Permit A. CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00539
li DEVELOPMENT SERVICES DATE ISSUED: 8/28/03
- 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2S103CC -06400
SITE ADDRESS: 13795 SW 124TH AVE
SUBDIVISION: WHISTLER'S WALK ZONING: R
BLOCK: LOT : 011 JURISDICTION: TIG
Project Description: NC wiring
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 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:
TODD ERICKSON OWNER
13795 SW 124TH AVE
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/28/03 $46.85
[TAX] 8% State Tax 8/28/03 $3.75 Elect'I Final
Total $50.60
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: r � Permit Signature:Z�
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
/
OWNER'S SIGNATURE: � `� -'� �r - DATE: � Y 0
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 Application FOR OFFICE USE ONLY
Received l Electrical
Date/By: O 12. g tad' 0 3 t Permit No.riejop3 '0 3 7
City f Tigard Planning Approval Sign
y g Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 Post - Review Land Use
� ?/ i i "� Date/By: Case No.:
Internet: www.ci.tigard.or.us ��IIi iiIJ y
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: Supplemental Information.
_1 „£. ' , & ' WA ke,41.7.117r. tai. 7 "4 - r ' !r , , o'mw. '.A4 f 0. A i 4 . s ' - ! y
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
• ddition/alteration/re s lacement ❑ Other: ❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
5 X g T M Ot � t 1 & 2 family dwellings four or more residential units in
® 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
n ❑ Building over three stories ❑ Feeders, 400 amps or more
111 Accesso Accessory Building ❑ Multi-Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
f , lef r , , a : 9 t � o r ra y Submit sets of plans with any of the above.
The above are not a 1 # Itcable to tem i orar construction service.
Job site address: '3'19$ �i_..) ( 2 , I tt A- C .,
Suite #: ` ti /, I Bldg. /Apt. #: 0,1-- Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total 1
Cross street/Directions to job site: New residential - single or multi - family per
l dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Subdivision: tc�l'ri.st1c rs wm i z I Lot #: t1 Limited energy, non r 75.00 2
Limited energy, non residential 75.00 2
Tax ma. /. arcel #: Each manufactured home or modular dwelling
o r } = service and/or feeder 90.90 2
� ..1- Services or feeders - installation,
'' L L,,') e i�TIQ k
(..—t; r ` / .)
% N-y ,l>, \ alteration or relocation:
/ 200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
M, , 1, s g, e "— 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: T, i Eli L Reconnect only 66.85 2
Address: Q'] 6 /2 tT4' )4 Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: - l i) O Q 72 2 0 200 amps or less 66.85 1
Phone: 5c -5 c' - c-% 2'Z Fax: 201 amps to 400 amps 100.30 2
S r._ `'1 ,,. 401 to 600 amps 133.75 2
`
Branch circuits - new, alteration, or
Name: ' , '2iLKSc extension per panel:
Address: 13'?°/5 6,,,- i 2,i(11 / .�- A Fee foeorfeedcircuits each branch circuit
( service or feeder fee, each branch circuit 6.65 2
City /State /Zip: 76,0. Pr( 9-7 2_23 B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 ( 2
Phone:. .'3 -s%'- ,--/ .7 `1 I Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included):
F Each pump or irrigation circle 53.40 2
' is tfG Via.
" ° Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: alteration, or extension Page 2 . 2
Description:
Address:
City/ State/Zip: Each additional inspection over the allowable in any of the above:
Y p Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
K , 7 j �
Supervising electrician Subtotal $ 46, . ,
signature required: Plan Review (25% of Permit Fee) $ 3 7 5
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $ S0 . (o a
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: t �., O _ _ / �.. Date: ,/4/":3 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
• T o t i> E Rir <' x s,- '
(Please print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
n Burglar Alarm
n Garage Door Opener
Heating, Ventilation and Air Conditioning System
n Vacuum Systems
0 Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
Audio and Stereo Systems
•
n Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
n Instrumentation
El Intercom and Paging Systems
n Landscape Irrigation Control
Medical
Nurse Calls
n Outdoor Landscape Lighting
0 Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03