Permit CITY OF TIGARD - D ELECTRICAL PERMIT
PERMIT #: ELC2007 -00114
COMMUNITY DEVELOPMENT DATE ISSUED: 2/21/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103BD -09700
SITE ADDRESS: 12957 SW 116TH PL ZONING: R -4.5
SUBDIVISION: HUNTER'S WOODLAND LOT : 009 JURISDICTION: TIG
PROJECT: THOREN
Project Description: (3) branch circuits for addition. Job #1337.
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: 2 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:
TED & KIM THOREN ABC ELECTRIC
12957 SW 116TH PL 135 NE 9TH AVE
TIGARD, OR 97223 PORTLAND, OR 97232
Phone: 503 - 579 -0768 Contact #: PRI 503 - 233 -7551
FAX 503 - 233 -7552
FEES
Description Date Amount Reg #: ELE 161501
[ELPRMT] ELC Permit 2/21/2007 $60.15 LIC 26-1226C
[TAX] 8% State Surcharge 2/21/2007 $4.81 SUP 5096S
Total $64.96 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: S y e.
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.
FEB -21 -2007 03:13P FROM: TO : B1 P50359B1 960 P.2
' El Permit Application FOR OFFICE USE ONLY
Received , i
City of Tigard ��— iii 7' _ - ? n RennitNo. G
13125 SW Hall Blvd., Tigard, OR 97223 --- , 1 Date /B s ' _
S = - Plan Review
Phone: 503.639.4171 Fax: 503.598.19600" I Date/B . Other Permit:
Inspection Line: 503.639.4175 F �. �u 20 �_'� 1 ''' � Date Ready /By: Jura 1E1 See Page 2 for
Internet: www. ci.tigard.or.us Notified/Method: Supplemental Information
TYEri#gi0F.Ktv1Q! m PLAN REVIEW ,
❑ New construction N. Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑Other: OService over 225 amps, comm'i ❑Hazardous location
❑Service over 320 amps - rating 0 Buildng over 10,000 sq. ft.,
• CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
Q 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑ Master builder ❑ Other: ❑ Building over three stories OFeeders, 400 amps or more
['Occupant load over 99 persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress /lighting plan RV park
Job no.: / 313 / Job site address: IA 9 5 .7 V J W i / / , -f 0 ❑Health -care facility ❑Other:
v Submit 2 sets of plans with any of the above.
City /State/ZIP: <0 �) K 9 70 The above are not applicable to temporary construction service.
�1 ; . FEE! SCHEDULE
Suite/bldg. /apt. no.: V Project name:, f I/» "/�/ trr Pi 1 Descdpllon I Qty. I Fee I Total I ••
Cross street/directions to job site: ✓ l j New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
DESCRIPTION . OF WORK Each manufactured or modular
0 (/CC 7 t' s� dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
"Q3 PROPERTY, OWNER , ❑ TENANT ,
401 amps to 600 amps 160.60 2
Name: �j Q r n _Q__ 2P c Y , C 601 amps to 1,000 amps 240.60 2
Address: / .2 TA '7 6 � • / J _ / t ms , I . P/ e Over 1,000 amps or volts 454.65 2
(� ( Reconnect only 66.85 2
City/ State/ZIP: e/ / A aaroP Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) & I 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 10030 2
intended fur 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
5 APPLICANT .I . . '❑ CONTACT PERSON A. Fee for branch circuits with
1 service or feeder fee, each 6.65 2
Business name: NbG `� c -. ( , branch circuit
/ B. Fee for branch circuits
Contact name: h r , i , h _ / a n yt �e' without service or feeder fee, '
t'( J�� / each branch circuit 46.85 (A .'52
Address: 1:7V a� Each add'I branch circuit o2 6.65 /3 5 i , 2
City/State/ZIP: / Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
, CONTRACTOR energy panel, alteration, or
, extension. Describe: Page 2 2
Business name: 1 Ck ��
I � + J C�, I = �1 E. qt � � � l Each additional inspection over allowa in any of the above
Address: w q _ Per inspection 62.50
City/ State/ZIP: -- \G. -( C r?a ■, Investigation per hour (I hr min) 62.50
Phone: (...3t) a : 7 ( Fax: ( j 5 , 3 75-5—a., _Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: )(p ,5)) Electrical Lic.,(L _ / Suprv. Lic. )Q ( Subtotal Z, 0 1 / S
- Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 1/ A /
Print name Shh l.e ,� �i an, i n () Date: 2 /v) // 7
TOTAL PERMIT FEE to L/ f K
Authorized signature: This permit application expires If a permit Is not obtained within 180
days after It has been accepted as complete
Print name: - `h1>.� M l (g .(� Date: /i�' t' • Fee methodology set by i n -County Building Industry Service Board
� \ I I
•• Number of inspections per permit allowed.
1.1Rn ilding \PermitS\ELC PermilApp.doe 12/03 440 - 4615T(10 /02/C0h1/wE8
■