Permit CITY OF TIGARD PERMIT
° P ERMIT #: ELC2006 -00734
°. COMMUNITY DEVELOPMENT DATE ISSUED: 12/26/2006
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1S135BD -01200
SITE ADDRESS: 09802 SW SHADY LN ZONING: C -G
SUBDIVISION: LOT : JURISDICTION: TIG
Project Description: Reconnect (3) rooftop gas paks & outlet.
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: SIGNAUPANEL:
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: 3 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:
FORBES, DONALD CAROLYN PRO CIRCUIT ELECTRIC LLC
BURDICK, DONALD LINDA PO BOX 3948
434 RIDGEWAY RD WILSONVILLE, OR 97070
LAKE OSWEGO, OR 97034
Phone: Contact #: PRI 971 - 563 -8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3-60 I C
[ELPRMT] ELC Permit 12/26/200( $66.80 LIC 161382
[TAX] 8% State Surcharge 12/26/200( $5.34 SUP 51075
Total $72.14 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: y ip
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.
r 'e --- t 3 ''' r
Electrical Permit • e " a ion
FOR OFFICE USE O \'LV
City of Tigard nct 26 2006 At. Received • - A MEM Perrot Na: ,„.. a 0
13125 SW Hall Blvd., Tigard, OR 97223 1 ""
Plan New
Phone: 503.639.4171 Fax: 503.598.1960 z^ '. I DatuBy. Other Permit.
Inspection Line: 503.639.4175 w t `il y or IL U , J_ . ua t_ ' _ . J. Date ReadReady/By: y /B lori,: Page 2 for
Internet: ww.ei.tigard.or.us [�`� T n'i1f : Noaf Supplemental Supplemental Informa
i p E OF PLAN REVIEW
❑ New construction pAddition/alteration/replacement Please check all that apply:
❑Service over 225 amps. comm'I ❑Hazardous location
❑ Demolition ❑ Other:
❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
CATEGORY OF CONSTRUCTION of 1- 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
['Building over three stories ['Feeders, 400 amps or more
❑ Multi - family ❑ Master builder ❑ Other:
❑Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job na: Job site address: 16 04 Su3 ❑Health -care facility ['Other:
Submit 2 sets ofplans with any of the above.
City /State/ZIP: a
T t(s �� � � The above are not applicable licable to temporary construction service.
Suite/bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I F. I Total I -.
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: I Lot no.: Ea. addi 500 sq. R 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
TNELs�� &-i .._ w. D p�
3 2L� coAs � dwelling, service and/or feeder 90.90 _ 2
` �� 1 1 Services or feeders installation, alteration, and /or relocation
I4:1 200 amps or less 80.30 2
❑ PROPERTY OWNER 1 ❑ TENANT _ 201 amps to 400 amps 106.85 2
Name:
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP:
Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: _ Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT I ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 f 9 �� 2
Contact name: B. Fee for branch circuits
without service or feeder fee, I 46.85 4 (,. 5 2
Address: first branch circuit (
Each add'l branch circuit 6.65 _ 2
City /State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) 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: ?PO � L E��n extension. Describe: Page 2 2
Address: ( F • t). .5 .i Each additional inspection over allowable in any of the above
. 150 � Per inspection 62.50
W ti
City /State/ZIP: fl V t. 7
q� 0 Investigation per hour (1 hr min) 62.50
Phone: ( it( ) 5 *•1„ 3 leQZ (I Fax: (51,3) T ( (3 1 Industrial plant per hour 73.75
CCB Lie.: (� 1s I Electrical (�
ectrical Lie.: 3 --t` Suprv. Lic.: ELECTRICAL PERMIT FEES*
Sl 07 Subtotal )( . f�
Suprv. Electrician signature, required: / „........--- Plan review (25% of permit fee) c ��
Print name: ...Tirade,. Ns- Date: l'7 " Z State surcharge (8% of permit fee)
L TOTAL PERMIT FEE 71.H
Authorized signature: This permit application expires If a permit isnot obtained within 180
days after it has been accepted as complete
I Print name: I Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number af inspections per penal tallowed.
i:\t tildin g14rmi ts1ELC mitApp.doe 12/03 440- 4613T( 10/02iCOM/WED
Z ' d 6t'£ L- 99Z -£09 /(6eN enea e6 L O L 90 9Z 08a