Permit ELECTRICAL PERMIT
- CITY OF TIGARD _
" PERMIT #: ELC2007 -00412
COMMUNITY DEVELOPMENT DATE ISSUED: 6/15/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S103AC - 00600
SITE ADDRESS: 11221 SW FONNER ST ZONING: R - 4.5
SUBDIVISION: LOT : JURISDICTION: TI G •
PROJECT: EMME
• Project Description: 1 Service. •
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: 1 W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 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:
EMME, LARRY M MIKE'S ELECTRIC
11221 SW FONNER ST 11070 SW ALLEN BLVD
TIGARD, OR 97223 BEAVERTON, OR 97005
Phone: 503 - 639 -3506 Contact #: PR1 503 - 649 -6991
FAX 503 - 641 -1902
FEES
Description Date Amount Reg #: ELE 34 -18c
[ELPRMT] ELC Permit 6/15/2007 $80.30 LIC 50209
[TAX] 8% State Surcharge 6/15/2007 $6.42 SUP 4230S
Total $86.72 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: 122u1144eL /4.17.4/) Permittee Signature: /71, (pp
OWNER INSTALLATION ONLY `"'�� TT
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.
•
•
Sent By: MIKE'S ELECTRIC; 591 7847; Jun -15 -07 14:00; Page 1/2
To: TIGARD At: 5035981960
Electrical Permit Ap i C i V E D FOR C)1'FICE Us1: ()NIA
CI of Tigard Receives _ o U v 1/5 131 SW Hall Blvd., Tigard, OR 97223 t' ',;',,,t De1°m / � . __. • • ��°�-
Pled Review
.!
Phone: 503.639.4171 Fax: 503.598,1960 � 1 - , --' Lull ' ; .r, , 1 i ,` Date/By; Oth Permit;
Inspection Line: 503,639.4175 r' (' CT ff/ _ a l,� I Date Ready/By €411 See Page 2 for
Internet: www.ei.tlgard.or.us -' � OF I R, t ■ Nounewi ethlod: �n Supplemental information
I ' e , , i ti r ", �tcrF i�r;ky .- qxa -• ' •t..•!; ;':: ' ■ 4 Y
'-. "- ! • ,■ . � .,:�., i l,,,r.:0,-,'.',`!': . . �' � h t t . ., i �t5, y�..3, r ,- .� .,c�,.�i�n �i.� Fe1r�S,+�.i:di.e•�x� a *r�r `-'7.''' -
0 New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition El Other: ❑service over 225 amps, comm'1 ❑Hazardous location
4 , d ty � ,, {' 6 +� k , , r ['Service over 320 amps - rating ❑13uildng over }0,000 sq. ft.,
,- ' (i + t 1 } 1 t ` , r" y 4t , { y +; ; 1�7,$ 3 ,E w f � yi of 1- and 2.-family dwellings 4 or more new residential
® 1- and 2- family dwelling ❑ Corrlitlercial/industx7ai ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- famil ❑Nagler builder ❑ OsJia: ❑Building over three stories ❑feeders, 400 amps or more
i 4 n ` ❑Occupant load over 99 persons ❑Manufactured structures or
i' ..,. - i - -i! ,t `:.. ['Egress/lighting plan RV park.
Job no.: 24047 Job site address: 11221 SW Fonner. St . ❑Health -care facility ['Other:
Submit l, sets of plans with any of the above.
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City /S tate/ZIP: Tigar OR 97223 The above are not applicable to temporary construction service.
x
Suitc/bldg. /apt no.: I Project name: i r ?� T1 � f „i { L' t . N .s l t i � � `a 1i 7
Deserlptloa Qty. F. Tolsl
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. R. or portion 33.40 I
Tax nnap/pareel no.: Limited energy, residential 75.00 2
„ Limited energy, non - residential 75.00 2
,- 2."...2. t, ,.. .e',. i c: J. ,.. : t . ' rl , '' ' ^r , "L ., 'W' _. ,' . .1, + . .,, Each manufactured Dr =Chilli .,.... - , liac
(;rounding & Bonding dwelling, service and/or feeder 90.90 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 80-30 - • • 8 2
' i 1 .` , .. ' i ; . v ' 1 �. �' ' `� ! �' , iyL ,f :, 400 $ V,' . 201 ampe to snips 1, 2
t ?
T_ Y <:' l n� l.� .n y r,' 401 alrips to 600 amps 160.60 2
Name: Larry Ernie _n._- 601 amps to 1,000 amps____ _. _ _ , t 4 2
Address: 11221 SW Fonner St . Over 1,000 amps or volts 454.65 2
Reconnect only 66.65 2
City/State/ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and/or -
Phone: 0O3 ) 639.3506 i F es: ( ) 200 amps
200 amps err lute 1 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
env 133.75 2
Owner signature: Date: Branch cireults - new, alteration, or extension, per panel
F a t p i , Y a A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business nano: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circui
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 Signal circuit(s) or limited.
extension. Describe: Page 2 2
Business name: Mi.kr F,7 pCtri( - JD Miller Const. Co -
Address: Each additional Inspection over allowable In any of the above
11070 S W Allen Blvd. Per inspection 62.50
City /State/ZIP: Beaver ton OR 9 700 5 Investigation per hour (t br min) 62.50
Ph Fax 1.19 0 2 Industnal plant par hour 73 75
one
(503) 649.6991 (50
641 .;+} .,i, Y.i r;i Sr, wu, , it, r? .: )°i,l ►v.i;t s!".`:
CCB Lie.: 0 5 0 2 Qs I Electrical Lie.: 34_1 £i C Suprv. Lic. ; 4 7 3 O S
Subtotal 80.30
Suprv. Electrician signature, requirod.........� ���� Plan review (25% of permit fee)
Print name: Douglas J Miller
Date: 06.15.07
S tate surcharge (8% of permit fee) 6.4 2
TOTAL PERMIT BEE i
-- Authorized signature: This permit application expires if a permit id net obtained within 180
-" ” days after It bah been accepted as complete
Print name: __ Date: • Fee methodology set by Tri•Counry Building industry Service Board
- '- Number of inspections per permit allowed.
1-1 BuildinstPami ;alai.;- rennaApp.doe 12/03 440-4613Th DA321COINWEB