Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00133
DEVELOPMENT SERVICES DATE ISSUED: 2/17/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 25111 CB -01703
SITE ADDRESS: 10128 SW LADY MARION DR ZONING: R -3.5
SUBDIVISION: HOOD VIEW LOT : 2_3 JURISDICTION: TIG
Project Description: (1) 200 amp service, (8) 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: 1 W /SERVICE OR FEEDER: 8 PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 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:
PATRICK CORRIGAN OWNER
10128 SW LADY MARION DR
TIGARD, OR 97224
Phone: 503 - 598 -4732 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 2/17/2006 $133.50
[TAX] 8% State Surcharge 2/17/2006 $10.68
Total $144.18 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 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 OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own whi h is-rot Jp ende for sale, lease, or rent.
OWNER'S SIGNATURE: / DATE: " — �G
f
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
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.
F.1'�ctrical Permit Application ®��0 FOR OFFICE USE ONLY
City of Tigard E I p i4� , Date/B L l 7- o � Pennit No.: g &� , n A I . i j
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /1"14 10 . '‘i I Date /B . Other Permit:
Inspection Line: 503.639.4175 FEB 17 20 1 i 1 ''II Date Ready/By: Ell ® See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
,TYPOWV D%61TIPAgQNU PLAN REVIEW
❑ New construction Al Add r tei ment Please check all that apply:
❑ Demolition El Other: ['Service over 225 amps, comm'l ['Hazardous location
['Service over 320 amps — rating ❑ Buildng over 10,000 sq. ft.,
' CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
1p 1 and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
ID Multi family ❑ Master builder ❑ Other: ['Building over three stories 0 Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
• - ,'JOB, SITE INFORMATION AND LOCATION , - .. ❑Egress/lighting plan RV park
❑Health -care facility DOther:
Job no.: Job site address: / J 1 U/ � ,,,,„ t
_ l � �? 1 Submit 2 sets of plans with any of the above.
City /State /ZIP: / / , c 4 <') fe__ q 1 �� (7 The above are not applicable to temporary construction service.
Suite/bldg. /apt. no.: 0 Project name: • FEE* SCHEDUI E
Description I Qty. I Fee. I Total
Cross street/directions to job site: / Jo /_ New residential single- or multi - family dwelling unit.
F/� Includes attached garage.
1,000 sq. ft. or less 145.15 4 • Subdivision: Lot no.: Ea. add'I 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
- . _ DESCRIPTION OF WORK Each manufactured or modular
dwelling, service and/or feeder -90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 80.30 70:7 0 2
Er PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 106.85 2
j, 401 amps to 600 amps 160.60 2
Name: t...-7 (' //� a J � /� 601 amps to 1,000 amps 240.60 2
Address: / /a s- L t r1�/ ` / /* /d �� Over 1,000 amps or volts 454.65 2
/ Reconnect only 66.85 2
City / State/ZIP: - 7 — , ( r - j v q ' 2- 2-'/ Temporary services or feeders installation, alteration, and /or
(� 4193.2 relocation
Phone: (57)3) 3't- + Fax: (S)3) S j' 't'78 200 amps or less 66.85 1
Owner installation: This installati e I ' b r . made on property that 1 own which is not 201 amps to 400 amps 100.30 2
dh
intended for sale, lease, - o e. • ' %c cor
re g to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner Signature: % / Date: — /7 66 Branch circuits — new, alteration, or extension, per panel
0- .4PLICANT' 1 , ❑ CONTACT PERSON A. Fee for branch circuits with
service or Business name: bran h circuit fee, each � J 6.65 53 LO 2
B. Fee for branch circuits d
Contact name: without service or feeder fee, 46.85 2
Address: first branch circuit
Each add'l branch circuit 6.65 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-
' CO NTRACTOR . energy panel, alteration, or
extension. Describe: Page 2 2
Business name:
Address: Ea additional inspection over allowable in any of the abov
Per inspection 62.50
City /State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
' EL ECTRICAL. PER MIT FEES* . . • '
CCB Lic.: Electrical Lie.: Suprv. Lic.: Subtotal / 33 j1)
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: - - - - - State surcharge (8% of permit fee) / 6g
TOTAL PERMIT FEE /L /9/, 7
Authorized signature: This permit application expires if a permit is not obtained within 180
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.
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Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
rRESIDENTIAL WoRK oNLY: ,
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
r COMMERCIAL WORK °ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
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