Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2007 -00178
- COMMUNITY DEVELOPMENT
DATE ISSUED: 3/22/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171 k PARCEL: 2S102CD - 04900
SITE ADDRESS: 09793 SW O'MARA ST ZONING: R -4.5
SUBDIVISION: PP1992 - 012 LOT : 002 JURISDICTION: TIG
PROJECT: CLAYTON -
Project Description: Temp. power.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: • 1 1 . SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps -1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: 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:
MARLIN L. CLAYTON OWNER
9777 SW O'MARA ST
TIGARD, OR 97223
Phone: 503 - 639 -8148 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 3/22/2007 $66.85
[TAX] 8% State Surcharge 3/22/2007 $5.35
Total $72.20 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: c__leid (.. Permittee Signature` (' V.
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: 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.
Biectrical Permit Application FOR OFFICE l.!SF: O\1.,1
1,,, City of Tigard REC FVED e 3 a1 d7 ' Permt N , 1 OD /7.
't 13125 SW Hall Blvd., Tigard, OR 9 Plan Rayiew
Phone: 503.639.4171 Fax: 503.598.19fipA 2 2 2007 ` D� Met Pe "t:
T I C; A R U Inspection Line: 503.639 M Date Ready/By: RI See Page 2 for
Internet: www.tigard-or.gov CITY OF , I lGpRp Notified/Method Supplemental Information
. • . . -•.' TYPE OF TOWING DIVISIOf .. .. PLAN REVIEW .
❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
• CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
2:11- and 2- family dwelling El Commercial /industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial use agricultural
y i g ampsfor all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
' JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 3 7 9 3 5 0.; C/y�'u�t�y�� � I00HP or more. Occupancy.
• / . / ` ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: drril/p ®A, r g 7 a 2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE -. ::
Cross street/directions to job site: ti Descripti I Qtr. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 145.15 4
Ea. add'I 500 sq. ft. or portion .' 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, nod/or relocation
200 amps or less 80.30 _ 2
❑ PROPERTY OWNER ❑ TENANT '' ' • ' ' 201 amps to 400 amps 106.85 2
Name: L-74/. � C . 401 amps to 600 amps 160.60 2
�d f ^ ,�. 601 amps to 1,000 amps 240.60 2 .
L
Address: f O p q 6 Gam-/, 1 p Over 1,000 amps or volts ,454.65 2
'
City/State/ZIP: (� � 7 R ttt/// �• Temporary services or feeders installation, alteration, and /or
✓✓ [ CJ} relocation
Phone: ($ 6 3 9, g'/ Li e )
Fax: ( ) 200 amps or less / 66.85 (4. I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to O 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: `77) , ,, Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
: ❑ APPLICANT
I ., ';❑ CONTACT;PERSON'.: -';!.;; above service or feeder fee, 6.65 2
Business name: r each branch circuit
B. Fee for branch circuits
without service or feeder fee,
Contact name: /1 46.85 2
Address: first branch circuit
Ea ch add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 90.90 2
Phone: dwelling, service and/or feeder
( ) • Fax: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR • - Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
5 /4, energy panel, alteration, or
Address: � extension. D
Describre: Page 2 2
City /State/ZIP: Each additional inspection over allowable in any of the above
Phone: ( ) Fax: ( ) Per inspection 62.50
Investigation per hour (I hr min) 62.50
CCB Lic.: • Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
. ELECTRICAL PERMIT FEES •
Suprv. Electricl • ature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
n State surcharge (8% of permit fee): 31j
Authorized signature:
1. 4O Ll � TOTAL PERMIT FEE: 7a, cup
Print name: PIA L I I/ 0 1... /f1 Y Date: g ) •^ This permit application expires if a permit is not obtained within 180
v days after it has been accepted as complete.
• Number of inspections allowed per permit.
1:\ Building \Pamits\ELC- PermitApp.doc 05/23/06 440.4615T(I I /O5 /COM/WEB