Permit CITY OF TIGARD ELECTRICAL PERMIT
° PERMIT #: ELC2008 -00251
.. :. • COMMUNITY DEVELOPMENT DATE ISSUED: 5/2/2008
TIGARD, 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
- - PARCEL: 2S104CA -08200
SITE ADDRESS: 13324 SW 136TH PL ZONING: R -7
SUBDIVISION: HILLSHIRE LOT : 082 JURISDICTION: TIG
PROJECT: HALL
Project Description: Installing (2) branch circuits.
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: SIGNAUPANEL:
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: 1 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:
RICHARD & JAMIE HALL OWNER
13324 SW 136TH PL
TIGARD, OR 97223
Phone: 503 - 524 -6972 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 5/2/2008 $53.50
[TAX] 12% State Surchar 5/2/2008 $6.42
Total $59.92 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Spec= 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 1; . Gays of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utilit .tification 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 questio •• o OUN' :t 503.2 6.6699 or 1.800.332.2344.
I
Issued By: ermittee Signature: vl
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.
,'- � s 6M�; ,,,,4 N' tie„, t r; .f ;' ' r
Electrical Permit Application ii,. . . , ' FOR :OFFICE USE ONLY r ,, 3
. :_.' City of Tigard r o' ' -' Date/By: S /Vt / Permit No.:,gL ? —c 5-1
s 13125 SW Hall Blvd., Tigard, O -- 972 4 s Plan Review
_ Phone: 503.639.4171 Fax: 50 Q8�1960. Date/By: y:
C ° Other Permit:
T I G A R D' ' Inspection Line: 503.639.4175 a 1:15.i'. ' Date Ready /By: orris: 55 See Page 2 for
Internet: www.tigard or.gov d Notified/Method: Supplemental Information
E OF WORK rt - � 7 A� ��' . • PLAN REVIEW
❑ d construction ddition /altel��t[f]gl/r m tI .J \' t Please check all that apply (submit 2 sets of plans w /items checked below):
° c a "tom ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: �`, ! 1 , - where the available fault current ❑ Marinas and boatyards.
. CATEGORY' OF' CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Af1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
. JOB• SITE INFORMATION AND LOCATION. 0 Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - ",
Job no.: Job site address: 1 3 3 L y 50 1 3 L -0- P�
w� or more. occupancy.
L ❑ Six Six o or r more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: 7 - 1 64124 , OA CI 7 Z2) ❑ Health-care a r dour fcatilocations.
❑Haz ❑ Supply voltage for more than
Hazardous ons. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE'. SCHEDULE
Cross street/directions to job site: Description I Qty I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK - ' . . . . • (with above sq. ft.)
Limited energy, multi - family 75.00 2
Paiv G'^ t1 C residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
- ❑ .PROPERTY OWNER. 1 ❑ TENANT 201 amps to 400 amps 106.85 2
4- - 3"A
Name: , �l c 44,t,tO r c--- L 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: 133 ( Stj / -7 6 't" " 141 CC_ Over 1,000 amps or volts 454.65 2
City/State /ZIP: -T � /r9 2 * C 9 7 z z Temporary services or feeders installation, alteration, and/or
i relocation
Phone: (/d3 ) 5' - 6 021 Z Fax: ( ) 200 amps or less 66.85 1
Owner installatio : his i allation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, 1 se, _ r e an a according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: 2 A. Fee for branch circuits with
APPLICANT ❑ CONTACT. PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
.� first branch circuit 46.85 1 2
Address:
� �6 'n Each add'1 branch circuit 6.65 1 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
�+ ei / extension. Describe: Page 2 2
Address:
(i° /( et -
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES .
Suprv. Electrician sign u e, required: _ Subtotal: 3,�
Print name: 1 Date: Plan review (25% of permit fee):
/ / I � State surcharge (12% of permit fee): . Li 2
Authorized signature' t ,/`,r TOTAL PERMIT FEE: } —
YYY This permit application expires if a permit is not obtained within 180
Print name: Ytl c ,a,,,, i L 0 l Date: 5/2.16 j days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:I Building \Permits\ELC- PermitApp.doc 05/23/06 440 4615T(t I /05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information -.
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK'ONLY:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
n Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
•
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I: \Building\Permits\ELC- PermitApp.doc 03/23/06
Information Notice to Property Owners About
Construction Responsibilities Statement
Oregon Law requires residential construction permit applicants who are not licensed
with the Construction Contractors Board to sign the following statement before a
building permit can be issued. [ORS 701.055 (4)]
This statement is required for residential building, electrical, mechanical and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010(7), need
not submit this statement. This statement will be filed with the permit.
Please check the appropriate box and complete the following statement:
1 own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
1 will instruct my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
I will be performing work on property 1 own, a residence that I reside in or a residence that 1 will
reside in. If I hire subcontractors, 1 will hire only subcontractors licensed with the Construction
Contractors Board. if I change my mind and hire a general contractor, 1 will contract with a
contractor who is licensed with the CCB and will immediately notify the office issuing this building
permit of the name of the contractor.
I have read and understand the Information Notice to Proper I 0 wners about Construction
Responsibilities contained on these two pages and I hereby ce , that the information checked and
completed above is correct and accurate.
)(AAA& a ltvi-u_ \;\(14,0
Print name of permit applicant Signature of permit applicant
(' °,
Date
Permit #: � �? , _cZ,(
This form is supplied to building . F / 2 `l S'`� i 2
permit offices by the Oregon ° : Address: —
Construction Contractors Board "'r * -kt.)
as required by ORS 701.055 (6) ? .
Issued by: " � D ate r /Ue
This copy to issuing permit office