Permit CITY OF TIGARD_ ELECTRICAL PERMIT
P ERMIT #: ELC2001 -00589
.mil .�i�;� DEVELOPMENT SERVICES DATE ISSUED: 11/28/01
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171 PARCEL: 2S110AD -07600
SITE ADDRESS: 14873 SW 106TH AVE
SUBDIVISION: LANG HILL NO.2 ZONING: R -12
BLOCK: LOT : 068 JURISDICTION: TIG
Project Description: Underground power supply for cable W.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 0 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: 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:
GOLD, CHARLES N POWER TECHNOLOGY
14873 SW 106TH AVE PO BOX 1766
TIGARD, OR 97224 OREGON CITY, OR 97045
Phone: Phone: 503 - 657 -0315
Reg #: LIC 129287
ELE 3 -511C
SUP 3575S
FEES Required Inspections
Type By Date Amount Receipt Elect'I Service
5PCT CTR 11/28/01 $6.42 2720010000( Elea! Final
PRMT CTR 11/28/01 $80.30 2720010000(
Total $86.72 EXPirtPi
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 through OAR 952 - 001 -0080. You may obtain copies of these rules or direct questions to OUNC at (503)
246 -6699 or 1 -800- 332 -2344.
Permit Signature: Issued By:
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 7:00pm for an inspection the next business day
r: .1 02:580 Nancy Jones
• 503 657 -0942 p.1
Al, Electrical Permit Applica ' on
Date received: f ) ., t _ J i Permit no.: = -, L V/ - c. 5 j
jt :1 1( City of Tigard Projecdappl. no.: Expire date:
City of Tigard Address: 13125 SW Hall Blvd, Tigard, OR 22: Date issued: By:by I Receiptno.:
Phone: (503) 639 -4171
Fax: (503) 598 - 1960 Case fileno.: Payment type:
Land use approval:
TYPE OF PERMIT
❑ 1 & 2 family dwelling or accessory Pi O Multi - family ❑ Tenant improvement
❑ New construction ❑ Addition /alteration /replacement Cl Other: O Partial
JOB SITE INFORMATION
Job address: 1 t- , S 1 6(,u 1 O(,p`Kt T4 CI Clrc L Bldg. no.: Suite no.: Tax map /tax lot/account no.:
Lot: IBlock: 'Subdivision: J
Project name: R-1- to ha_ 'pct -I Description and foe. Lion of work on premises: ((V CI (r(1(.,1.VL� O(,Q»2.-
Estimated date of completion/inspection: i s a (,1. E �.r i e t
CONTRACTOR APPLICATION FEE SCHEDULE
Job no: ` , Fee Max
Business name: PO ft ) e ', . - I EQr no 10 _ till_ Description Qty. (ea.) Total no. insp
�} New residential - single or multi - family per
Address
1 ` L • e s 11 L Le dwelling unit. Includes attached garage.
City: 0 rec C I State° I ZIP: Gil 043 Service included:
Phone1 '� - 031> Fattp 1 -0 c t-! E -mail: 1000 sq. ft. or less 4
CCB no.: f , Z) C C g C y Elec. bus. lic. no: 3 - 5' / G 0-›- Each eadditional energy, 500 sq. ft or portion thereof
Limited energ residential 2
City metro lie. no.: O(C ep O Limited energy, non residential 2
` / Each manufactured home or modular dwelling
Signature of supervising e ctric •n (required) , Date � Service and/or feeder 2
Sup. elect. name (print): L - 1 .4 V (115 License no C' Services or feeders — installation,
alteration or relocation:
PROPERTY OWNER 200 amps or less I ga:? 2
Name (print): 201 amps to 400 amps 2
401 amps to 600 amps 2
Mailing address: 601 amps to 1000 amps 2
City: [State: I ZIP: Over 1000 amps or volts 2
Phone: l Fax: I E -mail: Reconnect only 1
Owner installation: The installation is being made on property I own Temporary services or feeders -
which is not intended for sale, lease, rent, or exchange according to installation, alteration, orrelocation:
ORS 447, 455, 479. 670, 701. 200 amps or less 2
201 amps to 400 amps 2
Owner's signature: Date: 401 to 600 amps = , , , . s ; , 2
ENGINEER Branch circuits - new, a ` tilt, ,'
or extension per panel:
Name: A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 2
City: I State: I ZIP: B. Fee for branch circuits without purchase
Phone: Fax: E of service or feeder fee• first branch circuit: 2
Each additional branch circuit:
PLAN REVIEW (Please check all that apply) misc. (Service or feeder not included):
O Service over 225 amps - commercial ❑ Health -care facility Each pump or irrigation circle 2
O Service over 320 amps -rating of t &2 O Hazardous location Each sign or outline lighting 2
family dwellings O Building over 10.000 square feet four or Signal circuit(s) or a limited energy panel,
O System over 600 volts nominal more residential units in one structure alteration, or extension* 2
❑ Building over three stories ❑ Feeders, 400 amps or more *Description:
O Occupant load over 99 persons 0 Manufactured structures or RV park Each additional Inspection over the allowable in any of the above:
O Egress/lighting plan 0 Other. Per inspection I I
Submit _ sets of plans with any of the above. Investigation fee
The above are not applicable to temporary construction service. Other
'Not all jurisdictions accept credit cards, please call jurisdiction for more information. Notice: This permit application
Permit fee $ 550L 30
0 Visa A Ivlaste 1 7 � � ( � q expires if a permit is not obtained Plan review (at _ %) $
Credit c.. umber: ` 2 1 7 (.0 Li 1 r 1 (a31 `I /01 within 180 days after it has been State surcharge (8%) .... $ � ' 9
C11 Expires l accepted as complete. TOTAL $ CP . 7 c
v. ._ older shown on credit card $ lJ lD • .'X
C.. R older signatory Amount J 440-4615 (6J00/COM)