Permit . CITY O TIGARD
GARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00115
�I11 - DEVELOPMENT SERVICES DATE ISSUED: 3/12/04
'---' 13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 2 S 103AC -08900
SITE ADDRESS: 12835 SW FONNER POND PL
SUBDIVISION: ON FONNER POND TOWNHOMES ZONING: R-4.5
BLOCK: LOT : 007 JURISDICTION: TIG
Project Description: 6 branch circuits
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: 5 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:
JON FRANCE MOM'S ELECTRIC
23500 SW SCHOLLS FERRY RD 13909 UPPER ALDERCREST DR
HILLSBORO, OR 97123 MILWAUKIE, OR 97267
Phone: Phone: 503 - 702 - 0894
Reg #: LIC 52998
ELE 3 -525C
FEES SUP 3160S
Description Date Amount
Required Inspections
[TAX] 8% State Surcharge 3/12/04 $6.40
[ELPRMT] ELC Permit 3/12/04 $80.10 Elect'l Service
Elect'l Final
Total $86.50
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to O C at (503) 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permit Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
E1ec' ttical Permit • t i J fa c all WED FOR OFFICE USEONLY
'• r
City Of Tigard Received ed (
Date/By ''I / Permit No / � , t - ez / S
13125 SW Hall Blvd , Tigard, OR 97223 k 2 200 Plan n Review r
Review '
Phone: 503.639 4171 Fax: 503 598 19ffiU '+ + Date/B Other Permit
Inspection Line: 503.639 4175' II' Date Ready/By Duns 10 See Page 2 for
Internet www ci tigard or us C OF TIG Notified/Method Supplemental Information
! A+ n DIVISION
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#•�:� �.`�- PLA 1V: : R w, n T .� �.T}1,�W -: -
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❑ New construction Addition/alteration/replacement Please check all that apply
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'l ❑ Hazardous location
�. , , Atr ,� , , _ � ,, q <. C <- a ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq ft ,
,t -i '. , CATEGORY. .. i OF�;CON T TION. , ' - -gF ;, : 't.,,:ztt..�- � : ,i' i-'4' of I- and 2- family dwellings 4 or more new residential
i-- e_ S ,2U .1,:k e
�k e .y- ., �.�a$a -`.`s ss.m ...., .�.a a � c-' s>�.�..,a -. � ,,. 3aw�r. ....�: "a • - £s.,�..�- ;.:m,n, u . i.7
1 - and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
❑ Multi - family ❑ Master builder ❑ Other: ❑Building over three stones ❑Feeders, 400 amps or more
.,< , `j S a - ❑Occupant load over 99 persons EManufactured structures or
a i FORMATION° 21�iD I;0,��1TION�`, �, -:�_;. < ' � ' ' ' RV park
'�� x�s, � - � � �� - �. . ��;,.,; ❑Egress /lighting plan P
:� �� ..� -- se = '' �
['Health-care facility
Job no.: Job site address: 1-22335 5 � uAm i, Pi • ❑
submit 2 sets of plans with any of the abov
above
City /State /ZIP: lI Da q 7 2 ( C( The above are not applicable to temporary construction service
Suite/bldg /apt. no.: V Project name i? „(` ' ; :' FE'E SxCHEDLILE; ',,:. " **
Description Qty. 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 1
Tax map /parcel no.: Limited energy, residential 75 00 2
Limited energy, non - residential 75 00 - 2
;ts r . 0,,, P,TION; OF , , .„ ' ,: Each manufactured or modular
dwelling, service and /or feeder 90 90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80 30 2
4 „f „,- 4,' P R"OPE iff j`, < ' z; ,:, ='' i ,,,,,, n t ik :'z' ' ":`. 201 amps to 400 amps 106 85 2
1 rT
'r ” 4q. 401 amps to 600 amps 160 60 2
Name J t - ' NCo 601 amps to 1,000 amps 240 60 2
Address 23 S 00 s. to . SG�O1l - t Q4 - Over 1,000 amps or volts 454.65 2
/'S Reconnect only 66.85 2
City/State /ZIP. t 2
U Q� � 7 i z J Temporary services or feeders installation, alteration, and/or
(i5 ) 62 -6383 ( ) relocation 00 ms
Phone: 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, 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
,' `»�[:� `" � � "° r °mss` ,,��"� 'q : < � " "`'�` .;` A Fee for branch circuits with
" , : :', �°,; :,.` °w~ Q i aAI'I'LIC'A1V : r CONTACT=< "PERSON 4°`..n , •..,
service or feeder fee, each 6 65 2
Business name - A— [ A branch circuit
Contact name: B Fee for branch circuits
without service or feeder fee, 46 85 4 f 2
Address: each branch circuit
Each add'l branch circuit , 6 65 3 . 2
City /State /ZIP' Miscellaneous (service or feeder not included)
Pump or irrigation circle 53 40 2
Phone. ( ) Fax: : ( )
Sign or outline lighting 53 40 2
E - mail: Signal circuit(s) or limited -
3 - �'CO::i, ° `
,,�.. ='1'.,. ?mac i�� :���r`��� - � � �.. i`TTRACT?OR �,`��; ,. -_ ; ��"��,,', energy panel, alteration, or
y extension Describe Page 2 2
Business name: 1 S ELe — C-- , ``iL
Address• l "3C'k 01 1e -Y'2- C ,2- r 04 Each additional inspection over allowable in any of the above
t Per inspection 62 50
City /State /ZIP: Q _` I I__ _4. —K___1 C- 8IL g 7 2c 7 Investigation per hour (1 hr mm) 62 50
Phone: (s1)3 -2 to__ v Fax: ( ) ��C Industrial plant per hour 73 75
SL' �` r.�-' is .t'xr ; , a 5',''':7:F7":':
_ „ � �, �"; �';`;_ �, ":EI;�GTRTCAtit:PE<RMITt:FE�ES .. . -
CCB Lic :5 .ef q? Electrical Lic.: 3 - 2S c Suprv, Lic ' 3 1 (moo S Subtotal f �,
Suprv. Electrician signature, required:, Plan review (25% of permit fee) 7 F.{
State surcharge (8% of permit fee) 5L°
Print name: gyp, /�v `.---43/e ti.S s Date. 3 - / /--i.i ti-
TOTAL PERMIT FEE g -,-..,..„--,_,
Authorized signature: This permit application expires if a permit is not obtained within 180
� �— days after it has been accepted as complete
Print name: / ,Q Lei �! (, d�,t/S� Date: f,� o l .t. * Fee methodology set by Tn- County Building Industry Service Board
** Number of inspections per permit allowed
i \Buildiog\Pernuts\ELC- i'ermiiApp doc 12/03 440- 4615T(10 /02 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ A udio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning
System*
n Vacuum Systems*
n Other:
C,® �.1 . ?' W:07NA ,'
Fee for each commercial system $75.00
(SEE OAR 918-260-260)
Check Type of Work Involved:
❑ Audio and Stereo Systems -- - --
n B oiler Controls
n Clock Systems
n D ata Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
\Bu ldmg\Permfls\ELC- Perm4App doc 04/03