Permit CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2006 -00040
�M- � DEVELOPMENT SERVICES DATE ISSUED: 1/19/2006
� . 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 1S136AD-03400
SITE ADDRESS: 06918 SW PINE ST ZONING: R-4.5
SUBDIVISION: VILLA RIDGE LOT : 003 JURISDICTION: TIG
Project Description: Replace panel
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: SIGNALJPANEL:
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: 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:
JEFF DEBAUW IA, N
6918 SW PINE ST
TIGARD, OR 97223
Phone: 503 - 293 - 1059 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 1/19/2006 $66.85
[TAX] 8% State Surcharge 1/19/2006 $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: )/A ON 23 ulr_cz / . Permittee Signature:
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: // /'I
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.
Electrical Permit Application colt orrici.: i :si oNI.N
City of Tigard R�ia d / .-0,4 PermitNo.:(�L CZDo -000Y0 J3125 SW Flail Blvd., Tigard, OR 97223 Plan Review
'Phone: 503.639.4171 Fax: 503.598.1960 °• ' h ,;: I ' DaDate/E1 . Other Permit:
Inspection Line: 503.639.4175 � , 'j_
1i
� Date Ready/By: c PI See Page 2 for
Internet: www.ci.tigard.or.us - Notified/Method •• ' •- Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, comm'I ['Hazardous location
['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
❑ 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ❑Building over three stories ['Feeders, 400 amps or more
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job no.: Job site address: C'! 5'a, /J e ii 5 r ❑Health -care facility ❑other:
(2
Submit 2 sets of plans with any of the above.
City/ State/ZIP: The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: L), p./4.0 Description I Qty. I P« w To ••
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. 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
(94 9 vu de p 7v o zr € w / 741/ Services rfeservice feeders installation, feeder _ 90.90 2
G/ ! Services or feeders installation, alteration, and/or relocation
C t lir u 17 Yom( Ice — Co a a" /L1 510 //e1/74 200 amps or less 80.30 2
iii PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: . ,F/C ) / ' a KLt. 601 amps to 1,000 amps 240.60 2
Address: d q/ $ $ Over 1,000 amps or volts 454.65 2
�H� S / 7 Reconnect only 66.85 2
City/ State/ZIP: 7 Q , e .,„ 7 1 e .,„ 7 1 0 tQ Temporary services or feeders installation, alteration, and/or
�J ' `
Phone: ($ `j, 9 ? S 9 Fax: ( ) relocation
amps or less X 66.85 1
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 ORS 447, 449, 670, d 701. 401 amps to 600 amps 133.75 2
/,�F Owner signature: - 0/'"jCGut!/ Date: / / O Branch circuits — new, alteration, or extension, per panel
❑ A� 1� T I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: //'4- branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: " �] / first branch circuit
S / C /1 !, t� Ea ch add'I branch circuit 6.65 2
City/ State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: /) /t4— extension. Describe: Page 2 2
Address: (/ Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) I Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lic.: Electrical Lic.: Suprv. Lic.: , �
Subtotal L �J
Suprv. Electrician signature, required: Plan review (25% of permit fee) V /
Print name: Date: State surcharge (8% of permit fee) S,,. I
/ TOTAL PERMIT FEE .• (—V
x Authorized signature: 4., ,%� This permit application expires if a permit is not obtained within 180
/ , days after it has been accepted as complete ,
�( Print name: �' �� u w Date: / � / , Fee methodology set by Tri -County Building Industry Service Board
( Number of inspections per permit allowed.
is tBuilding \Pam 41
its 17/03 0.46 T(I0/07JCOM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial system. $75.00
(SEE OAR 918 - 260 - 260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
❑ Intercom and Paging Systems
El Landscape Irrigation Control*
❑ Medical
El Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
El ,Other
Total number of commercial systems:
*No licenses are required. Licenses are required
•
for all other installations
is\Building\Pennit \ELC•PatnitApp.doc 04/03
CITY OF TIGARD ELLL
BUILDING DIVISION PERMIT #: a �/
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: t 00 ( id
Phone: (503) 639- 4171omril
Inspection Requests (24 Hrs.): (503) 639 -4175 °`__—
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: ( Q ���A �! --at CLASS OF WORK:
SUBDIVISION: 0 LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: D�te: �° Pour Tim-: / ' ` 4 714
1 '
Code # Ins • -ction De - ' • ion Co nf tm # onta�- Message
Gq FiN(al� c5 tv► c'
Corre /Com - istructions:
\ •
•
•
PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: Date: {"2 3 ` n Phone #: (503) 718- Zltig