Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2002 -00108
4j i9l e lli&I DEVELOPMENT Tigard. O
SERVICES 639 -4171 DATE ISSUED: 3/14/02
Hall
PARCEL: 2S 111 CC -12100
SITE ADDRESS: 10415 SW HIGHLAND DR
SUBDIVISION: SUMMERFIELD NO.4 ZONING: R -7
BLOCK: LOT : 172 JURISDICTION: TIG
Project Description: Installation /alteration of (4) branch circuits for kitchen remodel.
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: 3 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:
WILLIAM JAMIESON ST JOHNS ELECTRIC INC
10415 SW HIGHLAND DR 4415 NE MINNEHAHA
TIGARD, OR 97224 VANCOUVER, WA 98661
Phone: Phone: 360- 693 -5100
Reg #: LIC 43135
. SUP 3024S
ELE 37 -350C
FEES Required Inspections
Type By Date Amount Receipt Rough -in
5PCT CTR 3/14/02 $5.35 2720020000( Elect'I Final
PRMT CTR 3/14/02 $66.80 2720020000(
Total $72.15
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 th 180 days. AU TION: Oregon law requires you to follow - rules- adopted by the Oregon Utility Notification
Center. Those rules are set br i i OAR 952 -0 "1 00 Y o may obtai oc p ies of these rul direct quest to Ask
Permit Signature: / it Issued By: K� 40 „Q 0 / � �/ `
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: i )11P-P (-. - DATE:
LICENSE NO: OCD-1` S
Call 639 -4175 by 7:00pm for an inspection the next business day
.
Electrical Permit Application -- . ", '
Date received: J l O Permit no.: ,,, - 4 , 1lO 0 d
— LJ . rR ` i Cl of Tigard Project/appl. �iiti�
►.: _... g 1 PP I. no.:
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City ofTigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: � , By: i liceiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: d en t type:
Land use approval:
TYPE - OF PERAIIT - `
1 & 2 family dwelling or accessory 0 Commercial/industrial ❑ Multi- family ❑Tenant improvement
New construction XAddition/alteration/replacement ❑Other: (Cl Partial
. JOBSITE INFORMATION . ='
Job address: /O r'/ 5 / (/A/ A /a,- d „Div Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision:
Project name: Description and location of work on premises: Si ,• • , , , r o
Estimated date of completion/inspection:
' µ CONTRACTOR APPLICATION ' - °` FEE SCHEDULE` : ; . •
Job no: Fee Max
Business name: St. Johns Electric, Inc. Description Qty. (ea.) Total no. insp
Address: New residential - single or multi-family per
4415 NE Minnehaha S t . dwelling wit. Includes attached garage.
City: Vancouver State:WA ZIP: 98661 Service included:
Phone:3606935100 Fax E -mail: 1000 sq. ft. or less 4
CCB no.: 43135 Elec. bus. lic. no: 3 7 -350C Each additional 500 sq. ft. or portion thereof —_
Limited energy, residential _•_ 2
City /metro lic ° ,r 01 00ge.. Limited energy, non- residential ___ 2
J a4V- 41 3 _ 2 Each manufactured home or modular dwelling
Signature o supervising electri required) Date Service and/or feeder ■■. 2
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Sup. elect name (print): Dea B• UT License no 30245 Services or feeders— installation, III
PR .... R 7 alteration or relocation:
.. . 200 amps or l ess 2
Name (print): - P 1 L( _A' -- '-- Vt'1 *M t 6 201 amps to 400 amps ___ 2
- - / , 401 amps to 600 amps ___ 2
Mailing address:
„ � I�sb 601 amps to 1000 amps ___ 2
City: ¶ te State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: E -mail: Reconnect only i 1
Owner installation: The installation is being made on property I own Temporary services or feeders - •
which is not intended for sale, lease, rent, or exchange according to installation, alteration,orrelocation:
ORS 447, 455, 479, 670, 701. 200 amps or less 2
201 amps to 400 amps _—_ 2
Owner's signature: Date: 401 to 600 amps ___ 2
- ENGINEER, , - Branch circuits - new, alteration,
- or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: • ZIP: B. Fee for branch circuits without purchase II■ESIMI
Phone: Fax: E-mail: of service or feeder fee, first branch circuit:
Each additional branch circuit: wA_raii
` ' ' PLAN REVIEW (Please check all -that apply)` ' misc. (Service or feeder not included):
O Service over 225 amps- commercial 0 Health -care facility Each pump or irrigation circle �■ 2
O Service over 320 amps- rating of 1&2 17 Hazardous location Each sign or outline lighting MI__ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* ill.
❑ Building over three stories O Feeders, 400 amps or more *Descri . tion:
❑ Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
❑ Egress/lighting plan ❑ Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Permit fee $
O Visa 0 MasterCard expires if a permit is not obtained Plan review (at _ %) $ J` • 3y
Credit card number. / / within 180 days after it has been State surcharge (8 %) $
Expires TOTAL $ 7a. /y
Name of cardholder as shown on credit card accepted as complete.
$
Cardholder signature Amount 440 -4615 (6/00/COM)
Electrical Permit Fees: Limited Energy Fees:
TYPE OF WORK INVOLVED - RESIDENTIAL ONLY
Complete Fee Schedule Below: Restricted Energy Fee $75.00
Number of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total 1, Check Type of Work Involved:
Residential - per unit
1000 sq. ft. or less $145.15 4 n Audio and Stereo Systems
Each additional 500 sq. ft. or
portion thereof $33.40 1 n Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular I Garage Door Opener
Dwelling Service or Feeder $90.90 2
Services or Feeders n Heating, Ventilation and Air Conditioning System*
Installation, alteration, or relocation
200 amps or less $80.30 2 n Vacuum Systems
201 amps to 400 amps $106.85 2
401 amps to 600 amps $160.60 2 n
601 amps to 1000 amps $240.60 2 Other
Over 1000 amps or volts $454.65 2
Reconnect only $66.85 2
Temporary Services or Feeders TYPE OF WORK INVOLVED - COMMERCIAL ONLY
Installation, alteration, or relocation Fee for each system $75.00
200 amps or less $66.85 2 (SEE OAR 918 - 260 -260)
201 amps to 400 amps $100.30 2
401 amps to 600 amps $133.75 2 Check Type of Work Involved:
Over 600 amps to 1000 volts, n
see "b" above. Audio and Stereo Systems
Branch Circuits n Boiler Controls
New, alteration or extension per panel
a) The fee for branch circuits
with purchase of service or I I Clock Systems
feeder fee.
Each branch circuit � — $6.65 _ 2 n Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee. GG
First branch circuit j $46.85 ` O n HVAC
Each additional branch circuit 3 $6.65 / +
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40 ❑ Intercom and Paging Systems
Each sign or outline lighting $53.40
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 n Landscape Irrigation Control
Minor Labels (10) $125.00
0 Medical
Each additional inspection over
the allowable in any of the above n Nurse Calls
Per inspection $62.50
Per hour $62.50
In Plant $73.75 [1 Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ IQ ' ` 0 n Other
8% State Surcharge $ �jt 35 Number of Systems
25% Plan Review Fee
See "Plan Review" section on $ • No licenses are required. Licenses are required for all other installations
front of application.
Fees: •
• Total Balance Due $ 72_ 1 S
Enter total of above fees $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
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