Permit i` CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00576
,� DEVELOPMENT SERVICES DATE ISSUED: 10/11/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S134DC-04500
SITE ADDRESS: 11695 SW 113TH PL ZONING: R - 4.5
SUBDIVISION: MUTTLEYS ADDITION LOT : 004 JURISDICTION: TIG
Project Description: 1 br. circuit to AC.
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: I 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:
FRANCIS HUGHES OWNER
11695 SW 113 PL.
TIGARD, OR 97223
Phone: 503 - 639 - 4016 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 10/1 1 /200( $46.85
[TAX] 8% State Surcharge 10/11/200( $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. 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: ,LG(iL[ .4f„ �ll� Permittee Signature: , - , //
OWNER INSTALLATION ONLY ll
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 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.
• Electrical Permit Applica ' s " - FOR OFFICE USE ONLY . • .
Received
City of Tigard Date/B .10 I I o ' : ! Permit No 0. & — ex
. a 13125 SW Hall Blvd., Tigard, OR 9V ' 11 F! 1 ll 1 Plan Review
' 11 ' Phone: 503.639.4171 Fax: 503.59:. • .0 — D , Other Permit:
• Inspection Line: 503.639.4175 it .'
TTG:A R D Date Ready/By: See Page 2 for
Internet: www.tigard or.gov J y', i ' Notified/Method �' ®
Supplemental Information
•
TYPE OE�WORKs,, ` . _ \1.rris 1 %' ?' - .
M PLAN REVIEW
❑ New construction ❑ Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONS TRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
111-1'= and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: / G . / !• I�i 100HPormore. occupancy.
�� cJv�/ / ❑Six or more residential units. ❑ Recreational vehicle parks.
• City/State/ZIP: 71 �� i� ❑ Haz do usl ocat oie . El 600vlolts no am i nor more than
( r' \ ❑Hazardous locations.
. Suite/bldg. /apt. no.: Project name: ; vl 6 1--\, S ❑ Service or feeder 600 amps or more.
FEE.. SCHEDULE - -
Cross street/directions to job site: . Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
. Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
. Tax map /parcel no.: Limited energy, residential 75.00 2
. . DESCRIPTION OF WORK ' (with above sq. ft.)
c / /C residential (with above sq. ft.) 75.00 2 L energy, multi - family
('
a o p? C >;‹,4`,/- ./
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
. , ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85. 2
•
• Name: L S 401 amps to 600 amps 160.60 2
�� 1 r G( h c,`, 601 amps to 1,000 amps 240.60 2
Address: ) 1 ( 5 // -i, e Over 1,000 amps or volts 454.65 2
City / State/ZIP: "r') 6 AdS 'D 0 9 '7R 2 3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503) (p'3 7 L./6/ 6, Fax: ( ) 200 amps or less 66.85 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, Dent, or excl27ge acco ding to ORS 447, 449, 670, and 701. 401 amps to 599 amps _ 133.75 2
. c '/ A �_ Branch circuits — new, alteration, or extension, per panel
Owner signature: —y-- Date: /0 'Jr' G
A. Fee for branch circuits with
0- APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
• each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, ' 46.85 (./6 85 2
Contact name: first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
• Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
. E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
(� ,. energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES '
Suprv. Electrician signature, required: Subtotal: / 1
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 3 15
Authorized signature: _ f ,C,—,----- TOTAL PERMIT FEE: V .o
1 //! �. This permit application expires if a permit is not obtained wi 180
Print name: F t, G i 5 a 14 v„X Date: U i 1 06 days after it has been accepted as complete
J • Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 05/23/06 4404615T(I I /05 /COM/WEB
Electrical Permit Application - City of Tigard - r'
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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:
r_ COMMERCIAL WORK_ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data 1 lecommunication 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
IABuildingTemlits\ELC-PermitApp.doc 03/23/06
CITY OF TIGARD
. BUILDING DIVISION ' • PERMIT #: ELC200€ 00576
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/11/2006
Phone: (503) 639- 4171,ary iIiutti
Inspection Requests (24 Hrs.): (503) 639 -4175 1L.
INSPECTION WORKSHEET FOR DATE: 10/19/2006 TIME: 7 :02AM PAGE: 33
SITE ADDRESS: 11695 SW 113TH PL CLASS OF WORK:
SUBDIVISION: MUTTLEYS ADDITION LOT #: 004 TYPE OF USE: .
PROJECT NAME: HUGHES r , ,' ,
DESCRIPTION: 1 far. circuit to AC. 10/18/06: Added (1) branch circuit. t ,l
OWNER: HUGHES, FRANCIS PHONE #: 503 - -4016
CONTRACTOR: OWNER PHONE #:
A. tI
Inspection Request Scheduled For: Date: 10/19/2006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
=ate _ - • - 4 ing unit circuit 038496-01 5 503- 639.4016 N
Corrections /Comments /Instruction .:
PASS I I PARTIAL APPROVAL ❑ CANCEL NO ACCESS
CALL FOR INSPECTION ADDITIONAL FEES ASSESSED
Inspector:
q --- l ' ` Lilt D ate: r • i ga„� Phone #: (503) 718-