Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00044
I DEVELOPMENT SERVICES DATE ISSUED: 1/23/2006
' 'I II 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 1S135AA-00906
SITE ADDRESS: 10230 SW 90TH AVE ZONING: R -4.5
SUBDIVISION: TOWN OF METZGER LOT : JURISDICTION: TIG
Project Description: (1) branch circuit.
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:
GENNIE HARRIS OWNER
10230 SW 90TH AVE
TIGARD, OR 97223
Phone: 503 - 977 -2374 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 1/23/2006 $46.85
[TAX] 8% State Surcharge 1/23/2006 $3.75
Total $50.60 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spedalty 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: 172, ' A Permittee Signature:
v . OWNER INSTALLATION ONLY
The installation is being made on pre • erty 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.
f• Electrical Permit AP r tCZIVED lOIZ(1P11(l l ti O \I.l
City of Tigard RDate/B ' — Permit No. f `t /
Air 2 2006 _ �
13125 SW Hall Blvd., Tigard, OR 97223 3 2006 Plan Review . ..
Phone: 503.639.4171 Fax: 503.598.19 - Date1B .
her Permit:
Inspection Line: 503.639.4175 ulTY OF TIGA' . 1. 1 •. I Date ReadyBy: HI See Page 2for
Internet: www.ci.tigard.or.us BUILDING DIVIS • 1 J Notified/Method: - Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
1:1 Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
OService over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- 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
DOccupant load over 99 persons ❑ Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: -} 1 ❑Health -care facility ❑Other:
_ f � ��� 'S W �) h - Submit 2 sets of plans with any of the above.
City /State/ZIP: 1 ' 0 O � � C •7 at - b , The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: � U 1 Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I **
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: 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
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
AfitOPERTY OWNER 0 TENANT 401 amps to 600 amps 160.60 2
Name: C R & ∎ C el y1 ') i (L � I -�. S 601 amps to 1,000 amps 240.60 2
Address: / }11 .3*( S 90 1 ., (-� - Over 1,000 amps or volts 454.65 2
l v `� Reconnect only 66.85 2
City / State/ZIP: t i 6 �(1 q 7 p Temporary services or feeders installation, alteration, and/or
)q-{� a,D 1 , / ( ) relocation
Phone: Ic t F 200 amps or less 66.85 1
Owner installation: This installation is be made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or e according to ORS 447, 449, 670, and 701. //1 401 amps to 600 amps 133.75 2
Owner signature: C5 Date: I — X4.3 V/ Branch circuits — new, alteration, or extension, per panel
❑ APPLIC - ❑ CONTACT PERSON A. Fee for branch circuits with
I^ service or feeder fee, each
Business name: [ `o rnvc) branch circuit 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'I 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
;fin v r.,
Business name: ��; c y � �
Address: "Y' Each additional inspection over allowable in any of the above
Per inspection 62.50 _
City/ State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: �))
subtotal 6 .
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) j7 75
TOTAL PERMIT FEE 5- c U
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
is\ Building \Pennits\ELC- PernitApp.doc 12/03 440- 4615T(10/02/COM/WFB
Electrical Permit Application - City of Tigard • -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
El Burglar Alarm
El Garage Door Opener*
El Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
El Landscape Irrigation Control*
El Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Pennits\ELC- PermitApp.doc 04/03
CITY OF TIGARD
BUILDING DIVISION ... PERMIT #: 1 =`1 t;:;)(k - (..0('-";/1
13125 SW Hall BIv.. Tigard, OR 97223 DATE ISSUED: i {',�i ;?t(:i
Phone: (503) 639 -417 Alli,„ pimy� p �11� 1 1 '' I 1\
Inspection Requests (24 . s.): (503) 639 -4175 ,„..�
INSPECTION WORKSHEET F• ' DATE: 104/2006 TIME: ()AM PAGE: ?,'?
SITE ADDRESS: ;1 ;1;30 �>W 90I AVE CLASS OF WORK:
SUBDIVISION: TOVV1 of MEI. ;F_R LOT #: TYPE OF USE:
PROJECT NAME: HARIZit;
DESCRIPTION: (1) branch t:ircuit.
OWNER: HAl41 - d - i, a rt i 1NIF PHONE #: ' , :413-9// };°./4
CONTRACTOR: ()MEP PHONE #:
Inspection Request Scheduled For: Date: 1/ }'.IU200 , Pour Time:
Code # Inspection Description -' • ' m : Contact # Message
120 Hectrict- l rough -in 1,564 01 601 -977 23'/ I'u
`qq F‘ N A L.
- io . - •• • _ _ . tions:
I
14PASS ❑ PARTIAL APPROVAL ❑ CANCEL n NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: 2 Iv 6 Q LE Date: I v Phone #: (503) 718- Milt