Permit CITY OF TIGARD ELECTRICAL PERMIT
D EVELOPMENT SERVICES
PERMIT #: ELC200400434
E ISSUED: 7/16/2004
' � I DATE
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 - 4171
PARCEL: 2S108AD -11100
SITE ADDRESS: 14480 SW CHARDONNAY AVE
SUBDIVISION: YOUNG PARTITION /MLP2002 -00010 ZONING: R -7
BLOCK: LOT : 002 JURISDICTION: URB
Project Description: Branch circuit for NC unit.
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:
JONES, DELMA EVERGREEN ELECTRICAL CONTRACTOR
14480SWCHARDONNEY 23861 SE442ND
TIGARD, OR 97224 SANDY, OR 97055
Phone: 503 - 579 -4668 Phone: 503 - 668 -4608
Reg #: LIC 136311
ELE 3 -472C
FEES SUP 4581S
Description Date Amount
Required Inspections
[UELPMT] ELC Permit 7/16/2004 $46.85
[UTAX] 8% State 7/16/2004 $3.75
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: - _ C ! / .! Permit 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 639 -4175 by 7:OOpm for an inspection the next business day
c trical Permit Application FOR OFFICE USE O \'LY
Received ll Electrical - / _
Date/By: ��j �� PermitNo.: L (,C U7o oKI/
City of Tigard Planning Approval Sign
Date/By: Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By: Permit No.:
Phone: 503- 639 -4171 Fax: 503 -598 -1960 /a e? t� Post - Review Land Use
l.a
Internet: www.ci.tigard.or.us , i , '�I� Date/By: Case
ris.: No.:
i- Contact Juris.: ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 Name/Method: (Kg2c3 Supplemental information.
. TYPE' OF WORK PLAN REVIEW (Please check all that apply)
❑ New construction ❑ Demolition ❑ Service over 225 amps- 0 Health -care facility
1=1 Addition/alteration/replacement ❑Other: commercial ❑ Hazardous location
❑ Service over 320 amps- rating of ❑ Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
::' & 2- Family dwelling ' ❑ Commercial/Industrial
0 System over 600 volts nominal one structure
• Accessory Building ❑ Multi- Family ❑ Building over three stories ❑ Feeders, 400 amps or more
0 Master Builder ❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Other: ❑ Egress/lighting plan , ❑ Other:
JOB SITE INFORMATION and LOCATION Submit sets of plans with any of the above.
The above are not applicable to temporary construction service.
Job site address: 11 '..' , J J L a& Li . , FEE* SCHEDULE
Suite #: Bldg. /Apt. #: t Number of inspections per permit allowe
Project Name: Description Qty Fee (ea.) Total
New residential- single or multi - family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15
Each additional 500 sq. ft. or portion thereof 33.40
Limited energy, residential 75.00
Subdivision: Lot #: Limited energy, non residential 75.00
Tax map /parcel #: Each manufactured home or modular dwelling
:. DESCRIPTION OF WORK service and/or feeder 90.90
Services or feeders - installation,
k ` `r o (} • crxi c\---(c , alteration or relocation:
200 amps or less 80.30
201 amps to 400 amps 106.85
401 amps to 600 amps 160.60
❑ PROPERTYOWNER I 0 TENANT 601 amps to 1000 amps 240.60
Over 1000 amps or volts 454.65
Name: 7 Reconnect only 66.85
Address: Temporary services or feeders - installation,
City/State/Zip: /State /ZI alteration, or relocation:
p 200 amps or less 66.85
Phone: '---'/ o Fax: 201 amps to 400 amps 100.30
401 to 600 amps 133.75
❑ APPLICANT ❑ CONTACT PERSON Branch circuits - new, alteration, or
Name: extension per panel:
A. Fee for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65
City/State/Zip: B. Fee for branch circuits without purchase of C'5
service or feeder fee, first branch circuit 1 46.85
Phone: I Fax: Each additional branch circuit 6.65
E -mail: Misc.(Service or feeder not included):
, CONTRACTOR Each pump or irrigation circle 53.40
Each sign or outline lighting 53.40
Job No: o -3 )S-7 Signal circuit(s) or a limited energy panel,
�� p n 1 C � 1
Description: n or extension Page 2
Business Name: t v�. i COT � Description:
Address: 93% lc \ ? `-
Each additional inspection over the allowable in an
City/State /Zip: SCU l C1 (�'Z_ - 1 LS S p Y of the above:
Per inspection per hour (min. 1 hour) 62.50
Phone: t Q . - L -t O? ax: (c ( o — C'SC Investigation fee:
CCB Lic. #: S (03 l 1 Lic. #: - Li 1 a (, Other:
,, Electrical_Permit Fees* . .
Supervising electrician Subtotal $ (4(p `-,
signature required: i� Plan Review (25% of Permit Fee) . $
Print Name: C,t)r 1'; ?X( . 1 Lic. #: 14 S; \ 5 State Surcharge (8% of Permit Fee) $ 7
TOTAL PERMIT FEE $ ��
Authoriz- I ' � Noti This permit application expires if a permit is not obtained within
Signature: _ t L4` Date1'' 1 - 180 days after it. has been accepted as complete.
� f �� *Fee methodology set by Tri- County Building Industry Service Board.
((y_x_ (Ple a print name)
i:\Dsts\Permit Forms \ElcPermitApp.doc 01/03