Permit CITY OF TIGARD ELECTRICAL PERMIT
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PERMIT ELC2007 -00424
COMMUNITY DEVELOPMENT DATE ISSUED: #: 6/20/2007
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S 102 DC -01900
SITE ADDRESS: 09300 SW EDGEWOOD ST ZONING: R -4.5
SUBDIVISION: EDGEWOOD LOT : 015 JURISDICTION: TIG
PROJECT: SIMMONS
Project Description: Install new meter base.
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:
CRAIG SIMMONS OWNER
9300 SW EDGEWOOD ST
TIGARD, OR 97223
Phone: 503 - 524 - 3488 Contact #:
FEES
Description Date Amount Reg #:
[ELPRMT] ELC Permit 6/20/2007 $80.30
[TAX] 8% State Surcharge 6/20/2007 $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 UN at 503.246.6699 or 1.800.332.2344.
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Issued By: �� �„ / Permittee Signature:
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 Perm Applicat10 , . FOR OFFICE USE ONLY
City of Tigard Received . 47 Permit No.: f /,_(_' 7 a
7 -o
y
a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone' 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit.
TIGARD Inspection Line: 503.639.4175 Date Ready/By: Jar ® See Page 2for
Internet: www.tigard - or.gov Notified/Method. t C ^a Supplemental Information
TYPE OF WORK ' PLAN REVIEW
❑ New construction ''Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1211- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND 'LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", `'E ", "1 -2 ", "1 -3 ",
I00HP or more. occupancy.
Job no.: Job site address: ' ...?00 Recreational vehicle
� S til.) ! , _ _ r J ❑ Six or more residential units. ❑ parks.
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City /State /ZIP: T t , p v ❑ Health -care facilities. ❑ Supply voltage for more than
r 1 6.(N - "C/ OR 7' Zac' ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE'
Cross street/directions to job site: Description I Qty. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
FA . a) (, it/1 ,eter ,6 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ( 80.30 J / 0 2
(IPROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: n ;! s , 401 amps to 600 amps 160.60 2
cc, lJ UUU� 601 amps to 1,000 amps 240.60 2
Address: O t Z `d Woo Over 1,000 amps or volts 454.65 2
City /State /ZIP: 77(5 Q� Ala 2 3 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5 ) 5--- it - Li. £sfs Fax: ( ) 200 amps or less 66.85 1
Owner installation: This ' st ation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, r t, exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
c Branch circuits - new, alteration, or extension, per panel
Owner signature: ( ` - r� 4 . - .4 . - v Date: A. Fee for branch circuits with
g .APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name' B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
G �,� vv., ,,,,,C yt s fi rst b ranc h c
Address: .C.,) Each add'! branch circuit 6.65 2
ddress:
1 P.t✓.,ctc1 Miscellaneous (service or feeder not included)
City/State /ZIP: ^� , O D C(' 7A 3 Each manufactured or modular 90.90 2
U dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONT_RAC OR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
Address:
0 ( k..) �l energy panel, alteration, or
extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lic.: Electrical Lic.: Suprv. Lic.: industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: SO. '0
Print name: Date: Plan review (25% of permit fee): �/
State surcharge (8% of permit fee)• �P . et' ,
Authorized signature: ^ � TOTAL PERMIT FEE: .
S Cp, ?2,
This permit application expires if a permit is not obtained within 180
Print name: �� /� Date: 64,107 days after it has been accepted as complete.
c et) QA, f?-.,1� _ cSVt � m nA3
* Number of inspections allowed per permit.
I:\Bu ldmg\Permits\ELC- PermitApp doc 05/23/06 440- 4615T(I1 /05 /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:
n Audio and Stereo Systems*
n Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
Pi Other:
COMMERCIAL WOR ONLY:
Fee for each commercial $75.00
system
(SEE, OAR 918 260 - 260)
Check Type of Work Involved:
n Audio and Stereo Systems
n Boiler Controls
n Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
❑ HVAC
n Instrumentation
❑ Intercom and Paging Systems
n Landscape Irrigation Control*
❑ Medical
n Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
Ft Other
Total number of commercial systems:
*No licenses are required. Licenses, are required
for all other installations
I:\Buildmg \Permits\ELC- PermitApp doc 03/23/06