Permit CITY ®F TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2005 -00137
�I� DEVELOPMENT SERVICES DATE ISSUED: 3/8/2005
„ `'" 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 1S134CB-10201
SITE ADDRESS: 12476 SW EDGEWATER CT
SUBDIVISION: MILLVIEW ZONING: R
BLOCK: LOT : 002 JURISDICTION: TIG
Project Description: Extending (1) branch circuit.
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:
DONIVAN, ETTAA OWNER
12476 SW EDGEWATER CT
TIGARD, OR 97223
Phone: Phone:
FEES Reg #:
Description Date Amount
[ELPRMT] ELC Permit 3/8/2005 $46.85
[TAX] 8% State Surcharge 3/8/2005 $3.75 REQUIRED ITEMS AND REPORTS
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 ese rules or direct questions to OUNC at (503)
246 -6699 or 1-800 -332 -2 4.
Issued By: Gt'7rl� Permittee Signature: Q.Arvoo �rcyV1Mxan
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 639 -4175 by 7:00pm for an inspection the next 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 Application a ' , FOROFFICEUSErONLY ry t rs
AT
City of Tigard 1 � Date /Bya �O m
Feri No :6,� O0 f 7 7
13125 SW Hall Blvd., Tigard, 0: &23 ' EN E Plan Review
Phone 503 639 4171 Fax 503 :' `. _' i 'y 44 Date/By Other Permit:
•
Inspection Line 503.639 4175 ?1 ,, , Date Ready /By. Ju H See Page 2 for
Internet. www ci ttgard.or us �� t', p B 2 S Notified/Method. ,r Supplemental Information
'MI i OF \\ U �� PLAN REVIEW
❑ New construction Xtic
tit n/altet�a Jcement Please check all that apply:
❑ Demolition f e iTY ❑Service over 225 amps, comm'l ❑Hazardous location
❑Service over 320 amps — rating ❑ Buildng over 10,000 sq ft ,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
\❑` 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family (II Master builder ❑ Other: ❑Building over three stories ❑Feeders, 400 amps or more
❑ Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lightin plan RV park
Job no.: Job site address / 11 7 / S w D 6 G -wR ; L2, c r ❑Health -care facility ❑Other.
Submit 2 sets of plans with any of the above.
City/State /ZIP: 77, 4 R .) 0 k , q 7 2_23 The above are not applicable to temporary construction service
Suite/bldg. /apt. no : Project name: FEE* SCHEDULE
Description Qty. Fee. Total o,`
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 1
Limited energy, residential 75 00 2
Tax map /parcel no.:
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder 90 90 2
it T tie A c //z G v / r Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
PROPERTY OWNER E] TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
Name: ,E TA l) 6 t) A d 601 amps to 1,000 amps 240.60 2
Address: S R {,tjl 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
v relocation
Phone: (5 o3 ) 'y' i 5.7 0 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 se, rent, or according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature:�� 61n/vM� cN (9'1 A Ci Date: Q Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON 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, i t
each branch circuit 46 85 2
Address: Each add'l branch circuit 6.65 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 -
CONTRACTOR energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.• Electrical Lic.: Suprv. Lic.: Subtotal 946 W ------
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) ,../, i
Print name* Date:
TOTAL PERMIT FEE Sa ?s
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name. Date. * Fee methodology set by Tn -County Building Industry Service Board
** Number of inspections per permit allowed
t \ Build tng\Pennits\ELC- PermitApp doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
I I Audio and Stereo Systems*
Burglar Alarm
Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
I I Vacuum Systems*
I I Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
I HVAC
Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
Medical
n Nurse Calls
I I Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Buildmg\Permds\ELC- PermdApp doc 04/03
CITY OF TIGAR® , .,
BUILDING DIVISION PERMIT #: gODS — Op 13 7
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171
A pl ii
Inspection Requests (24 Hrs.): (503) 639 -4175 ':_� '
INSPECTION WORKSHEET FOR DATE: ' q TIME: PAGE:
SITE ADDRESS: / a Lt 7 ( C.0 C� CLASS OF WORK:
SUBDIVISION: C LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
c--',%X.A,P eze-e_ s--90 3
OWNER: PHONE #.
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: Pour Time:
Code # Inspection Description Confirm # Contact # Message
r 1/t �.
Corrections /Comments /Instructions: \t."
/ 7 :<---------
7
J
PASS ❑ PARTIAL APPROVAL CANCEL ❑ NO ACCESS
I FAIL ❑ ALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: Date: 3 ` Phone #: 503
P � ) 718 -