Permit •
CITY OF TIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
� _I DEVELOPMENT H BMENT r S o ERV SERVICES 639 -4171 DATE ISSUED: 10/14/03
-00319
SITE ADDRESS: 13910 SW 87TH CT PARCEL: 2S102DD -06000
SUBDIVISION: KERR PART /MLP2002 -00004 ZONING: R -4.5
BLOCK: LOT: 002 JURISDICTION: TIG
Proiect Description: ALL ENCOMPASSING
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA /TELE COMM: NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
PAYS CUSTOM HOMES GARY'S VACUFLO INC
17481 SW HOODOO CT. 9015 SE FLAVEL
BEAVERTON, OR 97007 PORTLAND, OR 97266
Phone: 503 -591 -5078 Phone: 503 -591 -5078
Reg #: M 20400001895
LIC 69047
ELE 26- 728CLE
FEES Required Inspections
Description Date Amount Ceiling Cover
[ELPRMT] ELR Permit 10/14/03 $75.00 Wall Cover
Elect'I Final
[TAX] 8% State Tax 10/14/03 $6.00
Total $81.00
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 throuc
Issued by -172j-P � Permittee Signature , Q�� fil?
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 639 -4175 by 7:00 P.M. for an inspection needed the next business day
r
Electrical Permit Application FOR OFFICE USE ONLY
PP Received Electrical !�
Date/By: Permit No.: {�/ ,20 -- 3/7
City Tig ard of Ti d Planning Approval Sign
DateBy: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503-639-4171 Fax: 503-598-1960 " Date /By: Case No.:
Post- Review Land Use
Internet: www.ci.tigard.or.us " ' li'�
Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name /Method: Supplemental Information.
TYPE OF WORK PLAN REVIEW (Please check all that apply)
New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
E] Addition /alteration/replacement ❑ Other:
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
❑ Building over three stories ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi - Family ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
l v ` r 1 � � �� The above are not applicable to temporary construction service.
Job site address: ` W I`� FEE* SCHEDULE
Suite #: _ B1 . /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fee (ea.) Total i
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
/ 1000 sq. ft. or less 145.15 4
¥ ' DOA. a t b-L G ( Each additional 500 sq. ft. or portion thereof 33.40 1
�t 1, j t. - L ot #: 3 l etf(,(. ( Limited energy, residential 75.00 2
Subdivision: l Limited energy, non residential 75.00 2
Tax map /parcel #: p zS D /LA.) D Z Z-5 ( 1 4 : 2 Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
/ _ } 61-An Services or feeders - installation,
n i
v e (/ 5 / Al k � eh t `� �fj 1C.( -- alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
PROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 2
Name: 4,t1 5 car, 4--- --6 PI 5 / .r-c14.- . Reconnect only 66.85 2
Address: Temporary services or feeders - installation,
City/ State/Zip: alteration, or relocation:
Y P 200 amps or less 66.85 I
Phone: Fax: 201 amps to 400 amps 100.30 2
XI APPLICANT , ❑ CONTACT PERSON 401 to 600 amps 133.75 2
Branch circuits - new, alteration, or
Name: e C tyS _ 4 ` S t L. - extension per panel:
Address: 1 3 l s i_ �p,D L A Fee for branch feeder r f circuits each ranch circuit of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: ` 1>C M.✓' --ion 6 2 1-2 B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: S o3 $'j ' 56 ? `.3 I Fax: SO 3 21 3 -33 Each additional branch circuit 6.65 2
E -mail: C.- k.2'i� C e (D r'l -f Cp - , C a en Misc.(Service or feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 2
Job No: ��1 � . / f , ` �"i Signal circuit(s) or a limited energy panel,
Business Name: `� T`^� alteration, or extension Page 2 2
Description:
Address:
City /State/Zip: Each additional inspection over the allowable in any of the above:
Y P Per inspection per hour (min. 1 hour) 62.50
Phone: Fax: Investigation fee:
CCB Lic. #: Lic. #: Other:
Electrical Permit Fees*
Supervising electrician Subtotal $
signature required: Plan Review (25% of Permit Fee) $
Print Name: Lic. #: State Surcharge (8% of Permit Fee) $
TOTAL PERMIT FEE $
Authorized Q Notice: This permit application expires if a permit is not obtained within
Signature: P0 /4 Date: )(Y / /q (Ia' 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please priht name)
i \ Dsts\Permit Forms \ElcPermitApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
0 Burglar Alarm
Garage Door Opener
Heating, Ventilation and Air Conditioning System
Vacuum Systems
n Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
F - 7 Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
F - 1 Instrumentation
▪ Intercom and Paging Systems
n Landscape Irrigation Control
O Medical
❑ Nurse Calls
n Outdoor Landscape Lighting
❑ Protective Signaling
n Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms \E1cPermitAppPg2.doc 01/03