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Permit A, CITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00647 I;), DEVELOPMENT SERVICES DATE ISSUED: 10/6/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111DB-KE218 SITE ADDRESS: 15092 SW 94TH AVE SUBDIVISION: KESSLER ESTATES NO. 2 ZONING: R-4.5 BLOCK: LOT : 018 JURISDICTION: TIG Project Description: Temporary service for job trailer. RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS 1000 SF OR LESS: 0 - 200 amp: 1 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 WIO 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: BUENA VISTA HOMES ROSS ELECTRIC INC 6932 SW MACADAM #C 2870 SW 221ST AVE #203 PORTLAND, OR 97219 HILLSBORO, OR 97123 Phone: 503 - 443 -6033 Phone: 503 - 642 -2800 Reg #: LIC 157891 ELE 34 -436C FEES SUP 4232S Description Date Amount Required Inspections [ELPRMT] ELC Permit 10/6/2004 $66.85 [TAX] 8% State Surcharge 10/6/2004 •$5.34 Elect'l Service Elect'l Final Total $72.19 This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or 1 -800- 332 -2344. Issued By: _ Permit Signature: OWNER INSTALLATION ONLY The installation is being made on property I own which is not intended for sale, lease, or rent. OWNER'S SIGNATURE: DATE: CONTRACTOR INSTALLATION ONLY SIGNATURE OF SUPR. ELEC'N: DATE: LICENSE NO: Call 639 -4175 by 7:00pm for an inspection the next business day S , Electrical-Permit Application FOR OFFICE USE ONLY City of Tiga R I V E G / Received Permit No.: DateB '1 : tO 6 0 :�, C�ZOt? © 4 �`/7 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review . /�zr Phone: 503.639.4171 Fax: 503.598.1960 ndli v Date/B : Other Permit:: 'hP�a;a,, � � Inspection Line: 503.639.4175 OCT b 2004 &1 Date Ready/By: Juris: ® See Page 2 for Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information C ITV 1F 111 A A _ ,., ,`7d' '� .,n.''''w,.`� * +� .r2 J "' ", ;;` k . ; r , w o. ^y N-;n.,; - n:n.`a '.€ty -�� n� , p � u.. 64 !. _V - 5 ��: .. x �cr' ".�2'%u:r�"Rf+�t . � a.. .:.R:'�9a .. i&��, _ _ . �. ,. El New construction ❑ — Add ition/alteration/replacement Please check all that apply: ❑ Demolition CI Other: ['Service over 225 amps, comm'l ['Hazardous location «r o� #Y$ _..., , ;, , _ q t ['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft, p � � v e dioa Q t E �`C ®NS RCXe.ToN ' " � _ "i ' F''''' ` ' "- o 1 - an 2-family dwellings 4 �� ,. ,� .�, :. ,,.. � y gs or more new residential ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi family ❑ Master builder ❑Other: ['Building over three stories ❑Feeders, 400 amps or more - ['Occupant load over 99 persons Manufactured structures or .IQB r m iy- T .,..,; OR -r o E ess/li htin Ian RV.park ` ❑ ! g g P Job no.: I Job site address: /47)92_ g 4//i ❑Health -care facility ['Other: Submit 2 sets of plans with any of the above. / ` City/State /ZIP: h ✓ j /Q 9, 72 2-*/ ! The above are not applicable to temporary construction service. Suite/bldg. /apt. no.. Project name: • 4 *'rSCFIII) a ���`` — ''` . .. ' �. / .. ` Description Qty. Fee. Total Cross street/directions to job site: /a!/ /2, ti1 l t v . L 9 1/1 New residential single - or multi - family dwelling unit. Includes attached garage. ,� 1,000 sq. ft. or less 145.15 4 y Subdivision: / Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1 ' " P .) y .-- �( 1, 2 / i Limited energy, residential 75.00 2 Tax map /parcel no.: : x „ , a , Limited energy, non- residential 75.00 2 om. N - DES PT:, ,,a.WW.I .k - .- . ���� , c < c:�» � � ,. ,�`��. M . ,a,.,�- �' =., t ml��, .x,':,� _ � ��� >:. .,� <:` � .g4.v...:a.�u� 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 As pi '; "'' - c s fa .. _u., -_ - r ` ', s *=:. , 7, ,itw . r 4,.�•t ,. a u'= , .t 201 amps to 400 amps 106.85 2 � r Q ?• T WFkER j _ k •:� 1 , 1ta7zl~il!i l „� `a��<s,$. ay; :...u''rG,- 'taw.sr dzrr'*L^rsJ km ..'Rk`� '::�Y. asr" -n..t. rota .,'a 'r.:.. ✓ ^;K. °' �a' 401 amps to 600 amps 160.60 2 �f r� ) i s �/ / -L . Name: .I� L,G 2 I',.. C , jp . .G- 7,24/4 601 amps to 1,000 amps 240.60 2 Address: Over 1,000 amps or volts 454.65 2 �� 2 5 � e". G� � �`�' Reconnect only • 66.85 2 City/State /ZIP: fr00, 1 ` / Temporary services or feeders installation, alteration, and /or t, n� ) 0 2. 7 [V relocation Phone: ( � — �[ Fax: ( �3 lt�.f K l"�D�Q 200 amps or less 7 66.85 66 s5 1 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 _ 2 Owner signature: Date: Branch circuits— new, alteration, or extension, per panel 'a " R%�K .4e- sr �• s, « ra v ,. e" x k- - :>, L_k a� 3t r 1'L APIe, ff't y � irdyn m. A. Fee for branch circuits with Business name: branch circuit der fee, each 6.65 2 B. Fee for branch circuits Contact name: without service or feeder fee, 46.85 2 Address: each branch circuit Each add'I branch circuit 6.65 2 City/State /ZIP: Miscellaneous (service or feeder not included) 1 Phone: ( ) I F es:: ( ) Pump or irrigation circle 53.40 . 2 • Sign or outline lighting 53.40 2 E -mail: Signal circuit(s) or limited - ,: I* V lig f IM § N ., l . „ ; r r energy panel, alteration, or J � / extension. Describe: Page 2 2 Business name: f e/r c..]', 1 ' G 0 (1 C , Address: a 0 70 s ,,..0 -2..?,.../ yr /(9'/c tf. ea? Each additional inspection over allowable in any of the above Per inspection 62.50 City/State/ZIP: Y H; ns' r (J d V 9 7 7 21 Investigation per hour (I hr min) 62.50 Phone: 0 G 4/ 2 - Z r� 0 I Fax ( ) Industrial plant per hour 73.75 ;,fix EC' ,:»T' 17091 PsEI '1T`''E+`R$ 1 ' :c , : ; :, : ::,P2,`, iall ;A 3 1 I Electrical Lic.:3( / !/3irc Suprv. Lic.: 4 / 2.3 2.5' Subtotal , 4. Suprv. Electrician signature, required: g., °✓"'__ Plan review (25% of permit fee) Print name: J ` a,45 Date: f - ( — © (/ State surcharge (8% of permit fee) 5 3 y / TOTAL PERMIT FEE 7a , /9 Authorized signature: A 1 This permit application expires if a permit is not obtained within 180 � days after it has been accepted as complete Print name: !mss k p . [��., Date: * Fee methodology set by Tri- County Building Industry Service Board '� (��' ** Number of inspections per permit allowed. i:\ Building \Pemvts\ELC- PerrnitApp.doc 12/03 440- 4615T(10 /02/COM/WES t ,r Electrical Permit Application - City of Tigard Page 2 - Supplemental Information LIMITED ENERGY PERMIT FEES: ;;�,:.�r sue ^. * ,a� a,�.. .�_ O °^,n *i N4� .x� r,r r.> ; Fee for all residential systems combined $75.00 Check Type of Work Involved: ❑ Audio and Stereo Systems* ❑ Burglar Alarm ❑ Garage Door Opener* ❑ Heating, Ventilation and Air Conditioning System* ❑ Vacuum Systems* ❑ Other: 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 ❑ Data Telecommunication Installation ❑ Fire Alarm Installation ❑ HVAC ❑ Instrumentation • ❑ Intercom and Paging Systems ❑ Landscape Irrigation Control* ❑ Medical ❑ Nurse Calls ❑ Outdoor Landscape Lighting* ❑ Protective Signaling ❑ Other _ _ . • Total number of commercial systems: *No licenses are required. Licenses are required for all other installations i \Building\Permits\ELC- PermitApp doc 04/03