. - - ,, _ .. r� L . � Fee Max t
Job no: i 400 4 (ea.) Total no. ins
a ,,, 0 Description r
Address: Qty. ( ) P
Business name: C G fV v Q
New residential - single or multi - family pe
(( (0 `S6 Cti- ' dwel linguniLInchrdesattachedgarage.
City: p0 a e ( State: I ZIP: cinr�t LI Service included:
U 1000 sq. ft. r less 4
Phone: 2,3A(D p l I Fax�gW( 1E-mail: o
�c Each sq. it r less sq. ft. or portion thereof
72- l {Z I El ec. b lic. no:�� �j r� l � 2
CCB no.: Limited energy, residential
City /metr 1 •c- o.: Limited energy, non- residential 2
�`-\ 1 — L i ,- tt Each manufactured home or modular dwelling
k� 1 l Service and/or feeder 2
Signature of supervisi g electrician (required) Date Services or feeders — installation,
Sup. elect. name (print): .e„„v. c_ iiiii — License no: 3■. --/.5 alteration or relocation:
' .--1:4.- PROPERTY ONN ER '' ' 200 amps or less 2
201 amps to 400 amps 2
Name (print): 401 amps to 600 amps 2
Mailing address: - 601 amps to 1000 amps 2
City: 'State: 1 ZIP: Over 1000 amps or volts 2
Phone: l Fax: 1E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
installation, alteration, or relocation:
which is not intended for sale, lease, rent, or exchange according to 200 amps or less 2
ORS 447, 455, 479, 670, 701. 201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps 2
Branch circuits - new, alteration,
or extension per panel:
N A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 1 r / 2
1 State: ZIP: B. Fee for branch circuits without purchase / t f //' ,
City: 1 of service or feeder fee, first branch circuit: j� 2
�
Phone: Fax: E -mail: Each additional branch circuit: t? 4' Z i a. X
, I It E�'IEW'(Please;elieck aII 1Ii ` at'apply)' „ ? misc. (Service or feeder not included):
or irrigation circle 2
O Service over 225 amps- commercial 0 Health -care facility Each pump 2
O Service over 320 amps -rating of 1 &2 ❑ Hazardous location Each sign or outline lighting
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 *Description:
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 0 Other. Per inspection 1 I I 1
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other ��'�� yy�
Permit fee $
Not all jurisdictions accept credit cards, please call jurisdiction for more infomration. Notice: This permit application
Plan review (at _ %) $
0 Visa 0 MasterCard expires if a permit is not obtained $
/ / within 180 days after it has been State surcharge (8 %)
Credit card number Expires TOTAL $
accepted as complete. •
Name of cardholder as shown on credit card $
Cardholder signature Amount 440 -4615 (6N0 /COM)