Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00514
ik. ,,, f -• DEVELOPMENT SERVICES DATE ISSUED: 8/18/03
eJ 13125 SW Hall Blvd., Ticard. OR 97223 (503) 639 - 4171
PARCEL: 2S 102CC -07700
SITE ADDRESS: 10385 SW HILLVIEW ST
SUBDIVISION: TONYS PLACE ZONING: R-3.5
BLOCK: LOT : 001 JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for new generator.
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: 2 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:
KARL KAUFMAN E TECH ELECTRIC -
10385 SW HILLVIEW ST 3615 NW SOUTH RD
TIGARD, OR 97223 PORTLAND, OR 97224
t
Phone: Phone: 971 570 - 9298
v
_ Reg #: LIC 156530
ELE 34 -628C
FEES SUP 5005S
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 8/18/03 $60.15
[TAX] 8% State Tax 8/18/03 . $4.80 Rough -
Elect! Final
Total $64.95
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 n d'ay's - ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth ( „.......__ OAR 952 - 001 -0010 through OAR 952 -101 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246 -6699 or
1 -80 2 -2344.
Iss By: i Ii f i " , i , ' Permit Signature: �i ,.
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:
ONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ■ i � �� I" DATE: /-.-' S
LICENSE NO: .5-005
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit Application FOR OFFICE U ONLY :'
_ Received /� Electrical
'1 Date/By: g / (J y Q 3 Permit No.: 2 d i� '0057
Cit of Tigard Planning Appr. al Sign
Y g Date/By: PermitNo.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date /By: Permit No.:
Phone: 503- 639 -4171 Fax: 503-598-1960 4,001, Post - Review Land Use
Internet: www.ci.tigard.or.us
�° li ? �� Date /B y Case No.:
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 • U, W Name/Method: Supplemental Information.
tf -M a` '%" a "�' EI;Q M, ®. r. -. t `�"'_. MP a " `PLC`. ,�,.. W Y g"�S ?Ch_C_ata ifigli s MV: "..=
����,... -�_ �- � � � ��' � � uF�..��a._ p.M .� . _ f� _ ,. A�, _ - ��.a (�� a - --- -P.P_Y ����.__ ,��
❑ New construction ❑ Demolition ❑ Service over 225 amps- . ❑ Health -care facility
commercial ❑ Building over location
10,000 Addition/alteration /replacement ❑ Other:
❑ Service over 320 amps- rating of ❑Building over 10,000 square feet,
g tK C' A EGO :O ClO ,SE RU ' R { �'m i l : r te' • 1 & 2 family dwellings _�' � ..Ife lY °,eti€t�':.:z �?!s T "„" pings four or more residential units in
1 & 2- Family dwelling ❑ Commercial/Industrial 0 System over 600 volts nominal one structure
AU
❑ Building over three stories ❑ Feeders, 400 amps or more
Accessory Building El Multi- Family ❑Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
Wit : OBSITF °3NR a �� lR�NIAA a =ndOCA� f I�� ,. 't �; :'- _ .. Submit sets of plans with'any of the above.
. .
The above are not applicable to temporary construction service.
Job site address: f O S S SA/ C !✓in� J7 i
e< :* atey; ;
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total
Cross street/Directions to job site: New residential - single or multi - family per
dwelling unit. Includes attached garage.
1 I
1 CP (1 ��� 0 F 1' L Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 l
Subdivision: Lot #: Limited energy, residential 75.00 2
Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
' 4 k g x i €,
.��� $�.�� .;°.�.. >'•, �DESG`12I1'x`���lVl�Og�1?1�� . � � '' service and/or feeder 90.90 2
G.
Services or feeders - installation,
alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
7 401 amps to 600 amps 160.60 2
P/R ilt g : > ° . 1Q* ' I . . ;c 601 amps to 1000 amps 240.60 2
� rte Over amps or volts 454.65 2
/L Name: . L / l N) Reconnect nnect nett only 66.85 2
Address: Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: 200 amps or less 66.85 1
Phone: Fax: 201 amps to 400 amps 100.30 2
401 to 600 amps 133.75 2
Branch circuits -new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of 6.65 2
service or feeder fee, each branch circuit
City /State /Zip: B. Fee for branch circuits without purchase of /
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit Z 6.65 2
E-mail: Misc.(Service or feeder not included):
,- g n. ' , 1,41 :<, � •; Each pump or irrigation circle 53.40 2
� � � °--"� �` "'�'�`° Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: E-TECH C E-CTR/ alteration, or extension Page 2 2
Description:
Address: _3 Co f S% N W -Snip./ Rig •
CitCity/ State/Zip: {� /� .. Each additional inspection over the allowable in any of the above:
Y p o rV �'N l i � 772 Z Per inspection per hour (min. 1 hour) 62.50
Phone: t 7/- 5 7 c/2' 61 Fax: 3 g2 g e Investigation fee:
CCB Lie. #: /5‘.5) 0 Lic. #: Other:
Supervising electrician
P g Subtotal $ ,L [ S
signature required: Q Plan Review (25% of Permit Fee) $
L ic. #: p State Su rcharge ( 8% of Permit Fee) $ / TO
Print Name: /V(C/� A/ (,�S//lo� 5 OS --- TOTAL PERMIT FEE $ /n '/ 7 9 S
Authorized Notice: This permit application expires if a permit is no ob ained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set.by Tri- County Building Industry Service Board.
(Please print name) / /
i:\Dsts\Permit Formms \E1cPermitApp.doc 01/03 q /iii f U 5 10 0 5 /Gl y G •
Electrical Permit Application - City of Tigard i f
Page 2 - Supplemental Information - '71
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
n Burglar Alarm
Garage Door Opener
Heating, Ventilation and Air Conditioning System
I I Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
0 Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
HVAC
n Instrumentation
n Intercom and Paging Systems
Landscape Irrigation Control
Medical
n Nurse Calls
Outdoor Landscape Lighting
n Protective Signaling •
Other
•
Number of Systems •
* No licenses are required. Licenses are required for all
other installations
i: \Dsts\Permit Forms \ElcPermitAppPg2.doc 01/03