Permit CITY OF TIGARD 0? ELECTRICAL PERMIT
PERMIT #: ELC2007 -00118
COMMUNITY DEVELOPMENT DATE ISSUED: 2/23/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S114AB -13200
SITE ADDRESS: 09370 SW MARTHA ST ZONING: R -4.5
SUBDIVISION: KNEELAND ESTATES NO.2 LOT : 115 JURISDICTION: TIG
PROJECT: DOHERTY
Project Description: (4) branch circuits for kitchen lighting & appliances.
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: 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:
MARGARET DOHERTY PRO CIRCUIT ELECTRIC LLC
9370 SW MARTHA ST PO BOX 3948
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Contact #: PRI 971 - 563 - 8211
FAX 503 - 266 -1349
FEES
Description Date Amount Reg #: ELE 3 -60IC
[ELPRMT] ELC Permit 2/23/2007 $66.80 L(C 161382
[TAX] 8% State Surcharge 2 /23/2007 $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: 7 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.
/1 11 ; '" l5 ,�....
Electrical Permit Applicat L . ' % 0-4 roll ovvicE t si.: ()NIA
City of Tigard
F R • ,M_� , ,
` 2
13125 SW Hall Blvd., Tigard, OR 97223 ti - . ` oauys �'
COi , Plan Review
Phone: 503.639.4171 Fax: 503.598.19(0 r' u 'n`-i p�/g _ Other Permit:
Inspection Line: 503.639.4175 `' `l J _ isi l vi ;_ ' 1 1
Daze Ready/BY: lurir: BI Sec Page 2 far
Internet: www•ci.tigard.or.us I y- � rp � -' i,tur h yQ I Notified/Method Supplemental Information
TYPE OF W O K + t U )'rt�' J '
, PLAN REVIEW
❑ New construction Addition/altetation/replaceinent Iz Please check all that apply:
❑Service over 225 amps, email location
❑ Demolition 0 Other:
CATEGORY OF CONSTRUCTION ❑Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft,
of 1- and 2- family dwellings 4 or more new residential
1 1 A.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 no.: Job site address: 9 370 SW /rl ❑ Health -care facility. ❑Other:
ST Submit 2 sets of plans with any of the above.
City /State/ZIP: It & ry The above are not applicable to temporary construction service.
Suite/bldg./apt no.: Project name: FEE* SCHEDULE
. Dneriptioa I Qty. I Fm J Total
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. add'I 500 sq. ft or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
dwel ling, service and/or feeder 90.90 2
NEW Ki t-REp1 LAX HTH.J 4 . N A ee c�
f w J Services or feeders installation, alteration, and/or relocation
( 0A/ 4 E4-Tic" ) ) 7 200 amps or less 80.30 2
PROPERTY OWNER l ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: t (c, T 'i1 W j .i 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2 _
City/State/ZIP: Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocatio■
200 amps or less l 66.85 1
Owner installation: This installation is being made on property that I own which is not i 201 amps to 400 amps I • 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to 600 amps I 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each
Business name: branch circuit 6.65 1 9 16 2
Contact name: B, Fee for branch circuits
without service or feeder fee, ( 46.85 9{0E6 2
Address: first branch circuit
Each add'I branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) I Fax:: ( ) Pump or irrigation circle 53.40 ' 2
E-mail:
Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: ? �o (I�vrr E ���4 extension_ Describe: Page 2
Address: i i ar 6 4t >tt Each additional inspection over allowable in any of the above
p+�, �7 Per inspection 62.50
City /State/ZIP: (4J 5 ._. %le M. - ` /✓ !Z) investigation per hour(1 hr min) 62.50
Phone: (C171) 563 $.ZI 1 I Fax: ( Sri) 2/ _ (3 Or Industrial plant per hour 73.75
�� ELECTRICAL PERMIT FEES*
CCB Lic,: (f ISOZ Electrical Lic.: .—( Suprv. Lic.: 5107-5 Subtotal Ft
Suprv. Electrician signature, required: 1 _ Plan review (25% of permit fee)
Print name: 7Av� .R /• _ y Date: Zr2.-007
State surcharge (8% of permit fee) 5.. 39
�v�4i i TOTAL PERMIT FEE -T`. 1
Authorized signature:
This permit application espiresifa permit isnot obtained within 180
Print name: days after it has been accepted as complete
Date: • Fee methodology set by Tri- County Building Industry Servi et Board
•' Number of inspections per permit allowed.
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