Permit CITY OF T I A D ELECTRICAL PERMIT
PERMIT #: ELC2005 -00738
4 M1 DEVELOPMENT SERVICES DATE ISSUED: 10/4/2005
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S112BD -00700
SITE ADDRESS: 14655 SW 76TH AVE 33 ZONING: R -12
SUBDIVISION: MARCIENE II APARTMENTS LOT : JURISDICTION: TIG
Project Description: 4 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: 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:
BOOTH - HEYDON LLC ABC ELECTRIC
PO BOX 1185 135 NE 9TH AVE
LAKE OSWEGO, OR 97035 PORTLAND, OR 97232
Phone: Phone: 503 - 233 - 7551
FEES Reg #: LIC 26-1226C
SUP 5096S
Description Date Amount ELE 161501
[ELPRMT] ELC Permit 10/3/2005 $66.80
[TAX] 8% State Surcharge 10/3/2005 $5.34 REQUIRED ITEMS AND REPORTS
Total $72.14
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Speaalty Codes and all other applicable laws.
All work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is
suspended for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those
rules are set forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at
503 - 246 -6699 or 1-801,k332-2344.
Issued By: , Permittee Signature: 44 ( f
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503 - 639175 by.7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
SEP -28 -2005 09:59 AM P -01
electrical Permit ADDlication, t ilk I III It 1 I `I ()NIA , x
City of Tigard Permit No 'E 1 --G
13125 SW Hall Blvd., Tigard, OR 97223 P an - : Other Permit
Phone: 503.639.4171 Fax: 503.598.1960 1i ,alp ?' { L' ; Dater rune: 121 See Page z for
��
2 8 �� patoROadY/BY; lemental Information
Inspection Line, 503.639.4175 �r O (. ` , Notill Save
Internet www ci ngard onus l
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.,::. -- ,, t __ _. Please check all that apply:
r � e ,y, f l,;i , riiiii)fYf 1J:,
,! ,, I!! irll ^„�J r1 i.� ,.,1� z
[] New construction 1� ..'' 8HLIlfld$�® It 1St eR QService over 225 amps, comm'I Hazardous location
12 Demolition El Other: 0 Sery 1ce over 320 amps – rating 000 ❑ Buildng over 10, sq, ft.,
of l- and 2- family dwellings 4 it more new 0,000 residential
F , � ,.., .. - . . -- El System over 600 volts nominal units in one structure
❑ 1- and 2- family dwelling CS, Commercial /industrial ❑ Accessory blinding
[]Building over three stories ❑Feeders, 400 amps or more
Q Multi - family ❑ Master builder ❑ Other ❑Occupant load over 99 persona ❑Manufactured structures or
RV a
,. ... =? :Wealth-cam t feclity ['Other:
Job no.: e • • • Job site address: 3 Submit 1. sets of plans with any of the above.
ENESIMIIM The above are not applicable to temporary construct re
t
t / ! .. ! I ! 1 - t lt� f ... f I ion se lly ! i } �11ti <�j
. i F , .l ,!- :,.. i._1,...:. I.,..:..:� l.,.li,..,.11,itit .l:l!� i}`I{ gii
SuitefbldgJapt. no.: Project name: A � ./ ne ertpgoa Qty r••. tarsi
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
Lot no.: Ea : add'I 500 sq. ft. or portion 33.40 1
Subdivision; Limited energy, residential 75.00 2
Tax map/parcel no,: Limited energy, non - residential 75.00 2 • r n _:; li `,!,' ' ,, , , . _. , '- Each manufactured or tttodular
dwellln . service and/or feeder 90.90 2
I _ A - Services or feeders installation, alteration, and/or relocation -
200 amps or less 80.30 2
L— r 201 amps to 400 amps 106.85 2 V
160.60 2
Name: 601 amps to 1,000 amps 240,60 2
Over 1.000 amps or volts 454.65 . 2
Address: Reconnect only 66.85 2
City/State/ZIP; Temporary services or feeders Installation, alteration, and/or
relocation _
Phone; ( ) Fax: ( ) 200 amps or lass 66.85 I
Owner Installation: This installation is being made on property that 1 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 amps 133.75 2
Owner signature: Date: Branch circuits– new, alteration, or extension, per panel
- -
L ,,. ,.. A sorvice branch r fee, oach
6.65 2
_ ' A. branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fec, f 46,85 T Kr 2
eac b ranch circuit
Address: Each add') branch circuit -3 6.05 AA N 2
City /State/ZIP: Mlrcellaneous (service or feeder not Included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax:: ) Sign or outline lighting 53.40 2
E -Mail: Signal circuit(a) or limited -
I- -: }'..,:l: l....`..::;t.. .: _ :! extension panel.
escrbe: r
Page 2
0
Each additional inspection over allowable In any of the above
Address: � � ter A 111.1 � ' I i Per inspection 62.50
iiB�
d r J a - • Investigation per hour (1 hr min) 62.50
Industrial , lent per hour 7 3.75
Phone: ( ) f
IMEMPZIMI 1, .. id ,
Suprv. Electrician signature, required:
rj ' Plan review (25% of permit fec)
State surcharge (8v of permit fee) . 3
* / C . _ / / ,i. Date: 9 de TOTAL PERMIT FEE " ,
Authorized Signature: 5 This permit application expires If a permit is not obtained within 180
days otter it has been accepted as complete
Date: .. ` • Fee methodology set by Tri- County Building Industry Service Board
4. __ / • o "• Number of Inspections per permit allowed.
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