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Permit C ITY OF TIGARD ELECTRICAL PERMIT PERMIT #: ELC2004 -00789 DEVELOPMENT SERVICES DATE ISSUED: 12/9/2004 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111 CC 05700 SITE ADDRESS: 10020 SW CENTURY OAK DR SUBDIVISION: SUMMERFIELD ZONING: R BLOCK: LOT : 080 JURISDICTION: TIG Project Description: (2) branch circuits for furnace and a /c. Job No. 063500 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: 1 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: COOBS, KATHRYN EVERGREEN ELECTRICAL CONTRACTOR 10020 SW CENTURY OAK DR 23861 SE 442ND TIGARD, OR 97223 SANDY, OR 97055 Phone: 503 - 670 -9160 Phone: 503 - 668 -4608 Reg #: LIC 136311 ELE 3 -472C FEES SUP 4581S Description Date Amount Required Inspections [TAX] 8% State Surcharge 12/9/2004 $4.28 [ELPRMT] ELC Permit 12/9/2004 $53.50 Rough -in Elect'I Final Total $57.78 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 fort 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 -800 -33 344. • Issued y: 6� e/Ot A1.4 , 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: � 40-73401ezi` DATE: LICENSE NO: Si '/5 5 Call 639 -4175 by 7:00pm for an inspection the next business day c: Electrical Permit A 1 1 lication FOR OFFICE USE ONLY City City of Tigl>,d . - - ; � Dat/B ii 7 / Received M ...•tNo.: _ .ii // '' 13125 SWllall Bivd., Tigard; 0 . • 23 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 ke'r'i:1 :4, 1 ' Other Permit: Inspection Line: 503.639.4175 2U� "° DEC ©J w� ; r Date/B y: � { � � �` I I � Date Ready/By: y: luris: See Page 2 for IntInternet: www.ci.tigard.or.us Notified/Method: Supplementallnformatien 4-x �s`e„ . Y..c,ctrit iite 3%- } r -..,er r . , 1fime.f. .' S'c'• :r :.� - d k. .t+ ° ..4"z." '` ' "', 01 . y ,i . s y ,t N' '; F „ S ?`+ : t i ', , . . r; ” c r . r .,t � ,. _. , " , : :E. .P 0 ' 1' ' ' ' • . :�� - � , att5. �. Ss r3, 3��A '- � ®ax��f�<S.�Y",.- .. �•u^a,.�,.:.�., .... Jew 'W �� � ��:� �:F ^:�.x '��`. < - -. s� - r ❑ New construction � � <<:, ••.:. . - .,I.• ment Please check all that apply: B wt► ‘ e ' ❑Service over 225 amps, comm'l El Hazardous location ❑ Demolition • Other: 4` re � �� 4 � ��� ,�� Y - � - _ 7&, �` , - � . ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft., L q� a ' 4 A of 1 -and 2- family dwellings 4 or more new residential O. 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure ❑ Multi - family El Master builder OBuilding over three stories ❑Feeders, 400 amps or more ❑ Other: ❑Occupant load over 99 persons ❑Manufactured structures or Xr n. � " . 4 „. it e •��� ©y - fi 'e . -,, RV ark `x 3� 4 .44., , 0 4 , .. , : :2 .,, V ,,, , ; , _ ' ,. , v. ❑Egress/lighting plan p ❑Health -care facility ['Other: • Job no. ■ e7 Job site address: QL �0 � i , �� / _ II A I Submit 2 sets of plans with any of the above. City/State /ZIP: The above are not applicable to temporary construction service. • Suite/bldg. /apt. no.: Project name: `` -"' , " ' R0 -0 `° L ' : Description I Qty. I Fee' Total ." Cross street/directions to job site: New residential single-. or multi - family dwelling unit. Includes attached garage. 1,000 sq. ft. or less 145.15 4 Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I Limited energy, residential 75.00 2 Tax map /parcel no.: • Limited energy, non - residential 75.00 2 r /' f ; 1 q C' a 8 " ' , ,- , , .,-,:ii:.;,-:-. 3 Each manufactured or modular IIMMIr s dwelling, service and/or feeder 90.90 2 t gall_ 1, i .��� ► 1 t Services or feeders installation, alteration, and/or relocation CC l. 200 amps or less 80.30 2 mr 715 Z 201 amps to 400 amps 106.85 2 401 amps to 600 amps 160.60 2 Name: \ bl17 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 Phone: ) ( --9'‘ k Fax: ( ) relocation 200 amps or less 66.85 I Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 I 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 ., 1` P " t _ ?, ,7 e . t7 o 1 A. Fee for branch circuits with service or feeder fee, each 6.65 2 Business name: branch circuit B. Fee for branch circuits Contact name: without service or feeder fee, each branch circuit ) 46.85 . o SS 2 Address: Each add'1 branch circuit ( 6.65 6 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 - r 4 y ' ; a ; n 7 • v� •, - " � - ' energy panel, alteration, or �.' " : '< ,`" ter `,'. �, . extension. Describe: Page 2 2 Business name: 1&eir r ` t- 1L Address: 0%C d ) ."_Sit. Each additional inspection over allowable in any of the above Per inspection 62.50 City /State /ZIP: CV_ Gri b5S Investigation per hour (1 hr min) 62.50 Phone: ( L % - $ Fax: - 2 ) e - % Industrial plant per hour 73.75 ii_t�l CBE 0A%= :ft . CCB Lic.:) 31 ( Electrical Lic.: • — . Lic.: �g i S Subtotal t 52)b Suprv. Electrician signature, required: iiii illiV . Plan review (25% of permit fee) Print name: ( r e Date: - State surcharge (8% of permit fee) 4.- `. ' �M TOTAL PERMIT FEE S i r, �� Authorized si g n • ' This permit application expires if a permit is not obtained within 180 �.FI ►. days after it has been accepted as complete MEME Date: _ lr _ w Fee methodology set by Tri- County Building Industry Service Board _ "" Number of inspections per permit allowed. is\ Building \Permits\ELC- PcnnitApp.doc 12/03 440 4615T( /02/COM/WEB