Permit , •; CITY OF ,T I GARD ELECTRICAL PERMIT
PERMIT #: ELC2004 -00701
I
IIi DEVELOPMENT SERVICES DATE ISSUED: 11/2/2004
13125 SW Hall Blvd., Tigard, OR 97223 (503) 639 -4171
PARCEL: 25111 CB -01711
SITE ADDRESS: 10125 SW HOODVIEW DR
SUBDIVISION: HOOD VIEW ZONING: R
BLOCK: LOT : 010 JURISDICTION: TIG
Project Description: Alteration of (1) branch circuit for bedroom remodel.
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 NM/ 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: 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:
KATHRYN GARDNER PREMIER ELECTRICAL CONTRACTORS
10125 SW HAOODVIEW DR PO BOX 1132
TIGARD, OR 97224 NEWBERG, OR 97132
Phone: 503 539 - 4906 Phone: FX
Reg #: 1513- 537- 3QQ7i461
SUP 4891S
FEES ELE 36 -79C
Description Date Amount
Required Inspections
[ELPRMT] ELC Permit 11/2/2004 $46.85
[TAX] 8% State Surcharge 11/2/2004 $3.75 Rough -in
Elect'l Final
Total $50.60
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 a re set fortjri"n 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 or4 -800- 332 -2344
Issued By: p 1, 624 1 Permit Signature: , �yf 43,
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 IN S TAL ON -Y
SIGNATURE OF SUPR. ELEC'N: rcr(iz.�l�l i= oe-4� DATE:
LICENSE NO: (1
Call 639 -4175 by 7:00pm for an inspection the next business day
. • ..„.
Electcs .1 L PernUSAE. H [02. FOR OFFICE USE ONLY •
Cit- - ••••
+Cr; _ % igard ,.
• i Received / RN 3'ro. 'T
Date/B : . i Lit i Permit No.: • e - ,..xe, -6076,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /Ai A 1
.."itui4Iiii- Date/I3 : Other Permit:
Inspection Line: 503.639.4175 -MAO. t I Date Ready/By: Juri • El See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: . j 6, Supplemental Information
KW, 4 -I.;, WiTIV e :,:• .:.:" ''' • .
0 New construction p Addition/alteration/replacement Please check all that apply:
EService over 225 amps, comm'l ['Hazardous location
0 Demolition 0 Other:
EService over 320 amps - rating OBuildng over 10,000 sq. ft.,
I
--;:-' iedrilW of 1- and 2-family dwellings 4 or more new residential
-,:: = '; • , •:: -. 4.-el , • , ..,,,,, - ..4.: := :ba,natviinsialitonit•-• i '•:- :AZ' 4 w '" '' 'ei,;7-&
[ and 2-family dwelling 0 Commercial/industrial 0 Accessory building OSystem.over 600 volts nominal :units in one structure
DBuilding over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
c, DO cupant load over 99 persons ['Manufactured structures or
, •, , L1r5piFIrIcgrerelfr71'1 . i ,, , ,, O,1011, r'' r4 ,,,, *4 E RV.park
w, .,.., -21.,,A,,,-; .'•,;. , , ,.;ati..-- ,F V. ,i . , :,,,,,,:,' - ,tvaug - oza.•44 ne g: • - ,.:* .., ••!. , Egress/lighting plan
J DHealth-care facility DOther:
ob no.: Job site address 1 n.-, i c 1 e
' [Ai . t ) 11 CR, Submit 2 sets of plans with any of the above.
City/State/ZIP: Tc RR 0 inQ qI722 q The above are not applicable to temporary construction service.
tii=':4 ir4ritc ,: a-...,:s5e • :.,- - , :
Suite/bldg./apt. no.: Project name: cm;&M.1.k:;; :' :... ;.- " •
Description Qty. Fee. Total **
Cross street/directions to job site
• .1' . ST' X , &if_ 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
Limited energy, residential 75.00 2
Tax map/parcel no .
. Limited energy, non-residential 75.00 - 2
Mtlfra,;i:AMTORIttilkOik.. .•:,:* vtaiK,Hiv,-;',4 Each manufactured or modular
dwelling, service and/or feeder 90.90
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 _
am amp
p to s to 400 s 106.85 2
I'aii, :,;zAt,:wttt,,,t,tw41:4:,t:,.3...-;,-tr..:,' ; •ktAtNALVtklUe 401 amps 600 amps 160.60 2
Name: ie4 62.4rAi GA Z DI4c72. 601 amps to 1,000 amps 240.60 2
Address:
Over 1,000 amps or volts 454.65 2
3,47)
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (303 5 - 3 q Li 1 0 6 Fax: ( ) 200 amps or less 66.85 I
,,.
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 to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
iv ::;"c' :' 1 - - r 4" .:...-44 K' „i', ; AS A. Fee for branch circuits with
6.65 2
Business name: „Jo/4 yki-- A pg i _so 4 1 lion e. - / mR sck d branch circuit
B. Fee for branch circuits
Contact name: d a oi pA uLs 04 ( without service or feeder fee, (
46.85 ■96.33
each branch circuit
Address: / q9 ,70 s c.....9 6_1( _S?"-, Each add'l branch circuit 6.65 2
City/State/ZIP: 7 oz 9 '? 2 - 2 q Miscellaneous (service or feeder not included)
Pump or irrigation circle 53.40] 2
Phone: (5 _$ 76 -,Sc(9 ? I Fax: : (503 ) S9 _ 3 y /q
Sign or outline lighting 53.40 . 2 .
E ?AG? &SQ/.J c../ V._ y4Atc:ro ( co fr( Signal circuit(s) or limited
7,71W'r!AKI: 7Ric:„..2; :,;,w energy panel, alteration, or
extension. Describe: Page 2 2
Business name: 44 /SR e IcA( c
Address: P,o 3 it 3 2.. Each additional inspection over allowable in any of the above
Per inspection 62.50
City/State/ZIP: /1/4 42 - 0 e )a 2 .e... „ T? I 3 Investigation per hour (1 hr min) 62.50
Phone: (5c3) t70q _ gs Fax ( ) Industrial plant per hour 73.75
WM-kgrataatfq.qn1MMAREMSTYFIM rr=r :'`.
CCB Lic.: 126,4C, ( Electrical Lic.: 5/, - - ne Suprv. Lic.:A/9/ 5 Subtotal #.;/6 . ? 3
0
Suprv. Electrician signature, required: ' V/ / /7//e) 7
0 & . Plan review (25% of permit fee)
-
State surcharge (8% of permit fee) c 6 , 7
Print name: Date:
TOTAL PERMIT FEE ,2).0
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 \ PermitsELC-PematApp.doc 12/03 440-4615T(10/02/C01V1/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information • '" -R
LIMITED ENERGY PERMIT FEES:
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:
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 \Permits\ELC- PermitApp.doc 04/03
Nov 02 04 08:16p J Paulson (5031575 -3414 p.
CITY OF TIGARD
13125 S.W. HALL BLVD.
TIGARD, OR 97223
IMPORTANT PERMIT NOTICE
PREMIER ELECTRICAL CONTRACTORS
PO BOX 1132
NEWBERG, OR 97132
Electrical Signature Form
Permit #: ELC2004-00101
Date Issued: 11/2/2004
Parcel: 2S111CB -01711
Site Address: 10125 SW HOODVIEW DR
Subdivision: HOOD VIEW
Block: Lot: 010
Jurisdiction: TIG
Zoning: R -3.5
Remarks: Alteration of (1) branch circuit for bedroom remodel.
Your company has been indicated as the electrical contractor for the permit indicated above. In order for
the electrical permit to be valid, the signature of the supervising electrician is required. Please have the
appropriate individual from your company sign below and return this Electrical Signature Form prior to the
start of the work to the address above, ATTN: Building Division.
No electrical inspections will be authorized until this completed form is received
OWNER: ELECTRICAL CONTRACTOR:
KATHRYN GARDNER PREMIER ELECTRICAL CONTRACTOR
10125 SW HAOODVIEW DR PO BOX 1132
TIGARD, OR 97224 NEWBERG, OR 97132
Phone #: 503 - 539 -4906 Phone #: FX
503- 537 -3001
Reg #: LIC E 26461
SUP 4891S
LLE 36 -79C
AN INK SIGNATURE IS REQUIRED ON THIS FORM
x0 c61
Signature--6f Supervising Electrician
If you have any questions, please call 503.718.2433.
T' ETSB -b-Ir9 [EOS1 a -me, uaind eI2 :90 170 CO noW --