Permit C ITY OF TIGARD ELECTRICAL PERMIT
/:. PERMIT #: ELC2005 -00305
DEVELOPMENT SERVICES DATE ISSUED: 5/5/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 PARCEL: 2S111 DA 14500
SITE ADDRESS: 15490 SW EMPIRE TERR ZONING: R -
SUBDIVISION: APPLEWOOD PARK NO. 3 LOT : 138 JURISDICTION: TIG
Project Description: 1 branch circuit for new a /c.
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:
BARSOTTI, LISA EFFICIENCY ELECTRIC
15490 SW EMPIRE P.O. BOX 872791
TIGARD, OR 97224 VANCOUVER, WA 98687
Phone: 503 - 655 -7558 Phone: 503 - 805 -5821
FEES Reg #: LTC 101543
ELE 26 -878C
Description Date Amount SUP 3003S
[ELPRMT] ELC Permit 5/5/2005 $46.85
[TAX] 8% State Surcharge 5/5/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set f. • 9AR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -66• • or 1 -80• 3
Issued B _ Permittee Signatur •
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N:1� —P DATE:
LICENSE NO:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
FROM :EFFICIENCY ELECTRIC FAX NO. :360 996 2032 May. 05 2885 10:14AM P1
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Electrical Permit A p p s � 10 0\4 rt>11 • crlr ate c. 2 ii Otir.y
Received / Flee:deal
Dalcltl ; 7it X Permit No.: 40 65 •. '
City of Tigard Planning A • s1 " Sign
1>arrlt3y: Pcrinit No.;
1312$ SW HA Blvd. Pion Rev • Other •
Tigard,Oresnn 9722? • Chv'a1: _ Deland No.: •
Plume: S03 - fk39 - 4171 Fax: 503 - 59$ - 1960 {'out- lievtcw Land Vlc
imerrrcl, rvww.ci.rigard "onus
44 11411 Data/13y; Cage Nn.:
� t nn(ac1 lu — Page 2 for
24 - hear lnsixtetip1 Requtaet: 5[3;3. 63&1 1 rd:tmc:totclhod Su • lemental Information. _
TYPE or WORK • PLANREVIEW (Mono Check nil thatmpply)
ew eon struc(ion Demolition Acmvicu twc* 225 a1ri98• ff []3 {eakiicom.fecility i
Other:
commercial `' 8 14E1740 Na lominn
• Ad4 ttior1r�11teritkirrrlfr tlac c1T�ui? (3i15CI: 12i FScrvirc DVtr 320 ampr,.ratinr, 01 t J Building uyLr 16,01x1 square feet,
t AT GO[ V.Ols'CON5flWCTtON, ' I dc 21'amilyth 5I1tlQ? four or mnrc .r�aidco1iai unfgR I'
i & 2 -Fermis dwell-in r t'lnnlv1cni�clflnduSlrial I 0 35tttn over 6tS8vnit nollti one structure
Elul id over three stores Feedcto. Inns or mow I. Access I3laildill, i Mulii- Family oceeri,,,it.d e� pereons nionmsrewrod xwctures or IV Fork
I. Master Ruildtx a Other: L?y�resaitfighting i1 Other: " .. _
• . -.fOl1 SITE I FORM 3ttnmtt _ aelsofPtanr r.Ith . nyoilb rho e
Div &trou t are not bKUldc t t om rare euttstraet3nn; ;&vice.
Suite# Et tl ig. /Apt.zl: _ _ .. 'Number 0f Inspections per permit allowed
Prt act Namc: Ocser; den ' - Qty, F.. (m. Mile i
New retirterti #I- ldnR ity la or goad- feo per e
Cross street/Directions to jo Site dwelling dole. Atctudes anathed urn". �j /' r � Service t 1\. d- -
C� Qt ./ 7 ilSOU y. 11, a ur r J am - 145 "15 4
_.. ..
Ilan atAltIonel 509 sq, It or y:0715On thoreuf _ 33.40 t
Decal ener�4i,residenti ?5.00 _ a
iuluTieisitrfl' Lot ii! i ri Red enemy, non residential 73.110 2
Tax map /purl el' #: Each menufaennn.1 home or modular drolling 7
'DESCRIPT Ott WORK •.•,- service ;India' Caudal- +30+90 2
- • & ;&urea; or &term -kiwis/Poo,
(4 r e, alteration or rc.ideYrion[
4=3— . .. '� _200„,,n» kas 80.30 - 2
—! s to 20t stop 4 110 :um.p _ 106.05 i
401 soaps to 600 amps . 160.60 , 2
•g..,4 o r:gt y " - t '�wis a - lNANT Cher 60 atnlx to WO Ur ;moon 7240.00 2
N<vrs: C / S� fie � So�� � 101A) amps valts -- 454.65 -
Reconnect antg frG.85 2'
A ddress: L S" / 5 • /9 f 'Temporary rarsiowar feeders . inuatl ■ttatt,
' alter/Wino, or relocation: p �
Cily.Statel ip: -- FOO amps urles Nita8s l
P17o>ae:.S9! — Fax: m1 and to 400 �tnw� too. a
• A P�LICANi"1' • 0 CQiV'Tie PERSON 3tj J to No . nrxach circuit s - now, alteration, or
Name: • . extrusion tier panel;
A t m�,, . /1, roe lam brilCCM circuits with purchase Af
s♦ 11 eccdc. or Tcuder fcc, smelt branch circuit 6 .65 2
C:ityl State/ZTp: 1S Fee fur branch olrcutts lviblaai prvchvw of
... ..... '-- tcrYknor fee, fist brunch clrceii. • I 46.8 b pl 5 T XS :,.
l � rit. - Feahseiditiutrd braoah oirnu it
ti.t45 ----.
E-mail: Min-Orr/dm br tccdernal imlulled):
77,
, - .CONTRACTOR - Facie pomp or motion eine% .- 53.40
F;aetl sign ur outline' hghtog 53.4 . • 2
Job No: .... sl co:twigs) ur a iimitod=TTY panel, -- `
Name: � i� �J Aeration-or _ Page2
Business I�fSTT)e• C .A' .E�C'TjL or exti ._ .
... ... r trGCripliuA; .
Address: A ,e7,,,17./ -
CIL /S : ( . - •• _ fachDatttbdat inspection over the nlbwahlein any a tin, .bover
� ._" P 1..,G. (, c%d r . i
Pte cAtpetti4tr per HOW {min. 1 hour) 62-D0.
P'hone::0 r , 5 rQ.a'2.i VAX: V es 3 tmveeture.Dun f• e:
CCB Lie. lf_ /Q/ ..$1/3 Lie. . - e7 e G ()Cher: `
Supervising cloetru i in / / -, - BI+teifde4I ,ih W* • . ' . .
5,i ature re wired: •
Sub3olri[ $
...a Man Review f25% Of Permit rec).
Print Name: v 8 TN Li fit 3 o t, 3 $ _ j y , • „ State sureh u c 1;896 orP ars
ermil e S 7
TOTAL PERMIT FEED EMEtEr, •
A uthoriyc4l c./ ,< xoete: Th permit appllyl116n .Fpkwa I ra,pernit ix cwt gr nrdwithin
Signature: _ , - Date 7 m' 9 - 186 da�m: k Fae been ccplc { a9 complete.
'Fee mednrdnCogv ad by 't'rl- 'nonty Sullding todusery liarvlce noarti.
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