Permit CITY OF TIGARD - O ELECTRICAL PERMIT
. - q am meow Il
PERMIT #: ELC2006 -00723
COMMUNITY DEVELOPMENT DATE ISSUED: 12/21/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S112CB -13900
SITE ADDRESS: 14800 SW KENTON DR ZONING: R -7
SUBDIVISION: ASHFORD OAKS NO. 3 LOT : 148 JURISDICTION: TIG
Project Description: (1) branch circuit for towel rack.
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: 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:
ANDREWNALORIE WESTLUND OWNER
14800 SW KENTON DR.
TIGARD, OR 97224
Phone: 503 - 684 -8519 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 12/21/200( $46.85
[TAX] 8% State Surcharge 12/21/200( $3.75
Total $50.60 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: �� 14 /j) P
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.
Electrical Permit Application • FOR OFFICE USE ONLY '
City of Tigard FCE V ED / ErfAMA Permit No — CdODb- O )72'
. ° 13125 SW Hall Blvd., Tigard, OR Plan Review
Phone: 503.639.4171 Fax: 503.598. a y. huts: . Other Permit:
f I G A l' D Inspection Line: 503.639.4175 �t. C b 1 2006 Date Ready/By. ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TIQS14RD Notified/Method: "7 Supplemental Information
TYPE OF 11.IDING DIVISION PLAN REVIEW
•
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit; sets of plans wlitems checked below):
❑ Demolition Oilier ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
El 1 - and 2 - family dwelling ❑ Commercial/industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building mops for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION . ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1.3",
1 4 �OU S 1 1) (� elt h ^ Six or or more. occupancy.
Job no.: Job site address: Iv
r
(3 Six or more residential units. ❑ Recrereation onal vehide parks.
City /State/LIP: T L t aur D K 9- I a a (I ❑ Health-care facilities. 13 Supply voltage for more than
b ❑ 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: t3eser10600 1 Qty. 1 Fee. 1 '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
Tax map /parcel no.:
Ea. add'I 500 sq. ft or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
:121V5A _ { 1 p,. 75.00 2
�-1 Y l /h3d- LI.S Limited energy, multi - family
residential (with above sq. ft.)
rQe, LIL Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'( PROPERTY OWNER I ❑ TENANT . 201 amps to 400 amps 106.85 2
Name: Pr tA Cpl/ 'ems Nj A 0 Q 1 0 r ie., A , v e_ , t-urt3 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 1 'l_k_$ OD S LO V- E. ( 'k, D r Over 1,000 amps or volts 454.65 2
City/State/ZIP: T -� OR Qt." 0 a C4 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( 5 1: )-2. c Fax: ( ) 200 amps or less 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, : t, or exchange, according to ORS • RS 447 ' 9, 670, and 701 401 amps to 599 amps _ _ 133.75 _ 2
Jr //Z._ i • a �! , go / g ate: i Z� ?,( . Branch circuits - new, alteration, or extension, per panel
Owner signature: __ El I / A. Fee for branch circuits with
APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit 46.85 VA K 2
Address: Each add'I 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
et,0 a 0l oo r (e_ 0 l Signal panel, or limited-
energy
Business name: v panel, alteration, or
Address: i l 150 S LL) b•o 1, J rl Pr extension. Describe: Page 2 2
City /State/ZIP: / a,r a R Q D V- Each additional inspection over allowable In any of the above
p Per inspection 62.50
Phone: ( C� e) CL O --(9 Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour _ 73.75
ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: Subtotal:
Print name: Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 3 -7s
Authori zed TOTAL PERMIT FEE: 57,1 . 60
Print name: U �,- p r) £ A . UV es �te: L Z'l ze 16(0 �" permit days after it expires if has been permit b not obtained within 180
accepted as complete.
• I:\ BuildtaalPermin\ELC- PesmitApp.doe OS/23/06 Number of inspections allowed per permit.
440�613T(I I /0S/COMAV®
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 -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
I :\Buildmg\Pemits\ELC- Pamiapp.a« 03/23/06
r j
IN
Building Division
TIGARD Request for Permit Action
TO: CITY OF TIGARD
Permit System Administrator
13125 SW Hall Blvd., Tigard, OR 97223
Phone: 503.718.2430 Fax: 503.598.1960 www.tigard- or.gov
FROM: Owner ❑ Applicant ❑ Contractor ❑ City Staff
(check one)
REFUND OR Name: '
INVOICE TO: (Business or Individual) ' 6\ U n ` , 11,1 es 1. l LJ
v a 1 0 Mailing Address: 1 q. R bb s 1 v K �( r1 r\ Dr
City/State /Zip: TL _ 4) ) 0 Z q 1 D.D 4
0077 ;4(
��3 — C.2g ' 2. 1 9 1-1
P hone No.:
PLEASE TAKE ACTION FOR THE ITEM(S) CHECKED (1): � �j -� uU_ ���
® CANCEL PERMIT APPLICATION.
E REFUND PERMIT FEES (attach receipt, if available).
❑ INVOICE FOR FEES DUE (attach case fee schedule and explain below).
❑ REMOVE CONTRACTOR FROM PERMIT (do not cancel permit).
Permit #: LC O be (a` bo"7 a
Site Address or Parcel #: ('-0. j 4e,n C e. a,bo ll..
Project Name:
Subdivision Name: Lot #:
l
EXPLANATION: `D-4- a_ _ .e • 0 101 d 6 i e
- - \ - - b n t i g u - A - C7 L -
Signature: Ci' 4 1L6?,C A 1.6 Date: i/u / /67
Print Name: l/ a l D V 1 -e A M )e1-- LI,LY\
Refund Policy
1. The Director or Building Official may authorize the refund of:
a) any fee which was erroneously paid or collected.
b) not more than 80% of the land use application fee when an application is withdrawn or canceled before any review effort has been expended.
c) not more than 80% of the land use application fee for issued permits.
c) not more than 80% of the building plan review fee when an application is canceled before any plan review effort has been expended.
d) not more than 80 of the building permit fee for issued permits prior to any inspection requests.
2. Refunds will be returned to the original Payer in the same method in which payment was received. Please allow 1 -2 weeks for processing refunds.
FOR OFFICE USE ONLY
Rte to Sys Admin: Date / f '6 B) ? Rte to Bldg Admin: Date / /7/Q7 B iii
Refund Processed: Date / /p 7 By 'te nvoice Processed: Date By
Permit Canceled: Date ///7/ By arcel Tag Added: Date By
Receipt # pG — jam Date j;0f/ p/ Method (! e____ Amount $ .5 , 6, O
I:\ Building \Forms \RegPermitAction.doc R v 05/24/06 �� ,�/� ,:= /2,6-20.‘1N0 37 , Ve•