Permit C ITY OF TIGARD ELECTRICAL: PERMIT
PERMIT #: ELC2005 -00569
DEVELOPMENT SERVICES DATE ISSUED: 8/11/2005
1141
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 - 4171
PARCEL: 2S 114BA - 05500
SITE ADDRESS: 09970 SW KENT CT ZONING: R - 4.5
SUBDIVISION: PICKS LANDING NO.2 LOT : 085 JURISDICTION: TIG
Project Description: Install A/C.
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: 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:
GERALD CRAIG EVERGREEN ELECTRICAL CONTRACTOR
9970 SW KENT CT. PO BOX 1212
TIGARD, OR 97224 SANDY, OR 97055
Phone: 503 - 502 - 6573 Phone: 503 - 668 - 4608
FEES Reg #: L1C 136311
ELE 3 -472C
Description Date Amount
SUP 4581S
[ELPRMT] ELC Permit 8/1 1/2005 $46.85
[TAX] 8% State Surcharge 8/1 1/2005 $3.75 REQUIRED ITEMS AND REPORTS
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 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: :2 -- 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: T - -
Approved plans are required on the job site at the time of each inspection.
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Elecical Permit Application I , {
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City of Tigard r „ . Permit No. , , j 3 Z A al
13125 SW Hall Blvd, Tigard, OR 97223 �,a ,� 8
Phone: 503.639.4171 Fax 503.598.1960 �.�ty 0 20U5''' ` na y Other Permit:
Inspection Line: 501639.4175 L I.. Date Ready/By 0 See Page 2 for
Internet www.ci.tigard.or.us OiTY OF TIGARD Notified/Method: Supplemental t formation
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❑ New construction Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑ Other OServiee over 225 amps, comm'I ❑Hazardous location
u ❑Service over 320 amps - rating OBuildng over 10,000 sq. IL,
V A' ,. , ,, � 4 „ F. � . + — =rill s + t„ ` .. ;% s` <- , __ of 1- and 2- family dwellings 4 or more new residential
_F-� 1- and 2- family dwelling � Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi- family ❑Master builder ❑Other: OBBuilding three stories ❑Feeders, 400 amps or more
,� ,f -.. y yfti�. °s e �- � s z r r� r O load over 99 persons OManufacttnred struchues or
� " x G . . :
. _. 1, 4',,,,,k; ,., ,':,,,t,,,,'. 1 . ., 3 i . ;, iE ^; te ;�s .+t; R"' ❑ Egres'..ighnng plan
RV 1
Job n i . . n 1 Job site address: . q—( facility O
r Submit 2 sets of plans with any of the above.
City/State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: Project name: _. a ss :,4,,, w. . :, «_ ..: t . 3 : ', 6 - f — 4,, , , , ,<w " . ..
Description Q. Fee. Toed
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. It or less 145.15 4
Subdivision: Lot no.: Ea add'I.500 sq. ft. or portion 33.40 1
Tax snap /parcel no.: Limited energy, residential 75.00 2
_ Limited energy, non- residential 75.00 2
t,„=„t t: tz''G,, . , :rf,, <` ` ' . f'
,F: ti ' ; '.',. R R' -1 , �.,�,, ",, ' '
T ''. „a Each manufactured or modular
.r ..r_. *., - , .c .. ,. 1 4 4, -c s.
IIIIIIII' , rj dwelling, service and/or feeder 90.90 2
:L� Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
r y e * °` e .,` ' r '€ � - t 1-=' u pr 4i 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: • Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
- 1,(51, ft Fax ( ) 2 00 relocation
Phone: ( ) 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
4r,,,via r 4 . : ,. a, Ate, " a r '' , A. Fee for branch circuits with
fee, each 6.65 2
Business name: branch
B. Fee for branch circuits
Contact Herne:
wai.otct service or feeder fee, 1 46,85 Lb 5
Address: each branch circuit
Each add'/ branch circuit 6.65 2
City / State/ZIP: Miscellaneous (service or feeder not included)
Pump ( ) Fax: ( ) p or irrigation circle 53.40 2
Signor outline lighting 53.40 2
E-mail: S i g n a l c i r c a t i t ( s ) o r limited-
4 c ' t 1 j ' e . f'P" .k e �, ,� ' .. a . , v a ° ' : - t Panel alteration, or
„� ,.., �.: 0 :., extension. Describe: Page 2 2
Business name: ,- �� A ! • t i ik
\4 Address: Each additional inspection over allowable In any of the above
O . •1 Per inspection 62.50
' _ City /State/ZIP: , /O , j No CIS5 Investigation per hour (1 br min) 62.50
• � ax_ _rr �� 0 _ ial 73.75
.Azia plant per hour 73
Phone' ) � '_ F } / t �7 AP Indush
1 ..
- ! t Imo. ,, .. - �= =rte... Zt,;v
����IltC%1�'fCa • Subtotal A S °
Electrical Lic. , �,
Suprv. Electrician signature, required: /� Plan review (25% of permit fee)
el 1 if %1 .� ►._ State sin charge (8% of permit fce) %� l
Print name: _Date :� � �. - - - __ --
TOTAL PERMIT FEE (et
Authorized signs i i • 11 '!�'� ar1A ►� 'lids pelt appf tarioa rap ee a widths permit is not °Maimed wd 180 `
p � da after it Las beer aoeepned as eem pketP
Print name:'. ,` -` �l it ( Date: : oo -- Fee methodology set by Tri County Building Industry Service Board
INV Number of inspections per permit allowed.
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