Permit CITY OF T I GA R D ELECTRICAL PERMIT
PERMIT #: ELC2002 -00256
11 itk DEVE H PMENT rd OR ERVICES 639 -4171 DATE ISSUED: 6/10/02
- 13125 PARCEL: 2S 104CA -10100
SITE ADDRESS: 13721 SW JENNA CT
SUBDIVISION: HILLSHIRE ZONING: R -7
BLOCK: LOT : 101 JURISDICTION: TIG
Project Description: Alteration to (2) branch circuits for basement 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: 1 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:
REEB, RAYMOND L + KRISTY A ELECTRICAL CONNECTIONS LLC
13721 SW JENNA CT PO BOX 875
TIGARD, OR 97223 NEWBERG, OR 97132
Phone: Phone: 503 - 538 -8033
Reg #:
FEES Required Inspections
Type By Date Amount Receipt Rough -in
PRMT CTR 6/10/02 $53.50 2720020000( Elect'I Final
5PCT CTR 6/10/02 $4.28 2720020000(
Total $57.78
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable
laws. All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if
work is suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification
Center. Those rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0080. You m btai cu copies of these rules or direct questions to
Permit Signature: Iss ed By:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: C 'G „ -"° DATE: /� 2---
LICENSE NO: 4 /715 - 5
Call 639 -4175 by 7:00pm for an inspection the next business day
' E lectr i cal Pe Appl _ A Date received: !!IJ Permit no.: Eze > ,. , „ 1‘ ,
"v ,ill City of Tigard Project/appl.no.: • Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard OR 97223 Date issued: By: Receipt no.:
. Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
t„ , t r , : ; , , 7- ` . ~l , TYPE OF PERMIT',',''''; . 4 .>
lh 1 & 2 family dwelling or accessory ❑ Commercial /industrial ❑ Multi- family ❑ Tenant improvement
❑ New construction ❑ Addition/alteration/replacement ❑ Other: ❑ Partial
;$; ;
� r=` >' ` ' , T•;n':. ;'ir ':: ', 41' . y J
..s OBi ' S ITE' INFORMATION ' , +' , w �_ d t ,<a -rF r ''"41''''''''''' � ^ �
Job address: /3 /2S° J,e rn £ . , ed Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: '
Project name: Descrip ion and location of work on premises: ;H 174, /' Arefif
Estimated date of completion/inspection: 67 02_
wq' ,i ,b ",'» ` `. CONTRACTOR,APPLICATIONs t<s ai 1 '« '. %; ', , ;a r a k . • FEE ' ,SCHEDULE: 1 4 yr� ';44, "` •
Job no: Fee Max
Business name: E' /ec r/ ' CDNaec/ o..r LLC Description. Qty. (ea.) Total no.insp
Address: %Q LOX 8 7.5 New residential - single or multi-family per
dwelling unit. Includes attached garage.
- 4I4 ZIP: 9 7/32. Service included:
Phone 5 '3 - -53:'- F1'D Fax$3 sy$- Bb.Ca— 1000 sq. ft. or less 4
CCB ;no.: / 5t9 2 Elec. bus. lic. no: 3(0 — /DZC Each additional 500 sq. ft. or portion thereof ___
Limited energy, residential _ 2 __ 2
City /metro tic . no.: __ Limited energy, non- residential _ 2
/ e , e - 6 /p DZ Each manufactured home or modular dwelling
Signature of supervising electrician (required) Date i Service and/or feeder ■■. 2
Sup elect name (print): License no, /8-J
Services or feeders — installation,
alteration or relocation:
` ,? %'.(� x71, Irt ' . PROPERTY O sr '. 200 amps or less 2
Name (print): 201 amps to 400 amps ___ 2
Mailing address: 401 amps to 600 amps __ _ 2
601 amps to 1000 amps ___ 2
City: State: ZIP: Over 1000 amps or volts ___ 2
Phone: Fax: ' E -mail: Reconnect only __— 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
vx !' � , `ENGINEERc,.-i, 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
of service or feeder fee, first branch circuit: �■. 2
Phone: Fax: Email: __ _—
Each additional branch circuit:
. , PLAN REVIEW (Please check all that. apply) Misc. (Service or feeder not included):
❑ Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle ■■ ■ 2
❑ Service over 320 amps- rating of 1 &2 ❑ Hazardous location Each sign or outline, lighting ___ 2
family dwellings ❑ Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel,
❑ System over 600 volts nominal ' more residential units in one structure alteration, or extension* ■ 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
❑ Occupant load over 99 persons ❑ 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 h
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 $
❑ Visa ❑ MasterCard expires if a permit is not obtained Plan review (at _ %) $
Credit card number: / / - within 180 days after it has been State surcharge (8 %) .... $
Expires accepted as complete. TOTAL $ i7 1'
.
Name of cardholder as shown on credit card
Cardholder signature Amount 440 -4615 (6/00 /COM)
ELECTRICAL PERMIT FEES: LIMITED ENERGY PERMIT FEES:=
I ..
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 y 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 n 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
201 amps to 400 amps $106.85 2 l I Vacuum Systems
401 amps to 600 amps $160.60 2
601 amps to 1000 amps $240.60 2 n 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,
see "b" above. n Audio and Stereo Systems
Branch Circuits
New, alteration or extension per panel n Boiler Controls .
a) The fee for branch circuits .
with purchase of service or Ti Clock Systems
feeder fee.
Each branch circuit $6.65 2 Ti Data Telecommunication Installation
b) The fee for branch circuits
without purchase of service n Fire Alarm Installation
or feeder fee.
First branch circuit $46.85
Each additional branch circuit $6.65 Ti HVAC •
Miscellaneous n Instrumentation
(Service or feeder not included)
Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40 n Intercom and Paging Systems
Signal circuit(s) or a limited energy
panel, alteration or extension $75.00 Ti Landscape Irrigation Control
Minor Labels (10) $125.00
Each additional inspection over n Medical
the allowable in any of the above Ti r inspection $62.50 I I Nurse Calls
Per hour $62.50
In Plant $73.75 Ti Outdoor Landscape Lighting
Fees: n Protective Signaling
Enter total of above fees $ Ti Other
8% State Surcharge $ 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 $
Enter total of above fees A $
❑ Trust Account # 8% State Surcharge $
Total Balance Due $
All New Commercial Buildings require 2 sets of plans.
i:\dsts \forms \elc- fees.doc 08/30/01