Permit - CITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: E 13/200 10040
°'�1 DEVELOPMENT SERVICES DATE ISSUED: 3/13/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S102CA -00214
SITE ADDRESS: 13195 SW ASH DR ZONING: R - 4.5
SUBDIVISION: VIEWCREST TERRACE LOT : 012 JURISDICTION: TIG
Project Description: 1 service.
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: 1 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:
FORRETTE, JOSEPH T + OWNER
BRIDGET A
13195 SW ASH DR
TIGARD, OR 97223
Phone: Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 4/3/2006 $80.30
[TAX] 8% State Surcharge 4/3/2006 $6.42
Total $86.72 REQUIRED ITEMS AND REPORTS
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 -0100. You may obtain copies of these rules or direct questions to OUNC at 503 - 246 -6699 or
1- 800 - 332 -2344.
Issued By: A AP AF Permittee Signature: ! ` cam
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- 639 -4175 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.
Electrical Permit App' 7 'V FOR O FFI C E USE ONLY .
Cit '1)-- f T MAR r Date/B - / -o& a + PennttNo.: -6 ,O 06174
13125 SW Hall Blvd., Tigard, OR 97223 MAfi 1. t_ 200 '. Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 "a i74N(�r401ii' Date/By: Other Permit:
Inspection Line: 503.639.4175 as I Date Ready/By: FM El See Page 2 for
Internet: www.ci.tigard.or.us . CITY OF TIGA'i= J Notified/Method: Supplemental Information ,
BUILDING D'VISION
TYPE OF WORK PLAN REVIEW
❑ New construction VI Addition /alteration/replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'I 0 Hazardous location
['Service over 320 amps — rating ['Building over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION of 1- and 2- family dwellings 4 or more new residential
X11- and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building OSystem over 600 volts nominal units in one structure
❑ Multi - family ❑Master builder ❑Other: ['Building over three stories 0 Feeders, 400 amps or more
DOccupant load over 99.persons ❑Manufactured structures or
JOB SITE INFORMATION AND LOCATION ❑Egress/lighting plan RV park
Job Job site address: 131 6LV ❑ Health -care facility ❑Other:
_ r tt 1 �� Submit 2 sets of plans with any of the above.
City /State/ZIP: 1 Ird OR • -/ 7 as 3 The above are not applicable to temporary construction service.
FEE* SCHEDULE
Suite/bldg. /apt. no.: Project name: `
Description I Qty. I Fee. I Total I .•
Cross street/directions to job site: FP- C I New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: • Lot no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
Limited energy, non - residential 75.00 2
DESCRIPTION OF WORK Each manufactured or modular
J dwelling, service and/or feeder 90.90 2
ch- ih j ,,--i e'e' rir I Ca t box Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 • 2
1 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Joe For irell `e 601 amps to 1,000 amps 240.60 2
Address: 1 31 q5. n 4511 IX Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City /State /ZIP: 1 3 avei 0g ci 7 < aa 3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (Eb '3) 6 3 e7_a y65 Fax: ( ) 200 amps or less 66.85 1
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, xchan ccord'n to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: . Date: 3— /3 -t5 Branch circuits — new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2 •
Address: first branch circuit
Each add'I branch circuit 6.65 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 -mail: Signal circuit(s) or limited -
CONTRACTOR . energy panel, alteration, or
extension. Describe: Page 2 2
Business name: _ 0/4 ,NE/
Address: Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State/ZIP: . Investigation per hour (I hr min) 62.50
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES* .
CCB Lie.: Electrical Lic.: Suprv. Lic.:
Subtotal q0 Ile)
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 6 .../ Y
TOTAL PERMIT FEE '( /),._
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri- County Building Industry Service Board
•• Number of inspections per permit allowed.
i:\ Building \Pernits\ELC - PermitApp.doc 12/03 440-4615T(10/02/COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined .. $75.00
Check Type of Work Involved:
El Audio and Stereo Systems*
❑ Burglar Alarm
El Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
El Vacuum Systems*
❑ Other:
�COA/IlVIERCIAL WORK ONLY:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
El Audio and Stereo Systems
El Boiler Controls
❑ Clock Systems
El Data Telecommunication Installation
El Fire Alarm Installation
❑ HVAC
El Instrumentation
El Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
El Outdoor Landscape Lighting*
El Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building \Permits\ELC- PermitApp.doc 04/03
CITY OF TIGARD EZ--L
BUILDING DIVISION r PERMIT #:,.9)06.,- (;)
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13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 101i
Inspection Requests (24 Hrs.): (503) 639 -4175
INSPECTION WORKSHEET FOR DATE: TIME: PAGE: .
SITE ADDRESS: / / 9 s 444& Its' '� CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 — Ls 6k Pour Time: , 0 ,
Codp # L Inspection Description Confirm # Contact # Message
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Corrections /Comments /Instructions:
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$ PASS ❑ PARTIAL APPROVAL ❑ CANCEL ❑ NO ACCESS
❑ FAIL ❑ CALL FOR INSPECTION n ADDITIONAL FEES ASSESSED
Inspector: G' 1v tCal L'- Date: - \ 5 -0 4 Phone #: (503) 718 - 2.ALli6
CITY OF TIGARD =LC
BUILDING DIVISION - PERMIT #: 2-006 -- IOC `f d
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED:
Phone: (503) 639 -4171 i nstill
Inspection Requests (24 Hrs.): (503) 639 -4175 _,W
INSPECTION WORKSHEET FOR DATE: TIME: PAGE:
SITE ADDRESS: J 3 / S C 1-- CLASS OF WORK:
SUBDIVISION: LOT #: TYPE OF USE:
PROJECT NAME:
DESCRIPTION:
OWNER: PHONE #:
CONTRACTOR: PHONE #:
Inspection Request Scheduled For: Date: 3 — 0 ro Pour Time:
Code # Inspection Desc iption Confirm # Contact # Message
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Corrections /Comments /Instructions: p
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❑ PARTIAL APPROVAL ❑ CANCEL I I NO ACCESS
FAIL CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ,v %: Lc Date: 1 t'"C U a Co Phone #: (503) 718- 1. •