Permit Nov 06 06 02:33p CEDAR RIDGE HOMES 5036662408 p.6
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Electrical Permit Application ! 1 FOR OFFICE USE ONLY
City of Tigard o// d 7 � , `Received
Dale/By: �� Permit No.: C �'
13125 SW Hall Blvd., Tigard, (42.....21., y: �� �X C � r v�J
.5
Li , Plan Review
Phone: 503.639.4t71 Fax: 50 3: g 84 60 E i V Date/By: Other Permit:
T f G A R D Inspection Line: 503.639.4175 Date Ready/By: rvr E See Page 2 for
Internet: wv w.tigard or.gov ^ V 'On Notifled/Method: Supplemental information
TYPE OF WORK PLAN REVIEW
® New construction ❑ Additioni altdr"ariorrire' late{ l#'g'rit Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition Other: DIVISION ❑ Service or Feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
ID 1 and 2 family dwelling ® Commercial /industrial less to ground, or exceeds 14,00{/ 13 Commercial-use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder pump
❑ Other ❑Fire . ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ID Emergency system. larger separately derived syster,
❑ Addition of new motor load of ❑ °A , 'B ] -2 ", "i•3 ",
Job no.: Job site address: 9408 SW Coral St 0 / 100HPormore_ occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard/OR197223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 colts nominal.
Suite /bldgJapt. no.: Project name: Coral Commons ❑ service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/di1'eutions to job site: Description I Qty. I Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: , 1,000 sq. ft or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion . 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. 0.)
Vow Single Family Construction Limited energy, multi - family 75.0(1 2
residential (with above sq. It.)
Services or feeders installation, alteration, and/or relocation
l . 200 amps or less (` 80.30 2
I$ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Coral Commons, LLC 401 amps to 600 amps 160.6 2
601 amps to 1,000 amps 240.60 /' 2
Address: 1905 SW 257 Ave. Over 1,000 amps or volts 454.65 \ 2
City/State /ZIP: Troutdale /OR/97060 Temporary services or feeders installation, alteration, and /or
relocation ■
. Phone: (503)666 - 4240 Fax: (503)666 - 2408 200 amps or less 66.85 \ ]
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 \ 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 \ , 2
Owner signature: Date: I Branch circuits — new, alteration, or extension, per panel /
® APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder fee, 6.65 I 2
each branch circuit
•
Business name: Coral Commons, LLC B. Fee for branch circuits
Contact name: Dean Grey without Service or -- feeder- -fee. 46.85 2
first branch circuit
Address: 1905 SW 257" Ave. Each add'l branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Troutdale/OR/97060 Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (503) 666 - 4240 Fax: : (503) 666 - 2408 Reconnect only 66.85 2
E-mail: • Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Schroeder & Sons Electric Signal circuit(s) orlimited-
energy panel, alteration, or
Address: PO Box 748 extension. Describe: Page 2 2
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City /State/ZIP: Boring/OR/97009 • Each additional inspection over allowable in any of the above
_ Per inspection 1 62.50
Phone: (503) 658 - 3369 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lie.: 49027 Electrical Lie.: 3 -385C Suprv. Lie.: 41525 Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required:. Subtotal:
Print name: Donald Schroeder Date: Plan review (25 %ofpermit fee):
State surcharge (8% of permit fee):
Authorized signature: TOTAL PERMIT FEE:
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
• Number of inspections allowed per permiL
!'Tu:( ding \Ptzm:ts\E1.C- PerntitApp.doe 05/23/06 440- 4615T(] I SOS /COM/WEB
•
Building Division
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant _ Contractor 'A City Staff
(check one)
REFUND OR Name: N
INVOICE TO: (Business or Individual)
1/4
va D Mailing Address:
s/� City /State /Zip:
`-/ /} Phone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED ( ✓):
yl CANCEL PERMIT APPLICATION.
REFUND PERMIT FEES (attach receipt, if available).
(l INVOICE FOR FEES DUE (attach case fee schedule and explain below).
Fl REMOVE CONTRACTOR FRS I _ IIT do not cancel permit).
Permit #: J.-C.- A004) . 434 635 °` Lp 3!0
Site Address or Parcel # 9 08 93$ � 3aa �dos/ �u� &4, L
Project Name: / / j
Subdivision Name: eoi / /e,c1 j Lot #:
EXPLANATION: 0/-g/2 PE/2._H I s Gc)g2E C2f+9— f 9`
`0,2 /ire_ - 7/1E Gck)W-/_ (Ex--0A007— oo 'l 4�4a X9 3 c 4. A✓o
g, /k oiJ 1tEs E P6 TTS .
Signature: ,� L i _ � - Date: 7 4
Print Name: ,44. /
Refund Policy
1- The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
d) not more than 80 °'0 of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds • . FOR OFFICE:USE ONLY • . .
Rte to Sys Admin: Date By Rte to Bldg Admin: Date F o /Ci 7 By ,. "rp
Refund Processed: Date ^/,/F1` By Invoice Processed: Date By
Permit Canceled: Date ,1"///0 7 By „:0 Parcel Tag Added: Date By
Receipt # Date Method Amount $
I: \Bwldrng \Forms \RegPermitAction.doc Rev 05/24/06