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123'JO SW James Street
/�1 CITY �� ������ ELECTRICAL PERMIT
PERMIT#: 2-00092
DEVELOPMENT SEI�VI�:;E:.� DATE ISSUED: 3/7/02 3/7/02
13125 SW Hall Blvd., Tigard. OR 9725'3 (503) 639-4171 PARCEL: 2S103CB-01700
SITF. ADDRESS: 12300 SW JAMES ST
SUBDIVISION: WILLAMETTE ZONING: R-4.5
BLOCK: LOT : 042 JURISDICTION: TIG
Proiect Description: Remodel
_ RESIDENTIAL UNIT TEMP SRVC/FEEDERS MISCELLANEOUS _
1000 SF OR LESS 0 - 200 amp: PUMP/IRRIGATION:
EACH ADWL 500SF: 201 - 400 amp: SIGN/OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF .iM/ SVC/ FDR: 6014-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 SR`/C 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:
RADFORD, MIRIAM B FAITH ELECTRIC INC
12300 SW JAMES S1 PO BOX 20476
TIGARD, OR 97223 KEIZFR, OR 97307
Phone: Phone: 503-390-8208
Reg#: LIG 86309
SUP 35765
ELE 24-249C
FEES _ Required Inspections
Type by Date Amount Receipt Rough-in
PFAI T CTR — 3/7/02 $66.80 2720020000' Elect'I Final
9PCT CTR 317102 $5.34 2720020000(
– —1
Total $72.14
This Permit is iss.,c'i subject to the regulations contained in the Tigard Municipal Code,State of OR. Specialty Ccies and all other applicable
laws. All work will be,lone in accordance with approved plans. This permit will expire d work is not started within 180 days of issuance, or if
work is suspended for n;^re 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 952-001-0080. You may obtain copies of these rules or direct questions to
Permit Signature: '/It _l,, Issued By:
4 Ilel: '-1 _
OWNER INSTAL_ATION 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 639-4175 by 7:00pm for an inspection the next business day
Electrical Permit Application
Date received: it 11 _1,c)o -G'G•O
City of Tigard Project/appl.no.: Expire date:
/IIKW Address: 13125 SW Hall Blvd,Tigard,OR 97223 Date issued: Hy: Receipt no.:
Phone: (503) 639-4171
Fax: (503) 598-1960 Case file no.: r Payment type:
Land use approval:
1 &2 fa nil) dwelling or accessory ❑Commercial/industrial U Multi-family U Tenant improvement
U New const fiction U Addilion/alteration/replaccnlcnt :l 01her: U Partial
Job address: 1:36 .5U) `) T Rldg. no.: I suite no. Tax map/tax lot/account no.:
Lot: Bloc k: Subdivision:
Project name: I Description and location of work on premises: N lywclei Kii fn
Estimated date of completion/ins action
Job no: Fte Sfax
Business name: L _ DescriptionIlly. (ca-) Total no.iusp
New resideraial-Ongle or multi-family per
Address: P I ' , dwelling unit.Includes attached garage.
City: Slate:V ZIP:9I /30 Slervicrinchidef:
Phone:3(112- C' Faxa - i3:3 E-mail: __ 00 MM sq.it or less — 4
Each additional 5sy n 11 portion thereof
Ct B no.: " ;C Elec.bus. lic.no: Limited energy,residential 2
City/metro lic.no.: t!)00c;0c; J Limited energy,non-residential 2
Al.dt
7•-G Each manufactured home or modular dwettit.-
Signature oratipervising electrician(re uired) Date Service andlor feeder _ _ 2
Su elccronnn:(rrim). 1 License no r F Services or feeders-Installation,
Sup 1 l t F �% -?* 7F� ■Iteration or relocation:
•
U1111jullitallix off 21K1 amps or less 2
Name(print): I � I('l J��Io
to 400 amps 2
61K1 amps 2
Mailingaddress: ;1C,C tAe to 10(1(1 amps_ z
City: `i /��' Slate: 7.I P: Over IWo amps or volts 2
Phone: ��( Fax: E-mail: Reconnect only I
Owner installation:The installation is being made on pro,erty I o�.11 Temporun,altecesorfeedeoc
which is not intended for sale,lease,rent,or exchange according to installation,altent!on,orrclocaunn:
2(x1 amps or less
URS 447,455,479,670,701. _
2111 ontps l0 41K1 amps -'
Owner's si mature: Dale: 401 to 61K1 ams z
_ - - -_ -- Branch circuits-new,alteration,
or extension per panel:
Natne: _ A Fee for branch circuits with purchase of
Address: service or feeder fee,each branch circuit 2
City_ State: 7_II
H. Fee for branch circuits without purchase
- — �' --------- of service or feeder fee,lust branch circuit: I 4i'u�Tr 2
Phone Fax: E-mail:
[loch additional btnnch circuit: _
Mise.(Service or feeder not included):
7LJService
vice over 225 amps-commercial U Health-care facility Each puny or irrigation circle 2
over 320 amps-rating of 1&2 U Hazardous loci non Hoch sign or outline lightingnilydwellings U Building over 10,1100 square feet four or Signol circuil(s)or a limited energy panel.
stern over 6(10 votes nominal nitre residential units in one structure alteration,or extension"
U Building over three stories U Feeders.400 amps or more •Descri tion:_--
U(kcupant load over 99 persons U Manufactured structures or RV park Eich additional ins"lon over the allowable In any of the above:
U EgressAighlingplan U(hhet _ — Pertnspecoon — E_T
Submit_sets of plans with any of the alcove. Investigation fee
The above are not applicable to temporary construf tion service. other
--- — --- - Permit fee........... S , S�
Not all jiuMicturi rap cmfit ca¢ra,pleat cult nu mhomn t^,noir i„tui matnm Notice:This permit application
U Visa U MasterCard expires if a permit is not obtained Plan review(at )
credit cud number: _—.—I—- ___-.i I within 180 days offer it has been State surcharge(8%)....$ r��•
p
accepted as complete.
Expires A v
--- —- TOT._. .......................$ �
Name of car(Orolder u shown on chit cid
S
—- Cardholder signature Amount 440.4615(6WCOM)
Electrical Permit Fees: Limited Energy t=ees:
----- -
- TrPF.. OF WORK INVOLVED -RESIDENTIAL ONLY
Complete Ft a Schedule Below: Restrictei Energy Fee..................................................... $75.00
Nrumber of Inspections per permit allowed (FOR ALL SYSTEMS)
Service included: Items Cost Total � Check Type of Wor„Involved:
Residenti:.l-per unit
1000 sq it o:less $t45 15 _ 4 Audio ano Stereo Systems
Each addition,1500 sq.It or O
portion thereof $33.40 t Burglar Alarm
Limited Energy $75.00
Each Manufd Home or Modular ❑ Garage Door Cpene '
Dwelling Service or Feeder $9090
Services or Feeders ❑ Heating,Ventilation and Air Conditioning System'
mctallalion,alteration.or relocation
200 amps or less _ $8030 2 ❑ Vacuum Systemc'
701 amps to 400 amps _ $106.85 _ 2
401 amps to 600 amps _ $160.60 2 other
bi11 amps to 1000 ampe $240.60 2
Over 1000 amps or volts — $454.65 2
Reconnect only $66.85 2
TYRE OF WORK INVOLVED -COMMERCIAL ONLY
Temporary Services or Feeders Fee for each system................. ................................... $75.00
Installation,alleralion,or relocation (SEE OAR 918.260-260)
200 amps or less _ $66.85 _
201 amps to 400 amps _ _ $100 30 2 Check Type of Work Involved:
401 amps to 600 amps Y $133.75
Over 600 amps to 1000 volts, Audio and Steres rvstems
see"b"above.
Branch Circuits ❑ Boller Ccntrols
New,alteration or emersion per panel
a 1 The fee for branch circuits I I Clock Systems
with purcnsrre of servit-c of
feeder fee.
Each branch circr'it $6.65 — Data Telecommunication Installation
b)The feo for branch circults
wlthouf purchase of t 9rvice ❑ Fire Alarm Installation
or feeder fee. L. r
First branch circuit $46.85 HVAC
Each additional branch circuit $6 65 C1(i
Miscellaneous T� ❑] Instrumentation
(Service or feeder riot included)
Each pump or irrigation circle $5340 ❑ Intercom and Paging Systems
Each sign or outline lighting _ $53.40 _
Signal circuits)or a limited energy �� Landscape Irrigation Control'
panel,altoration or extension _ $75.00 _—_
Minor Ir.oers(10) $12500 ❑
Medical
Each additional inspection over
the allowable In any of the above Nurse Calls
Per inspection $62,50
Per hour $62.50 _
in Plant $73.75 Outdoor Landscape Lighting'
Fees: Q� F-1 Protective Signaling
Enter total of above fees $ Ca L,3 C-) C� Other
8%State Surcharge $ 5, 3`, — _Number of Systems
Plan Review Fee ' No'tenses are rec eked Licenses ere Squired for all other Installations
See"Plan Review"section on $
front of application
I,
Fees:
Total Balance Due —1 Enter total of above fees s_
ElTrust Account M —__ _ 80i:Stale S ircharge =
Total Falance Due
i A&tsAroM1s\CIL-lees doc I0,091m)
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