Permit •
CITY OF T I A R D ELECTRICAL PERMIT
PERMIT #: ELC2000 -00702
s�y Ay A, DEVELOPMENT SERVICES DATE ISSUED: 12/19/00
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S1126D -00700
SITE ADDRESS: 14655 SW 76TH AVE 030
SUBDIVISION: MARCIENE II ZONING: R -12
BLOCK: LOT : JURISDICTION: TIG
Project Description: Installation of one branch circuit for new bathroom fan.
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: WISERVICE 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:
BRENDA REILLY ELECTRO WIRE INC
7524 SW ELMWOOD 18857 SE SUNNYSIDE RD
TIGARD, OR 97223 BORING, OR 97009 -9271
Phone: 503 - 246 -7908 Phone: 658 -8136
Reg #: ELE 26 -667C
LIC 67879
SUP 2717S
FEES Required Inspections
Type By Date Amount Receipt Wall Cover
PRMT CTR 12/19/00. $46.85 2720000000( Elect'I Final
5PCT CTR 12/19/00 $3.75 2720000000(
Total $50.60
This Permit is issued subject to the regulations contained in the Tigard Munidpal 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 -0080. You may obtain cop - : - - - rules or direct questions to OUNC at (503)
246 -1987.
PERMITTEE'S SIGNATURE / � 7/ ISSU , D BY:
Ay
OWNER INST LATION ONLY
The installation is being made on property I own which is not i 'ended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: ..PIl �-� i` '6 DATE:
LICENSE NO: c9-7/ 75
Call 639 -4175 by 7:OOpm for an inspection the next business day
V Po/ -eia-e--7/uLe-a_A- ,_e_i4.1,..30--1.)c-t- j }
0 ' • A Electrical PerniitApplication
Datereceived: 4-, Permit &,,ii - 60709_,
__,,W, City of Tigard Project/appl. no Expire date:
City ofTigard Address: 13125 SW Hall Blvd, Tigard, OR 97223. Date issued: By: Receipt no,:
Phone: (503) 639 -4171
Fax: (503) 598 -1960 Case file no.: Payment type:
Land use approval:
TYPE OF PER�I11 „' .
❑ 1 & 2 family dwelling or accessory 0 Commercial/industrial ! Multi- family ❑ Tenant improvement
0 New construction 0 Addition/alteration /replacement ❑ Other ❑ Partial
;., , JOB SITE INI:0It 1ATION - - , " ;' '
Job
address: , 55 ' • ' , r _P Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: Block: Subdivision: "
Project name: Description and location of work on premises:
Estimated date of completion/inspection:
" CONTRACTOR APPLICATION TEE 'SCIIEDULE;
Job no: Fee Max
. Description Qty. (ea.) Total no. insp
Business name:
New residential - single or multi - family per
Address: 4-, C ,, a __, A _ dwelling unit. lncludes attached garage.
��.
State: g-j ZIP: - y M Service included:
� 1000 sq. ft. or less 4
Phone: , 5 — �,FaX: E-mail: Each additional 500 sq. ft. or portion thereof __
CCB no.: - Elec. bus. lie. no: ,( — (
.. Z Limited energy, residential ___ 2
City /metro lic. no.: Limited energy, non- residential ___ 2
, 1,777 ! 2/,� 1 , i 4. • Each manufactured home or modular dwelling ■■-
. Signature of supervising electrician (required) i Date Service and/or feeder
Sup. name (poor) 2 7 �] t ! �� I icense no: 7 / 5
Services or feeders— installation, OM �
P u alteration or relocation:
PROPERTY OWNER 200 amps or less 2
Name (print): a rt C /., C all 201 amps to 400 amps ___ 2
401 amps to 600 amps ___ 2
Mailing address: g ' A / ME 601 amps to 1000 amps ___ 2
��� ZIP: 7' t Over 1000 amps or volts ___ 2
Phone: •, . • A . ,W f 1 E -mail: Reconnect only 1
Owner installation: a installation is being made on property I own Tema°rern,xrnces or feeders - 11=i .
which is not intended for sale, lease, rent, or exchange according to installatio, alteration, or relocation:
200 amps or less 2
ORS 447, 455, 479, 70, 70. y, 201 amps to 400 amps ___ 2
/
Vte: 401 to 600 amps Z _� 2
_
Owner's signature �, , _ / //� 1,1,
r ENG1 ?l, I : L .R Branch circuits - new, alteration,
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: State: ZIP: B. Fee for branch circuits without purchase _ rsin
of service or feeder fee, first branch circuit:
Phone: • Fax: E -mail: Each additional branch circuit: NMI _
PLAN' REVIEW' (Please check all that apply) . Misc .(Service feeder not included): e■ ■
O Service over 225 am s- commercial 0 Health-care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of 1&2 0 Hazardous location Each sign or outline lighting ___ 2
family dwellings 0 Building over 10,000 square feet four or Signal circuit(s) or a limited energy panel, .■■
0 System over 600 volts nominal more residential units in one structure alteration, or extension* 2
O Building over three stories 0 Feeders, 400 amps or more 'Descri • tion:
0 Occupant load over 99 persons 0 Manufactured structures or RV park Each additional inspection over the allowable in any of the above:
O Egress/lightingplan 0 Other. Per inspection __
Submit sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
Permit fee $ .1 ' ;
Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application Plan review (a[ %) $
O Visa 0 MasterCard expires if a permit is not obtained 7s
Credit card number: / / within 180 days after it has been State surcharge (8 %) .... $
Ex accepted as complete. TOTAL $
Name of cardholder as shown on credit card
$
Cardholder signature Amount 440"4615 (6/00 /COM)