Permit CITY OF TIGARD ELECTRICAL PERMIT
c, PERMIT #: ELC2003 -00593
DEVELOPMENT SERVICES DATE ISSUED: 9/23/03
illl 13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 25111 BC -03700
SITE ADDRESS: 10420 SW VIEW TERR
SUBDIVISION: DOUGLAS HEIGHTS ZONING: R
BLOCK: LOT : 004 JURISDICTION: TIG
Project Description: Installation of (7) 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: 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: 6 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:
FAIRLEY, RONALD S + KAREN S OWNER
10420 SW VIEW TERRACE
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 9/23/03 $86.75
[TAX] 8% State Tax 9/23/03 $6.94 Rough -in
Elect'I Final
Total $93.69
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.
Air
•
Issued By: A .1A. , L /' - Permit 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 639 -4175 by 7:00pm for an inspection the next business day
1.1ectrical Permit Applicatio 5 FOR OFFICE USE ONLY
Receive. Electrical ,�, /,� p�
DateB : p? . Ab Permit C Pent No : 1 /0 / - / i
. - :
Q Planning App oval Sign
City of Tigard � Permit No..
13125 SW Hall Blvd. �� � ` ) J P • - view Other
Tigard, Oregon 97223 �C4 . � \te/B Permit No.:
Phone: 503- 639 -4171 Fax: 503 - 598 -196 ` Post- Review Land Use
a � t ,�n.. . k O
B
m i i l � `� • 0. Date : Case Use
Internet: www.ci.tigard.or.us :.• I ' Contact
_�_� Su See Page 2 for
24 -hour Inspection Request: 503 - 639 -4175 • N. ,- Name/Method: Su lemental Information.
0
- '''`, -. : '''F ' ` ' : NYPP'OF-R(ORK' ', •'! - _. m4."t" ' .:. PLAN RI ` lease checlZallttliat� PPly) ..
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
10, Addition/alteration/replacement ❑ Other:
commercial ❑ Bilding Hazardous over 10,000 ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
r . -? - i :•- ":`•i;;CATEGORYb.F dONSTitti Fid'isi4: , -
- • I & 2 family dwellings four or more residential units in
0 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stones ❑ Feeders, 400 amps or more
El Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
. ;#JOB SITE INFORMATION and,LOCQ`r)orr:._ _ ,_ -. Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: /04) 0 SW ki ew- /err, •.~x • ": 'f. ' L "r: FEE* .
Suite #: -- Bldg. /Apt. #: — Number of inspections per permit allowed
Project Name: i p /e t / , Description Qty Fee (ea.) Total
Cross street/Direc Ons to jab site: New residential - single or multi- family per 1
/ Pail j dwelling unit. Includes attached garage.
`�t
/ C ail ce / f0 / a 3 /'� to V/ CLY j e P'r. Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft or portion thereof 33.40 1
Subdivision: Jo He /' rd S Lot #: �f Limited energy, non residential residential 75.00 2
75.00 2
JUc A s Limited energy, non reside
Tax map /parcel #: Each manufactured home or modular dwelling
' ` " 4 ' . - . • . T - ' I3ESCRIPTI'ONi OF-NVORK_ ; ' : ' ; ,i: service and/or feeder 90.90 - 2
/ Services or feeders - installation,
/ ! / e I4 J r e 1 es 1( 1 7 1 f 4(44 ( l4/Oi / — /n aa''C alteration or relocation:
/)Cc7 Lf U 4 /, -7 / 1 0d//5 / c% q'7 f /11,7 f h c 200 amps or less 80 30 2
/ ,/ 201 amps to 400 amps 106.85 2
,� • 4. i" 1,0 5 L _7 ,tt -e'r, 401 amps to 600 amps 160.60 2
i 11 �- P ROPER= , OWNER ° ■ i I / ❑ TENANT , w , - r! 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
ame: pa e1 f � /` / .. Reconnect only 66 85 2
Address: /,0/20 Lip
/`O S ' / j/r cr td V' t /` / ( Temporary services or feeders - installation,
2.R 7, 2000 0 2 amps
alteration, or less relocation:
City/State/Zip: T � "c Qr ss 66.85 1
Phone: l a 201 amps to 400 amps 100.30 2
> y F ax:
4 T . 401 to 600 amps 133.75 2
09,,LICA JT" . • ' • > . , El OO YTA'CT PERSON • .,. ,- i
Branch c new, alteration, or
acne: aby 4 ' 0 extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of i '95
service or feeder fee, first branch circuit 46.85 / " 2
Phone: Fax: Each additional branch circuit ( 6.65 j 7,90 2
E -mail: Misc (Service or feeder not mcluded):
f.� , . T r; ,�. A Each pump or irrigation circle 53.40 2
E i c , , 'CONTRACTOR vo::_..,,. ° Each sign or outline lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
alteration, or extension Pa • e 2 2
Business Name: 2W4 CY' Description:
Address:
City/State/Zip: Each additional inspection over the allowable in any of the above:
`J p Per inspection per hour (mm. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
�k • • '" "''' 'Elects icat Pe mitFeeS'v = , <.: _,
Supervising electrician ,�_ Subtotal $ ?i/ 7
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $ �J !J� a.
el TOTAL PERMIT FEE $ 7i 0
Authorized /� , Notice: This permit application expires if a permit is not obtained within
Signature: /7 l/W. Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri - County Building Industry Service Board.
i? 4a / 5, �/ r /-P/
(Please pnnt name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard • "
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Burglar Alarm
• Garage Door Opener
Heating, Ventilation and Air Conditioning System
Ei Vacuum Systems
• Other
COMMERCIAL WORK ONLY: -
Fee for each system $75.00 � � ` \
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
E Boiler Controls � \ »Cf ' ' 4�1 C`,
0 Clock Systems . \. `ti •\ ti �� rid ,
Data Telecommunication Installation
■
D Fire Alarm Installation
n HVAC ` \\ ,\ ti •`
� `. � <
▪ Instrumentation ' < - \
❑ Intercom and Paging Systems
• Landscape Imgation Control
E Medical
• Nurse Calls
❑ Outdoor Landscape Lighting
Protective Signaling
• Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i \Dsts\Permit Forms \ElcPemutAppPg2.doc 01/03