Permit CITY OF TIGARD PERMIT #: ELC2005 -00745
- �- ELECTRICAL PERMIT
�4� DEVELOPMENT SERVICES DATE ISSUED: 10/4/2005
' 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 115BD -00100
SITE ADDRESS: 11584 SW ROYAL VILLA DR ZONING: R -12
SUBDIVISION: LOT : JURISDICTION: URB
Project Description: 1 branch circuit.
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:
BRAND- BROADWAY ASSOCIATES + PARKIN ELECTRIC INC
KARNO, NORTON S 14001 FIR STREET
16255 VENTURA BLVD OREGON CITY, OR 97045
ENCINO, CA 91436
Phone: Phone: 503 - 657 -4958
FEES Reg #: SUP 4241S
Description Date Amount EL 34 E 34
[UELPMT] ELC Permit 10/3/2005 $46.85
[UTAX] 8% State 10/3/2005 $3.75 REQUIRED ITEMS AND REPORTS
Total $50.60
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 2
Issued By: �� 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:
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.
10/03/2005 10:39 FAX 5036574958 PARKIN ELECTRIC C • Elec.tri Permi n� t -r FOR OFFICE USE ONLY
Cety of Tigard 4cj 3 2005 Date
Received 10 4 0( ' • I f .
13125 SW Hall •Blvd., Tigard, OR 97 Plan Review
phone: 503.639.4171 Fax: 503.598.1960 ' ' . OtherPetffic
Inspection Line: 503.639.4175 r' T OF ICI • e 4} ,_1 -• '' I i runic Ready/Hy ♦ 1 ® See Page 2 for
'mane: www ci tigard or us I.- - Notifed/Method I I �,. opptemenntt information
a i1 k . _
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` .�^L4•�. k., , �n�ya � .rl.�_ _ ` •!;-‘-', -�, ^ r -, te r c. r i , L� ����4�4�f°t - �Gd+r tip .� -c .•
.� •• ,'
❑ New construction 4 Addition/alteration/replacement Please cheek all that apply.
❑Service over 225 amps, comm'1 ❑Hazardous location
❑ Demolition ❑ Other to _ OServiee aunt 320 amps - rating ❑13uildng over 10,000 sq. ft..
� r } y , '� I r f 5, ' 1 , 1 h iy i YI ( � a r 'jy ; �r 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 ❑Pecdets, 400 amps or more
❑ Multi - Family ❑Master builder ❑Other
❑Occupant load ova 99 persons ❑Manufactured structures or
^.er r r1 i �;9 yt t a t
i o ' 1 } r � � 1 `! , i r. _ ,r , .. r' i r []}?g[ess/lightingplan RV. park
7 ,C.* • ai 1• :b:.. r_.}i --� --- ��_ o� : t o L �... _ . i' ... ,
❑Health-care facility ❑Other:
Job no.: Job site address:
��s� l g Gt „ U► i Submit 2 sets of plans with any of the above.
City / State/ZIP: i I S g't/ The above are not applicable to temporary construction service.
t . tJ . l � x . -.___ ....
Suite/bldg. /apt. no.: Project name: Ip.... . ' - - yr r .. , rt. z•tnt ..
l ^ s Description Q1'
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: l Lot no.: Ea. add'1500 sq. tt, or portion 33.40 1
Limited energy, residential 75.00 2
Tax trap /parcel no . Limited energy. non - residential 75.00 2
- ..e . fir r Sr i " - , --1, '1";;;'.1•.;;„:477.4 -1, :; --, L• 4 ,..' , ', . :1'..Y:.,:' i F :7 1 Tar _ i `1, ti Each n7anU1cDired or modular
. CO dwelling, service and/or feeder 90.9
11 4 0/ f7T �,f ' J Services or feeders installation, alteranion, aod/Or relocatio
200 arils or less 1 80.30 2
ti, -," ) 17-- F , r �7 - , ` : q 1 7 ,; ; ; .:_ t �,, `n :.yam e f }': 201 amps to 400 arms 106.85 2
+ . � �e � ,- 1
1 - f ∎`
.!. . - . 1.1 i ... 1 t - i ll _ ]r r "'5.4 `
s �i_ �,.,•___ � . _ y r -11- - a _ - 401 amps to 500 amps 160.60 z
Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts I I 454.65 2
Reconnect only 1 66.85 2
City/ State/ZIP: Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 2 01 arms to 400 err ps 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
r , . r � - L 1 -, .,,i , > A. Foe for Minch circuits with
= r__ f
if. , •t •_ I r, , i - . _ E . . • _ _ •. _ . service of feeder fee, each 6.65 2 ■
Business name: brooch circuit - ,
B. Fcc for branch circuits
Contact name: without service or feeder fee, 1 46.85 43/A6
(, /, 2
each branch circuit
Address: Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Pump or irrigation circle J 53.40 l 2
Phone: ( ) J Fax: : ( ) Sign or outline lighting 53.40 2
E -mail; Signal circuit(s) or limited-
.r 7, -- r _ .7'1, .rn r energy panel, alteration, or
Jr Farlon electric, Inc. 14UV1 1'12 Stret;t ' ` ° '`* extension. Describe: Page 2 2
Oregon City, OR 97045 503 - 657 - 4958 fax: 557 - 1059
Contractors License #: 34-4C exp. 07 - - Each additional inspection over allowable in any of the above
Supervisor: 4241 -S exp. 07 -01 -06 - Per inspection 62.50
Contractors Board Reg #: 35151 exp. 10 -12 -08 Investigation per hour (1 hr min) 62.50
Metro # 2416 exp 11-01 Industrial plant per hour 7335
Owner: ;: 7r1r 71 , 5 sr I ', ".F o, 1ii)"- ' .... , ","`` : .
_ .. Subtotal k to , Vs
SupN. blecrrician signature, required: . Plan review (25% of permit fee)
State surcharge (8% of permit fee)
Print name: Date:
TOTAI. PERMIT FEE t up
Authorized signature: �f�'� %` Thu permit application espiree if a permit it not obtained within 180
days aver It has been accepted as complete
Print name: ag(/iD ,g. p.4 .v✓A./ Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit aUewed.
iABuildineVemis '5I.C•PetrehApp.doe IV03 44045157(10m2/COMIW513