Permit � 11 1 OF F 1 I G L R D ELECTRICAL PERMIT
� PERMIT #: ELC2006 -00002
�
�',y; DEVELOPMENT SERVICES DATE ISSUED: 1/4/2006
;41
� - 1..,13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
� PARCEL: 2S111 BA - 07000
SITE ADDRESS:'09437 SW INEZ ST ZONING: R - 4.5
SUBDIVISION: BUTLER TERRACE LOT : 004 JURISDICTION: TIG
Project Description: (3) 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: 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:
LADD & LYN MCKITTRICK VAST ELECTRIC
9487 SW INEZ ST 1525 SEATTLE SLEW DR. SE
PORTLAND, OR 97224 SALEM, OR 97301
Phone: not available. Contact #: PRI 503 - 780 - 8597
FEES
Description Date Amount Reg #: ELE 24
[ELPRMT] ELC Permit 1/4/2006 $60.15 L1C 160065
[TAX] 8% State Surcharge 1/4/2006 $4.81 SUP 43605
Total $64.96 REQUIRED ITEMS AND REPORTS
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
suspende. mo - • an 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules a : set forth in OA' 9 -•:1 -s 10 through OAR 952 - 001 -0100. You may obtain copies oft - e ru es or direct questions to OUNC at
503 -2 , . -6699 or 1 -800 -3 • -234•.
• 4111111W
Issue. By: Ai. ,ii 1I1 I � . � _ Permittee Signet ii _ NTIQ>.
•
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 I STALLATION ONLY
-
SIGNATURE OF SUPR. ELEC'N: j flfi/ , % — DATE:
LICENSE NO: o 5
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.
It •
EMectrit ali P t 1 A a ilicatit n F o R 01:1:1( 1-1 l !..1:. c1 1.‘
City of T g ar. I oat /B : / aie) ' Permit No.: Eap 7 240.2
13125 SW Hall Blvd., T Cgar_41 R19 � 200 Plan Review
Phone: 503.639.4171 Fax: 503b9i. 4
1 "*" " +1i i' 1 Date/By: Otter Permit:
Inspection Line: 503.639.4175 '/ 1 Date Ready/By: �a ' • „. la See Page 2 for
Internet: www.ci.tigarCJ j.l�y of i Notified/Method: / /. Supplemental Information
13Ulf,DINT.GTATE,PkYlorkK PLAN REVIEW
❑ New construction IZ, Addition / •, Please check all that apply:
['Service over 225 amps, comm't ❑Hazardous location
❑ Demolition 0 Other:
['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of I- and 2- family dwellings 4 or more new residential
el I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ['System over 600 volts nominal units in one structure
['Building over three stories ❑Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other: ['Occupant load over 99 persons ['Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
I Job site address: /l �,pp � ❑Health -care facility ❑e'er
Job no.:
I �7d t /il�l P z Submit 2 sets of plans with any of the above.
City/ State/ZIP: _r 601 1/'1P ) i Q-73 \--/- The above are not applicable to temporary construction service.
Suite/bldg. /apt. no_: C) Project name: 1/A £/J .#7/;" C• FEE'S EAULE
' 'l Deseriptioo Fee. ` Total I ..
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. R or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIP OF WORK Each manufactured or modular
I dwelling service and/or feeder 90.90 2
(Pi/0461 Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 ` 2
5- PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
L 401 amps to 600 amps 160.60 2
Name: He. 1 , trot , /t a -f.... 601 snips to 1,000 amps 240.60 2
Address: 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
Phone: ( ) J Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that 1 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
❑ APPLICANT 1 ❑ 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,
each branch circuit 46.85 Lib 2
Address: Each add'I branch circuit 6.65 /3 . 1 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax : ( ) Pump or irrigation circle 53.40 2
I 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: j /0} / f_ /
Address:/5'a,- y . S� Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: ( �/� 7501 Investigation per hour (1 hr min) 62.50
`' Industrial plant per hour 73.75
Phone: (SJ3) 7,� eV Fax/ f ,,ct�7f� P ELECTRICAL PERMIT FEES*
CCB Lic.: j47CO, S Electrical Lie.: 0., /C Sup �.: k& Subtotal /1�Dt L
Suprv. Electrician signature, required: 6, ` X11 ;. Plan review (25% of permit fee)
I _ }
Print name: 4j. ' 4 , f V 1 Date: i /3/7 State surcharge (8% of permit fee) /'�, t j . � � � }' n
/ ]t:/ j S TOTAL PERMIT FEE �!J`7 / CY
Authorized signature: This permit application expires if a permit is not obtained ,t•ttbin ISO
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•• Number of inspections per permit allowed.
2 'd B2BB- S8S -EOS 0'U4 ISEA eGS =TT 90 EO UeC
�1
�' 'JAN 2 7 2005
cl R®
U /LDING DNr77ON
446 Building Division
Request for Permit Action or Refund
C o Ti: ard
TO: CTTY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: ❑ Owner ❑ Applicant Contractor ❑ City Staff
(cheek one) , 1
7 s
Name: a lndividuel) \ l Q.s -- ' pr 1v t c_,
,. \ 0 1 D M Address: t i ) S � �O �Q L1' SE
City /State /Zip: _, e ,vvI • D`i \ ( 4 - 13n/ --
/5d/a,6 Phone No.: in set - (- s03 - Sto �- 7a 77
PLEASE TAKE ACTION FOR THE ITEMS) CHECKED (1):
VCANCEL PERMIT APPLICATION.
❑ REFUND PERMIT FEES. A/O ,e6A.Ach As //✓ 7 / ®A) #9S , ®GA / •
❑ REMOVE CONTRACTOR. FROM PERMIT (do not cancel permit).
Permit #: _ EL. C. 200 & - ()COO 2—
Site Address or Parcel #: Qa ` I t)-- _Ni\-e
Project Name: t r\ li L v VA C c W kr k. ci'
Subdivision Name: Lot #:
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EXPLANATION: ) )!) O� �'� Aircl " C.k G V 1
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t J�'J `� t r D t o 7, ? r
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Signature: • i _
Print Name: - 0.. A 0 ' - s
Refund Polite
I . The Building Official may authorize the refund of
a) any fee whirls WAS aroneousty paid or collected.
b) not snore man SO pawn of the [mina tie far issued permits prior to any inspection requ _ effect has been expended
c) not mac than $0 permit of plan review fee when an application is canceled before any plan review
2. Refunds win be returned to the original Pars in the same method in which pnymait um received
. C)1 OI I-1( r. l O \l.l
s -
Rte to Sys Admin: Datei,L 7 Mil Ric to Bldg Admin: DDaatte e 010 0 - $y
Refund Processed: Date A/ i Invoice processed:
Permit Canceled: Date /�e (, By t,-7_ Parcel Tag Added: Dom By
Date Receipt # Method Amount S
1:1 Building1Forms \RegPermitActim- Bldg.doe C. tao/o6
•nnr A IWATt . XTT't oARTRRS£OS X Y.4 b£:TT 9002/LZ/i0
1' SZBB- SBS -EOS 0 T- a4Qa13 ISLIA ES��TT 90 LZ UeL'