Permit Q PERMIT #: ELC2006-00622
I ELECTRICAL PERMIT
DEVELOPMENT SERVICES (�
�I�1 CITY OF TIGARD DATE ISSUED: 10/31/2006
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171
PARCEL: 2S 102CD -02000
SITE ADDRESS: 09680 SW O'MARA ST ZONING: R - 4.5
SUBDIVISION: EDGEWOOD LOT : 010 JURISDICTION: TIG
Project Description: 200amp service and 12 branch circuits.
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: 12 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:
MARTY FRANCIS P B ELECTRIC INC
9680 SW O'MARA 1108 SE DOGWOOD LN
TIGARD, OR 97223 OAK GROVE, OR 97267
Phone: Contact #: FAX 503 - 786 -6005
PRI (503)786 -4499
FEES
Description Date Amount Reg #: ELE 3 -428C
[TAX] 8% State Surcharge 10/31/200( $12.80 LIC 85896
[ELPRMT] ELC Permit 10/31/200( $160.10 SUP 45415
Total $172.90 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 law • II
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 s • - nded
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those . es 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- • . -6699 or
1- 800 - 332 -2344.
Issued By: . • Lame , _ 4 _ / Permittee Signature:
OWNER INSTALLATION ONL
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 Application rOR OITICE I ISE ONLY
RECEIVED Received
City of Tigard Rate . / D 3 t oh a R Permit No.,) Dog* (� D .-
II
q 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
0 Phone: 503.639.4171 Fax: 503.5ty CIO 3 1 2006 Date/B . Other Permit:
T I G n tz 11 Inspection Line: 503.639.4175 Date Ready/By.. lw;s: ® See Page 2 for
Internet: www.tigard- or.gov CITY OF TrGARD Notified/Method �C Supplemental Information
' TYPE Autteilin DIVISION 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 0 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
'I- 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 ", "I -2 ", "I -3
Job no.: I Job site address: (9455 , S L4.) C) i „y K, I Six or more more. R occupancy. Recreational aFvL./ ❑ Six or more residential units. ❑Recreational vehice parks.
City/State/ZIP: ---- ,o ❑ Health -care facilities. ❑ Supply voltage for more than
c � �� ❑ 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 I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 l
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
4/ k, r ,z Bsr*rri ' f L,,� V tob residential (with above sq. ft.) 75.00 2
��
/� c • . Services or feeders installation, alteration, and /or r location
e.l.E.�.clN LCD. 200 amps or less / 80.30 Q ,R) 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
. Name:) 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
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, r panel _
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
Business name: each branch circuit f� 6.65 2
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Signal circuit(s) or limited -
Business name EL.cc7 if / A/ L- energy panel, alteration, or
Address: a//c)g s,- Laaom Z extension. Describe: Page 2 2
City/State/ZIP: (f) K ,... Each additional inspection over allowable in any of the above
Per inspection 62.50
• Phone: (spa) T34 - S'LZ S Fax: ( ) Investigation per hour (1 hr min) 62.50
CCB Lic.: 96, Electrical Lic.: 3_ v , Suprv. Lic.: yes / S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician ignature, required:
Alwm■ _ Subtotal: I ( (0
•
Print name: /4,�— �e�Ar Date: 4:7 _ / _ d 4,
Plan review (25% of permit ee .
State surcharge (8% of permit fee): I oZ )
Authorized si attire: TOTAL PERMIT FEE: / 7a _R a
Print name Date: This permit application expires if a permit is not obtained within ISO 1 1 days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:�Building�Pemmits - PamihApp.doc OS 2 3/06 I ' 0 4404615T(1 .5 /COMlWF9
t _ /_o 10 -1_v
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:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other.
COMMERCIAL WORK ONLY:
Fee for each commercial $75.00
• system
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
p 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
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