Permit ELECTRICAL PERMIT
- CITY OF TIAR®
PERMIT #: ELC2006-00689
°' COMMUNITY DEVELOPMENT DATE ISSUED: 12/5/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S104DA -10800
SITE ADDRESS: 12885 SW BEAGLE CT ZONING: R -4.5
SUBDIVISION: QUAIL HOLLOW - WEST LOT : 094 JURISDICTION: TIG
Project Description: Inspection fee for ELS 84729.
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: 1
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:
KAREN BROKKEN CONDUIT ELECTRIC
12285 SW BEAGLE CT 19461 SW 89TH AVE
TIGARD, OR 97224 TUALATIN, OR 97062
Phone: Contact #: PRI 503- 692 -1428
FAX 503 - 692 -3652
FEES
Description Date Amount Reg #: ELE 26 -905C
[ELPRMT] ELC Permit 12/5/2006 $62.50 LIC 109669
[TAX] 8% State Surcharge 12/5/2006 $5.00 SUP 4501S
Total $67.50 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: ,---7)�� �� Permittee Signature: ... _54.e_ P
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 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.
2006 /DEC /05 /TUE 09:28 AM Conduit Electric FAX No, 5036923652 P. 001
• - Electrical Permit A 1 '', I 7�k' I V D FOR OFFICE USE ON!.N'
R041,-,43-; Permit No:
•
City o Tigard
_ - - — 0 D • • A
. ,
13125 SW Fall $ivd -, Tigard, OR 97223 ((l� ((' C Plan Review
Phone; 503.639.4171 FaX 503.598,1960ULI_ 0 200 4 : 1 i'1 P1. i ' • Date/By: • Other Permit; •
"Inspection Line; 503,639,4115 _ �a '1 i Date Ready/By: 0 SeePage2 for
Internet www.ei.tigard.or,us CITY OF. TIGA { . Notified/144,a: Sup lemenfatInfoatnatton
!h ' �`l:a :,y '_ +� -w �/,� 1 ° .' :,f' °Sr: i "ivaa tt ' >,•' .�� 'F "' ,ar�:l`. ,: • ""• ci�b;�,`'t': Tk`..,.
r N j f. :- `' ; "5 i' p a 1F i'1 " :':".1 "e. � , y �S ^(�yS� -.>,
;a . ;.�„ d �F S c.r., �,�• � x � i v . 'L� ":%'' �� >,n.- v h i*' �,. y ? e" � :nn ,,.k.. � ' n, R' f)'iiY''k�;!'. j.,a �,,��,',,�•'. •, �,
x�� -d i � r � ��� � �'cr .�,,,���'; ;� >,� ��n �i�i ?�. R
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❑ New construction ❑ Addition /alteration replacement Please check all that apply;
• 111 Demolition El Other: amps ous
.... Y_ .. ;: ._” t P' 4•:- �.�+l nSA .,,,�. .:� -.. �.�,; . iy +. r N��; 14v.�,r>w?3"YM�:,"r.1 7 h 4 eri '
LCI Serviceover225amps cotton'! Hazard location .
r,� ,� ti� „ �� � !� � � ter � ['Service over 320 rating ❑ Buildng over 10 000 s�_ $,
V; 03,.E ' �:`ti X. S+:x � )r s j ,. ,' Q i:e ' , Mt 1 � .',' 441 S .^ ''N.,, of l and 2 family dwellings. or more new residential
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑ Multi- family ['Occupant load over 99 persons ['Manufactured structures or
;�';?Xz�t "ytir0,P "a'.2 , A u S '�`r4 �y.0 . o ..�fy�, ',Elg , uG } a',i (,- ,'i? UEgress/ighting RN park
,:4y.;:!j,,,r; ? �., �, N�: �p. � � .��r,�Atsi^^1::t�� .• �;e�, ^C(�,�; � + �.���J.,. , .1. + .=a... ; .t,.y"`,,'''.:^ c�. ;,, •
Job no.: ELS q -4 Job site address: I .)<8S .s C)--
Submit facility ❑ether:
Submit._ set's of plans with any of the above.
City/State/ZIP: -T curri at q`7 p� The above are not applicable to temporary construction service.
•�7 °- ` F
Suite/bldg /apt no.: Project name: k � 1C rs� y �' '1 ;+ �' r... * 5.:, E t 'o' ' " '. ir:t 7 ,?; .. 3 ;,x; ss `
0.„,,,,,„„ Q . '$ems '!('old -
Cross street/directions to job site New residential edgie or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 . ' • 4
Subdivision: I Lot no.: Ea. add'l 500 sq. R or portion 33.40 1
• Limited energy, residential 75.00 2
Tax map /parcel Ito._ Limited energy, non residential _ 75.00 2
' ,� r'a45t iati f' #; �0aSl,c "r;. S ' *i0i c !( #41 ,� a ;�_ ONS ` : t .�.. „a, Each dwelling, servic
menu #seemed or modular .
_ on F e E J 5 � — Services eand /or feeder 90.90 2
e.. Serves or feeders Installation, alteration, and /or relocation
200 amps or less . ' ' 80.30 2
i e:r:,. { �»{ of +w ;t , r ' •' }F Si'u .;i �;d:�r P' n^a� 201 amps to 400 umpS 106.85 z
t 1e QY u .s�to-. 401 amps to 600 amps.
_ 160.60 2
Name: )r�� ,C- ). /` , 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
. Reconnect only 66.85 2 •
City /State/ZIP: • Temporary services or feeders installation, alteration, and /or
relocation
Phone- ( ) I Fax: (. ) 200 amps or less • 66.85' 1
Owner installation: This installation is being.madc on property that I own which is not 241 i, 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 signattai e: • Date: Branch circuits -, new, alteration, or extension,, per panel .
9 s e i < ' a ' w t' � : tin' n , L< 14;x aIF ,per Fee for branch circuits with
�3� . �"Y ef . d d n5 *_ err service or feeder fee, each •
Business name: branch circuit . 6.65. . . 2 .
13 for branch circuits'
Contact name: without service or feeder fee,
each branch circuit 46.85 .2
Address: Each add'l branch circuit 6.65 2
LMlseellaiieoas scr_vice:ar ceder -
_ �tty /Stste/��: - -- _.. - - --
' - - - -- - -- ,� not-ltticluded)---•---
Pump or irrigation circle 53.40 2
Phone: ( ) - I Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: - Signal circuits) Or limited- .
•'tg :Gf -:'�,tr `.:q;�iad Y� � . .._ ••� : 7,. ry'ti. , .Y , t, • , '' 1 ' . i;+i`M .: H1'4:, 'r J':e;;>1 energy panel, alteration, or
x: z 4 �:1;:: ? a .... , - e, ..,�Q 5 , . 5,. C,�CQJR Sc•l . rNr.. 5.:. „I: ,.s;4 n ,:K. s,r.,, i?, s:t >.; .� >.
- . extension. Describe: Page 2 • 2
Business name: con 4 0_,; / _F / �r
Address: 19 �/J I
j Each additional inspection over allowable in any of the above
nn 1
_ _ ��.• ) 1 � U c___ Per inspection I 6250 bg �
City /SInrWZIP: ! i • ` • , .. Investigation per hour (1 hr i lio) 62.50
. .. . . strial- plour ... .„..73:75,, ..
.. .. .. ._... . .
Phone:. .w ..( . s ., _ ... Poi:: . . / . 4 ' "` ant- er.h W l
' �5` f :ltM iiEi•. ,}n'�( ..., .... '�' '1 �ty� ?:citiy:'.�i.,= ��7tPc =�.
CCB Lie.: /0 Electrical Lie.: 'a( - - S .rv. Lic.: 4/5(y., Subtotal r
Suprv. Electrician signature, required: -, , /// Mao review (25% of permit fee)
Print name: /a Date: / State surcharge (8% of permit fe so
Cam! J� c J ��� . D I � i ` Q TOTAL PERMIT 'FEE (p7
Authorized signature: This permit application expires if a penult isnot obtained within 180
' . -' days after it has been accepted as complete
Print name: Date: • " Fee methodology set by To ltuilding industry Se-nice Board
. •• Number of inspections per permit allowed.
1,' luildingTelmite\ELCPmniulpp -doo 12/03 44D- 461sx(lo/02/COjufWEB
•