Permit CITY. OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00292
i . �l`, DEVELOPMENT SERVICES DATE ISSUED: 6/28/02
Ic "" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DC-07000
SITE ADDRESS: 11675 SW 91ST AVE
SUBDIVISION: CHARBEN ZONING: R -4.5
BLOCK: LOT : 8 -9 JURISDICTION: TIG
Proiect Description: Install 1 200amp /less service panel and 4 branch circuits. This permit replaces #ELC2000- 00560.
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: 1 W /SERVICE OR FEEDER: 4 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
JOHN W. DRENNAN OWNER
11675 SW 91ST
TIGARD, OR 97223 Ep NFIED
Phone: Phone:
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 6/28/02 $106.90 2720020000( Wall Cover
Elect! Service
5PCT CTR 6/28/02 $8.55 2720020000( Elect'l Final
Total $115.45
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 -0080. You may obtain copies of these rules or direct questions to
Permit Signature: • � 1b Issued By: ` /
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 639 -4175 by 7:00pm for an inspection the next business day
r •. 1
Electrical'Permit Application -
A,,
Date received a2, , Op.__ Permit no.: h -. App lrZ
Zl r..) 11 City of Tigard / Projecdappl. no.: • Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 972231 (i>• w Date issued: B : A Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
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
:t . JOB SITE INFORMATION .
Job address: %/6 7.S S114/ 9/ S r ,4.IIf, Bldg. no.: Suite no.: Tax map /tax lot/account no.:
' Lot: I Block: Subdivision:
Project name: I Description and location of work on premises: PANS e / N G-14+2116--i
Estimated date of completion/inspection: .
. .•'_::. '' CONTRACTOR,APPLICATION " , - - ..FEE 'SCHEDULE •
Job no: Fee Max
Business name: Ow X) /L Description Qty. (ea.) Total no. insp
New residential - single or multi- family per
Address: dwelling unit. Includes attached garage.
City: I State: I ZIP: Service included:
Phone: I Fax: I E -mail: 1000 sq. ft. or less 4
Each additional 500 sq. ft. or portion thereof
CCB no.: I Elec. bus. lic. no: Limited energy, residential 2
City /metro lie. no.: Limited energy, non- residential 2
Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date Service and/or feeder 2
Sup. elect. name (print): License no: Services or feeders — installation,
alteration or relocation:
I , PROPERTY OWNER . 200 amps or less / 90.59',26:3D 2
-� 201 amps to 400 amps 2
Name (print): JDNN 14/ I aeAi iv N 401 amps to 600 amps 2
Mailing address: P, at 30 X .2 3 e U 3 601 amps to 1000 amps 2
City: T) GAi D State: 1 ZIP: Over Over 1000 amps or volts 2
Phone:56 — 6 31-59q 2I Fax: I E-mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479, .70 01. 200 amps or less 2
a 201 amps to 400 amps 2
Owner's signature: w 1 i2.Q.K.rtQ� Date: 6 % - G 2 401 to 600 amps 2
- 5 - • ' ENGINEER - 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 / G.a:X QO 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
of service or feeder fee, first branch circuit: 2
Phone: Fax: E-mail: Each additional branch circuit:
PLAN REVIEW (Please check all that apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2 .
❑ Service over 320 amps - rating of 1 &2 ❑ Hazardous location Each sign or outline lighting 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lightingplan ❑ Other: Per inspection
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ l (.9 Co O
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $ q- S S
Expires accepted as complete. TOTAL $ I l 5, 4 5
Name of cardholder as shown on credit card •
$
Cardholder signature Amount E t P _ E ,' 4 440 -4615 (6/00 /COM)
1. • -•,
ELECTRICAL PERMIT FEES: LIMITED ENERGY - PERMIT FEES:
Complete Fee Schedule Below: TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
/� Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total `, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 ❑ Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular n Garage Door Opener
Dwelling Service or Feeder $90.90 _ 2
Services or Feeders ❑ Heating, Ventilation, and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 _ 2 ❑
201 amps to 400 amps $106.85 2 Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts,
see "b" above. D Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls
a) The fee for branch circuits
with purchase of service or n Clock Systems
feeder fee.
Each branch circuit $6.65 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 n HVAC
Miscellaneous - n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 n Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above
Per inspection $62.50 n Nurse Calls
Per hour • . $62.50
In Plant $73.75 n Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ Ti Other
8% State Surcharge $ Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ No licenses are required. Licenses are required for all other installations
front of application.
Fees:
Total Balance Due $
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All.New Commercial Buildings require 2 sets of plans.
•
i:\dsts \forms \elc- fees.doc 08/30/01