Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00103
A llh H,1 4 . ''"
DEVELOPMENT SERVICES DATE ISSUED: 2/23/2005
4111 13125 SW Hall Blvd.. Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S135DC-05200
SITE ADDRESS: 11830 SW 95TH AVE
SUBDIVISION: TANGELA ZONING: R -7
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: Service and br. circuits.
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: 10 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:
MAHLON, SMITH OWNER
11830 SW 95TH AVE.
TIGARD, OR 97223
Phone: 503 - 603 -1875 Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 2/23/2005 $146.80
[TAX] 8% State Surcharge 2/23/2005 $11.74 REQUIRED ITEMS AND REPORTS
Total $158.54
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 - 44.
Issued By: �,„Zae_w Permit Signature: FAI6A-
OWNER INSTALLATION ONLY
The installation is being made on property I o n vkhich is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: )( (1T in,. 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
Electrical Permit AFI3E@g IV E FOR OFFICE: FSF: ()NIA
City of'Yigard DateBy �:'� /O�j� Permit No.: E y )0‘ ��1
13125 SW Hall Blvd., Tigard, OR 97223 EB 23 2005 Plan Revie
Phone: 503.639.4171 Fax: 503.598.1966 A il I � ' Date/By: Other Permit.
Inspection Line: 503.639.4175 'I 1 .� Date Ready/By: J ® See Page 2 for
Internet: www.ci.tigard.or.us c ITN CAF ' °. Notified/Method: 7 / u Supplemental Information
- . c :.
:I 1 i NOitiC PLAN REVIEW
❑ New construction 4" Addition/alteration /replacement Please check all that apply:
I=I Demolition Other: ID Service over 225 amps, comet ❑ Hazardous location
❑ Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
>6f 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
JOB SITE INFORMATION AND LOCATION 0 Egress/lighting plan RV park
Job no.: Job site address: ` 1530 5A1 qs-*Airt ❑Health -care facility ❑Other:
Submit 2 sets of plans with any of the above.
City/State /ZIP: 1- /h t O L 01� �3 The above are not applicable to temporary construction service.
U FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name:
Description I Qty. I Fee. I Total I '*
Cross street/directions to job site: �Y j bl i2 q ^ New residential single- or multi - family dwelling unit.
@ Gj , # 1( l b ' J � Includes attached garage.
6 f th 'I' 4'�lG1,GC p •' . C . 1,000 sq. ft. or less 145.15 4
Subdivision: Q Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non- residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
I`A l \ J YCiI(�l,( 'T
_ `l . a „ ` ` I (1(J— T(f e 1 „ 5 dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less ( 80.30 p.oso litEEIDEEETy OWNER j ❑ TENANT 201 amps to 400 amps 106.85 2
J 401 amps to 600 amps 160.60 2
Name: f \ aln Vtt 6 Y 601 amps to 1,000 amps 240.60 2
Address: 1 k 8 7) C r: - /- Over 1,000 amps or volts 454.65 2
v l Q Reconnect only 66.85 2
City/State /ZIP: �� i 2 � 3 Temporary services or feeders installation, alteration, and/or
Phone: (50S) 60 ,, , rJ 5 Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: is instal tion is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, le , r t, o exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: ,` Date: a - 15 9 Branch circuits — new, alteration, or extension, per panel
0 APPLICANT , ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each / 0 6.65 (ot'o • 50 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name: A) )i k n
Address: 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 Lie.: Electrical Lie.: Suprv. Lie.: Subtotal / , 6.,.
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date:
State surcharge (8% of permit fee) // , 7L f
TOTAL PERMIT FEE /s
Authorized signature: This permit application expires if a permit is not obtained within l ib
days after it has been accepted as complete
Print name: I Date: * Fee methodology set by Tri -County Building Industry Service Board
,. v W
i
Mr. Darrel "Hap" Watkins Mahlon E. Smith
Inspection Supervisor 11830 SW 95* Ave
City of Tigard, OR Tigard, OR 97223
13125 SW Hall Blvd. FILE COPY 5.603
Tigard, OR 97223 mahlon ma rtini.nu
August 31st, 2005
Dear Mr. Watkins,
I was told to contact you in regards to an extension of my residential electrical
permit. My permit (number ELC2005- 00103) expired last Monday, the 22'. I came in
on Tuesday and was told I could extend my permit by 6 months by writing you this letter.
I don't think I overestimated my abilities to get this finished, but I definitely
underestimated the time in which I could get it done. (I'm learning as I go, here.) I'm
hoping to schedule the first inspection sometime in the next month, but need my permit
extended in order to get this done. Thanks for your attention to this, and please don't
hesitate to call (or email) me if I can answer any questions.
Sincerely,
Mahlon E. Smith
PN6
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