Permit ELECTRICAL PERMIT
CITY O I TIGARD
CARD
PERMIT #: ELC2004 -00011
DEVELOPMENT SERVICES DATE ISSUED: 1/13/04
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S111AC
SITE ADDRESS: 14695 SW 92ND AVE
SUBDIVISION: PINEBROOK TERRACE ZONING: R
BLOCK: LOT : 062 JURISDICTION: TIG
Project Description: Installation of (3) branch circuits for new a /c, furnace & water heater.
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: 2 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:
WALKER, DAVID R AND JUDY K OWNER
14695 SW 92ND
TIGARD, OR 97224
Phone: Phone:
Reg #:
FEES
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 1/13/04 $60.15
[TAX] 8% State Surcharge 1/13/04 $4 Rough -in
Elect'l Final
Total $64.97
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 i suspended
for more 80 - days, ATTENTION: Oregon law requires you to follow rules adopted by the Orege. • ' ' otification Cente Th• e r I es are set
fortln OAR 952- 001 -00' through OAR 9 2- 001 -0100. You may obtain copies of these rules or direct questi. ns to OUNC - 73) 2 . ^■.99 or
1-800- 332 - 2344.
Issued By: jk "1,4 1 411k, /' . i4 Permit Signature: ■ U %i lr A ■
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: \_X� LA # ( C1 DATE: / �� /2/
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 i FOR OFFICE USE ONLY
i • A : ' 1 i . ,
City of Tigard . Received
Date P /8 y: A e nt N • 14 ru o .. _ ap e 1449,/
42/5 '
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 hoot Date/B : Other Permit:
Inspection Line: 503.639.4175 _s4 ei7/ if Date Ready/By: Juris: 10 See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
,: Fe:,i',AlaWfM•lki:ggf*Wfir, fiparVairipAR*IM. 4-74 :1 TWitir..;' V.41,11,4016.1hivThlixe-4 .':',,,';':. "-- . - . .
gi.',W'C'JI,'.-".',2]'r%.14(tMA.::&alialviwIwg:rwrxii!'1:‘.x-ewwm,,M1-4.,41.k'la,^,:li-nf,5t4VI.Tira;,r''s, ,:qn xri&k ,„,,,,,,„;,4„4.4l - .T . - . 4:44..;,i , t•k-.,, - 4 .
0 New construction gr Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'l ['Hazardous location
C] Demolition 0 Other:
OService over 320 amps - rating 0 Buildng over 10,000 sq. ft.,
reit.W
eiaP4A1414:11',X rIN;=::-',,%,!.,;,,v,',4.-,:,-,..1‘,,,,A,,,i,:k,,,,,,,,..•.244:-PfkaTitIntil.MZ4:4,17w.: of 1- and 2-family dwellings 4 or more new residential
El 1- and 2 dwelling 0 Commercial/industrial 0 Accessory building ['System over 600 volts nominal units in one structure
0Building over three stories ['Feeders, 400 amps or more
0 Multi ['Master builder ['Other:
['Occupant load over 99 persons DManufactured structures or
`:,1.7... -1. 2 " 1 4 1, 1 riailfrEIMSVar w lei: i itirNitetikt 17 Egress/lighting plan RV park
,4 ''' :341).:.:,, :v.p.,,,, 4 v , .4.: ,, ,sc2;,, , :•.,4, - ,,,i, 'IZI A4 i_j
['Health-care facility ['Other:
Job no.: Job site address:
Submit 2 sets of plans with any of the above.
City/State/ZIP: 1 (.), a i 4 6 c i 5 S t"..) ( '1 .- A (
9 J 2_2- 4 The above are not applicable to temporary construction service.
0 1 SAM 25,c;:
Suite/bldg./apt. no.: Project name: :17} M ,
Description Qty. Fee. Total I I **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
- Includes attached garage.
SCAA,G k r 4 :, - 2, 1 ' - ' 4- 1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 I
Limited energy, residential 75.00 2
Tax map/parcel no.:
, , _ Limited energy, non-residential 75.00 2
lti-Alt Each manufactured or modular
4 .;,,_ - :', dwelling, service and/or feeder 90.90 2
00 An tA) C.,: SLIAi i ,5 r () Services or feeders installation, alteration, and/or relocation
.
• Pk1(...- --- hAlliAtt I .- Wctts.,r 1--\ ad t( 200 or less 80.30 2
0'744:00414010703PAre4RiI4L4. ROCilliWkie ,` :7::
401 201 am amp to s to 400 amps 106.85 2
ps 600 amps 160.60 2
Name: be, v i el L a I I< eq,- 601 amps to 1,000 amps 240.60 _ 2
Address: I Li 6 9 .. G o 9 .). ky. A v e Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: 7-- 7A. r a j o e 9 '7 - .2- (-1 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (93 ) 6,3 . _ s": 0 7 I Fax: (5)3) 6, 3 9 _ 9 7
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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 10 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
- 11W.W717 - .: ; ;V=4a iiiilar l'afp.;,,:.! A. Fee for branch circuits with
service or feeder fee, each 3
5
Business name: ,--___bra-rrch-FiTait 6.6 2
K. Fee for branch circuits
Contact name: \ without service or feed e, /
46.85 g .f
2
each brat_lejacifecti
Address:
Each add'l branch circuit 9....._ 6.65 /5• in 2
City/State/ZIP: Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40 2
Phone: ( ) Fax: : ( ) Sign or outline lighting 53.40 2
E Signal circuit(s) or limited-
WeargiangaSMATTi#W,76Ii2Mi5inniXariZit arR,SIM energy panel , alteration, or
0 eX extension. Describe: Page 2 2
Business name: .)A)
Each additional inspection over allowable in any of the above
Address:
Per inspection 62.50
City/State/ZIP: Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
i1-MOSOMM.14M.WWITIVE.O
CCB Lie.: Electrical Lie.: Suprv. Lic.: Subtotal &et", /
Suprv. Electrician signature, required: Plan review (25% of permit fee)
State surcharge (8% of permit fee) 1- g 9-
Print name: Date:
TOTAL PERMIT FEE (0 97
Authorized signature: D :i p (A ) A.,...._ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: "e1
4_, a v; J R Ke,7 Date: 1,2.- 2 q - 6 . Fee methodology set by Tri-County Building Industry Service Board
.. Number of inspections per permit allowed
i. \Building \ Permits3ELC-PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard.,
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
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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:
CO : 4 071, '- �?'V, . a ONLY ' F.. !
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ 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\Pemtits\ELC -Pete itApp doe 04/03