Permit C ITY OF TIGARD g 0 ELECTRICAL PERMIT
PERMIT #: ELC2006 -00443
DEVELOPMENT SERVICES DATE ISSUED: 8/9/2006
'I I 13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 104 DC - 03200
SITE ADDRESS: 13221 SW CLEARVIEW WAY ZONING: R-4.5
SUBDIVISION: BENCHVIEW ESTATES LOT : 032 JURISDICTION: TIG
Project Description: 1 branch circuit for natural gas refueling station.
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:
RATH, MARY J CONDUIT ELECTRIC
13221 SW CLEARVIEW WAY DBA DUIT LEVEL TOOL CO
TIGARD, OR 97223 19461 SW 89TH AVE
TUALATIN, OR 97062
Phone: Contact #: PRf 503- 692 -1428
FAX 503 - 692 -3652
FEES
Description Date Amount Reg #: ELE 26 -905C
[ELPRMT] ELC Permit 8/9/2006 $46.85 LIC 109669
[TAX] 8% State Surcharge 8/9/2006 $3.75 SUP 45015
Total $50.60 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: g-Cat-
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.
- ,Electrical Permit Applica b FOE P4iF � F OR OFFICE U SE ONLY',;, .,
City of Tigard Received G /
Dat e ive Q O 6" 136 Permit Nooi C 6 --.-4,10 --.-4,10 ( 7 ( 63
13125 SW Hall Blvd., Tigard, OR 97223 AUG 0 P lan Revi •
Phone: 503.639.4171 Fax: 503.598.1960 t 4` Dale /Bv: Other Permit:
Inspection Line: 503.639.4175 , ' 67 �. Date Ready /By: Juris 0 See Page 2 for
Internet: www.ci.tigard.or.us city �jl g j j - aj • . j • Notified /Method: '/ C Supplemental Information
TYPHIN Rtialkikli P' v,TR (!1\ Print name:
❑ New construction ❑ Addition /alteration /replacement
❑ Demolition ® Other: COMPRESSED NATUAL GAS PLAN REVIEW
REFUELING APPLIANCE ELECTRICAL CONNECTION Please check all that apply:
CATEGORY OF CONSTRUCTION ❑Service over 225 amps, comm'l ❑Hazardous location
['Service over 320 amps — rating DBuildng over 10,000 sq. II..
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building of I- and 2- family dwellings 4 or more new residential
❑ Multi - family ❑ Master builder ® Other: COMPRESSED ['System over 600 volts nominal units in one structure
NATURAL GAS REFUELING APPLIANCE ELECTRICAL CONNECTION OBuilding over three stories ['Feeders. 400 amps or more
JOB SITE INFORMATION AND LOCATION DOccupant load over 99 persons ['Manufactured structures or
❑Egress /lighting plan RV park
Job no.: Job site address: 13221 S.W. CLEARVIEW WAY DHealth-care facility ['Other
Submit 2 sets of plans with any of the above.
City/State/ZIP: TIGARD OREGON 97223 The above are not applicable to temporary construction service.
Suite /bldg. /apt. no.: Project name: FEE* SCHEDULE
Description I Qty. I Fee. I Total I .•
Cross street/directions to job site: BENCHVIEW New residential single - or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: BENCHVIEW ESTATES Lot no.: 32 Ea. add'I 500 sq. II. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK Limited energy, non - residential 75.00 2
COMPRESSED NATURAL GAS REFUELING STATION ELECTRICAL Each manufactured or modular
CONNECTION dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: MARY J. RATH TRUST 601 amps to 1,000 amps 240.60 2
Address: 13221 S.W. CLEARVIEW WAY Over 1,000 amps or volts 454.65 2
City /State /ZIP: TIGARD OREGON 97223 Reconnect only 66.85 2
Temporary services or feeders installation, alteration, and /or
Phone: (503)579 -8443 Fax: (503)641 -9284 relocation
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 100.30 2
intended for sale, lease rent, or excharge, ace to ORS 447, 449, 670, and 7 1. 401 amps to 600 amps 133.75 2
Owner signature: / ' /,�QQ� Datc:� / �� Q�O Branch circuits new, alteration, or extension, per panel
® APPLIC NT ❑ CONTACT PERSON A. Fee for branch circuits with
Business name: service or feeder fee, each 6 65 2
branch circuit
Contact name: ROBERT S. RATH AND MARY J. RATH TRUSTEE B. Fee for branch circuits
without service or feeder fee. I 46.85 2
Address: 13221 S.W. CLEARVIEW WAY first branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: TIGARD OREGON 97223 Miscellaneous (service or feeder not included)
Phone: (503) 579 - 8443 Fax: : (503) 641 -9284 Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: RSRATH @PRODIGY.NET Signal circuit(s) or limited -
CONTRACTOR energy panel, alteration, or
Business name: CONDUIT ELECTRIC extension. Describe: Page 2 2
Address: 19461 S.W. 89TH AVE. Each additional inspection over allowable in any of the above
Pcr inspection 62.50
City /State /ZIP: TUALATIN, OREGON 97062 -8537 I O e. i Investigation per hour (I hr min) 62.50
Phone: (503) 692 - 1428 Fax: ( •1 t Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES*
CCB Lie.: /(9 Electrical Lic.:A6 ....4)5 Suprv. Lic.450 /5 Subtotal ! f(o -g5
Suprv. Electrician signature. required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee)
/, /./f C����` , TOTAL PERMIT FEE 5?)., 1,0
signature: ���
i:\ Building \Permits \ELC- PermitApp.doc 12103 440.4615T( l 0 /02/COM/WEB