Permit ' f
f ~' �` " CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00436
DEVELOPMENT SERVICES DATE ISSUED: 7/17/03
^�`�' 1.111 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S135DB-04300
SITE ADDRESS: 11285 SW 92ND AVE
SUBDIVISION: DOGWOOD RIDGE ZONING: R
BLOCK: LOT : 1 - JURISDICTION: TIG
Project Description: Reconnect.
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 FOR: 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: 1 SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
JACOBS, BRETT WILLAMETTE ELECTRIC INC
11285 SW 92ND AVE PO BOX 230547
TIGARD, OR 97223 TIGARD, OR 97281
Phone: Phone: 503 - 624 - 3631
Reg #: LIC 75059
SUP 1965S
FEES ELE 34 -283C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 7/17/03 $66.85
[TAX] 8% State Tax 7/17/03 $5.35 Elect'I Final
Total $72.20
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 -669' or
1- 800 - 332 -2344.
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:
Call 639 -4175 by 7:00pm for an inspection the next business day
t x OFFICE USE ONLY
• Ei ct� cal Permit Application Received ,7 Electrical �./
Date/By: / / 7 -03 �� Pe No. L Cc 22 � /
City of Tigard RECE V ,. Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 JUL 17 2, . Date/By: Permit No.:
Post - Review Land Use
Phone: 503 - 639 -4171 Fax: 503 G 41 ,,. ; Date/By: case No.:
Ju
Internet: www.ci.tigard.or.us OF Tie i See Page 2 for
g Rc,U r Contact
24 -hour Inspection Request: 503 -'t159' W W D `, - -" . Name/Method: Supplemental information.
',. • TYPE•OF WORK >` =` 4?` :; + ?; ;u, ;Vi.i ;i : V:: `; °! :',g :t.PLAN REVIEW (Please check all that a l :
❑ New construction Q Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ hazardous location
❑ Addition/alteration/replacement IJ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
t t `:*.,: c :':'• CATEGORY; OF; CONS,T1R1.1cTION: !:, , `' ,..:0 +'., 1 & 2 family dwellings four or more residential units in
gfi
1 & 2- Family dwelling ❑ Commercial/Industrial El
System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building Multi- Family El Occupant load over 99 persons ❑ Manufactured structures or RV park
EI Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
-. ?JOB SITE INFORMA &nds,I: C,Aii ;'; / E:�" Submit sets of plans with any of the above.
s.. O ='Q The above are not applicable to temporary construction service.
Job site address: i i Z8 t S W 9' 22'4-9- : <,, 1 I:: , . . j:V •i 7 . ; 0 !;:
::, f ,i
_ - :�has. �:`er�e>�:c . .. • ' : :FEE a .SCIiEDULE�'. -'.. : , • .F.,, , -.�: ; Vi.;:.rs<,,. =� i it;
Suite #: I Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: R At fif one D b S Description Qty Fee (ea.) Total
Cross street/Directions to job ,site: : New residential - single or multi - family per
1 dwelling unit. includes attached garage.
Service Included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. (I. or portion thereof 33.40 1
Limited energy, residential 75.00 2
Subdivision: ' Lot #: Limited energy, non residential 75.00 2
Tax ma /parcel #: Each manufactured home or modular dwelling
'.
+ia •..,a. ,,; •, .zi''.. ;, t;;r H• l5 4 li service and/or feeder 90.90 2 • �t�; ^AF: . �... .;.. ,:;: DESCRIPTION, iOF,. WORI��t' E 'c�r� �
Services or feeders - installation,
alteration or relocation:
)9 _ ce .¢-- /> 200 amps or less 80.30 2
t ' �'R -C/1 1 4 �t�'P�i� 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
, Lei q4.
' p ' 0:; ' : r. t ,O.NyiNER= ,ii., ," #:, lm , ►.� r'+ g � lif 601 amps to 1000 amps 240.60 2
- � `' " � Over 1000 amps or volts 454.65 2
' Name: '-j j � e u . Q
/a Reconnect only 66.85 , &s. 2
Address: / - c_ N n • A L Temporary services or feeders - installation,
alteration, or relocation:
City /State/Zip: G) 7 a,c} . 200 amps or less 66.85 I
Phone: 9'69 — 3/ Fax: 201 amps to 400 amps 100.30 2
It filr,P 4NT'; r' , ;,_ ._.` t :' :., , _ , . : r ® ±CO t1:� , x , !gi' `o * } ,. :,�, % 401 to 600 amps 133.75 2
r Branch circuits - new, alteration, or
Name: extension per panel:
Address: A. Fee for branch circuits with purchase of
s ervice or feeder fee, each branch circuit 6.65 2
City /State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: I 'Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
. - l a c x . ; r ,� Each pump or irrigation circle 53.40 2
,' ' �' , ' t (r C u"�' m ' r ' 11 " Each sign or outline lighting 53.40 2 •
Job No: 3 6'9 7 Signal circuit(s) or a limited energy panel,
alteration, or extension Page 2 2
Business Name: W , ti IN At e t+ c E'(l. L r t c /"- ,- Description:
Address: Po &d Z.30 sy ?- •
. r 5 a n n 0A Each additional inspection over the allowable in an of the above:
City /State /Zip:
9? Z 1F' l Per inspection per hour (min. I hour) 62.50 •
Phone: 42.4 - 3 6 3/ Fax: 6 24 - Z9 t 6' Investigation fee:
CCB Lic. #: a Lic. #: 3& - Z L � Other: xs � °(` `t1 f €Elentrlciil1F i�mlt Fees* .- ;'1:...� }= ifa tr ; .
'� ) c . �� Vii.. 7x '�i � E : f�i � � r?r,�psim
Supervising electrician `'` Subtotal $ G G ,
signature required: 61,- Plan Review (25% of Permit Fee) $ ,
Print;Name: D ti- - i= , (c • Li . #: 11 4 s-- S State Surcharge (8% of Permit Fee) $ S 3 S
TOTAL PERMIT FEE $ "4 2, 71)
Authorized Notice: This permit application expires If a permit is not obtained within
Signature: Date: 180 days after It has been accepted as complete.
"Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
i:\Dsts\Permit Fornu\ElcPermitApp.doc 01/03
Electrical Permit Application - City Jf Tigard - } i
Page 2 - Supplemental Information U, ;
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY: a
Fee for all systems $75.00 ' '
Check Type of Work Involved:
Audio and Stereo Systems
Burglar Alarm •
Garage Door Opener •
n Heating, Ventilation and Air Conditioning System
Vacuum Systems
Other
_ COMMERCIAL WORK ONLY:
Fee for each system $75.00
•
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
Data Telecommunication Installation
•
Fire Alarm Installation
n HVAC
Instrumentation
n Intercom and Paging Systems
Ei Landscape Irrigation Control
Medical
El Nurse Calls
Ei Outdoor Landscape Lighting
Protective Signaling
n Other
• Number of Systems
* No licenses are required. Licenses are required for all
other installations
i :\Dsts\Pcrmit Forms\ElcPermitAppPg2.doc 01/03
•