Permit t T. CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2009 -00002
COMMUNITY DEVELOPMENT DATE ISSUED: 1/2/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S125DA-09200
SITE ADDRESS: 06621 SW WALNUT TER ZONING: R -4.5
SUBDIVISION: PP1991 -075 LOT : 001 JURISDICTION: TIG
PROJECT: MORRISON
Project Description: Repair and upgrade (6) 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: 5 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:
NATHANIEL MORRISON OWNER
6621 SW WALNUT TERRACE
TIGARD, OR 97223
Phone: 503 - 245 -2837 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 1/2/2009 $80.10
[TAX] 12% State Surchar 1/2/2009 $9.61
Total $89.71 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 -00 % • • • ugh 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 = : 0 ' / 0 4 1( 1 % Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on propert , own w ich is not inten•_ - d 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.
L4ctrical Permit Application x011' orFicr. usr: oNi_)
� � � �j ^�O n ^(/l.(�/ �
City of Tigard Date/B
• 13125 SW Hall Blvd., Tigard, OR 97223 Received 0 9
Plan Review
/ Permit No.: di/t/7
• Phone: 503.639.4171 Fax: 503 598 1960 Date/B : Other Permit:
T I G A It D Inspection Line: 503.639.4175 Date Ready/By: 1 uns ; l� r ID See Page 2 for
Internet: www.tigard- or.gov Notified/Method �! (l t Supplemental Information
TYPE OF WORK 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 stones.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ CommerciaUindustrial • Accessory building amps for 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: 6621 SW Walnut Ter IOOHP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 2009 Electrical Upgrades ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: SW Taylor's Ferry and 69 S on 69 to Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Walnut Ter, E to 6621 Includes attached garage.
Subdivision: Kings View Lot no.: 1 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: 1S125DA -09200 Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75 00 2
Repair and upgrade work to 6 circuits residential (with above sq. ft )
Services or feeders installation, alteration, and/or relocation
See Plan, Attached, for details 200 amps or less 80.30 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: Nathaniel Morrison 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 6621 SW Walnut Ter Over 1,000 amps or volts 454.65 2
City /State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)245 -2837 Fax: ( ) 200 amps or less 66.85 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, leas • . e according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
- . i - Date:
Branch circuits — new, alteration, or extension, per panel
Owner signature: _ A. Fee for branch circuits with
® PLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: Nathaniel Morrison without service or feeder fee 1 46.85 46 2
first branch circuit
Address: 6621 SW Walnut Ter Each add'I branch circuit 5 6.65 33.25 2
Miscellaneous (service or feeder not induded)
City /State/ZIP: Tigard, OR 97223 Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: (503) 245 -2837 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: N/A (C cv Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City / State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (I hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 80.10
Print name: Date:
Plan review (25% of permit fee): =583"
State surcharge (12% of permit fee): 9.61
Authorized signature: TOTAL PERMIT FEE: 49944^
This permit application expires if a permit is not obtained within 18
Print name: Date: days after it has been accepted as complete. $ ` t
• Number of inspections allowed per permit.
I.\nuddmgU'ermns' il.C- PcrmaApp.doc 05/23/06 440- 4615T(I I /05 /COM/WEB
Y v \
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:
❑ 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 $75.00
system
(SEE OAR 918- 309 -0000)
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
I WuildingWermits \CLC- PennitApp.doc 03/27/06