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11850 SNV CREENBURG RD
CITY OF TIGARD � ELECTRICAL PERMIT
TIGARD tt: ELC2004-00004
DEVELOPMENT SERVICES DATE ISSUED: 1/5/04
13125 SW Hall Blvd., Tiqard, OR 97223 (503) 639-4171 PARCEL: 1S135DD-04300
SITE ADDRESS: 11850 SW GREENBURG RD
ZONING: R-12
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Reconnect service. Job No.473
4
RESIDENTIAL UNIT TEMP SRVC/FEEDERS _ MISCELLANEOUS 1
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 HMI SVC/FOR: 601+amps - 1000 volts: MINOR LABEL (10):
SERVICE/FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: WISERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st WiO SRVC OR FOR: PER HOUR:
401 - 600 amp: EA ADD'L. BRNCH CIRC: IN PLANT:
601 - 1000 arnp: PLAN REVIEW SECTION
1000+ amp/volt: >=4 RES UNITS: > 600 VOLT NOMINAL_:
Reconnect only: 1 SVC/FDR>=225 AMPS: CLASS AREAISPEC UCC:
Owner: Contractor:
PATHFINDERS HOMES INC WILLAMETTE ELECTRIC INC
20055 SW PACIFIC HWY STE 105 PO BOX 230547
SHERWOOD,OR 97140 TIGARD,OR 97281
Phone: 503-625-9151 Phone: 503-624-3631
Reg #: LIC 75t1�1r
---. - SI 1' 19655
FEES 111
Description Date Amount
Required Inspections
IAX� Statr tiutchurge I ni $66.85 — —
I'AXJ h State Surcharge I � n.1 $5.35 Flert'I Final
Total $72.20
This Permit is Issued subject to the regulations contained in the Tigard Municipal Code,State of OR. Specially 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. /1
Issued By: t�, ��CXC���( Rs _ Permit SignatureX -
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 7:00pm for an Inspection the next business day
Electrical Permit Application Received Electrical
Dat
Receive
: J / Permit No.:�'�► •
City of Tigard Planning royal Sign E'�_C7-*e) �ez Xk'
Date/By: _ Permit No.:
13125 SW Hall Blvd. Plan Review Other
Tigard,Oregon 97223 Date/By: Permit No.:
Phone: 503-639.4171 Fax: 503-599.1960 Post-Review land Use
Internet: www.ci.tigard.or.us DatdB : Case No.:
Contact Juris.: See Page 2 for
24-hour Inspection Request: 503-639-4175 Name/Method: Supplemental Information.
TYPE OF WORK _ PLAN REVIEW(Please check all that apply)
New construction Demolition Service over 225 amps- Health-caretuctlity
AdditioNalteration,/re
cement Other: commercial ❑Hazardous It-Ovation
❑Service over 320 amps-rating of ❑Building over 10,000 square feet,
CATEGORY OF CONSTRUCTION I &2 family dwellings goer or more residential units to
—1 & 2-FamilydwellingCommercial/Industrial ❑system over 600 volts nominal one structure
Accesso Buildin Multi-Family1-1Buildingover three stories ❑Feeders,400 amps or more
❑Occupant load over 99 persons EJManufactured structures or RV park
Master Builder Other' ❑Egress/lighting plan ❑Other:
JOB SITE INFORMATION and LOCATION Submit_sets of plans with any of the above.
/ The above are notapplicable to temporary construction service.
b
Job site address: //kms 5 4 C. , ___ _ FEE*SCHEDULE
Suite#: Bld ./A t.#: _ Number of Ins ectlons per permit allowed
Project Name: r L Ip ( Descri inion Qty I Fee lea.► Total
New residential-single or multi-ramily per
Cross street/Directions to Job Site: dwelling unit.lncludes attached garage.
Service included:
I(X)0 sq ft.or less _ 145.15 4
Each additional NX)sq.Il.or ixuiiun ihrreof 314J I
Subdivision: Lot#: Limited energy.residential 75.00 2
Limited energy,non residential 75.00 2
Tax map/parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service an&or feeder 90.90 2 F
^ Services or feeders-Installation,
alteration or relocation:
2(X1 amps or less - _80 30 2
201 ams to 400 ams 106.85 2
401 amps to W)ams 160.60 2
PROPERTY OWNER JEJTENANT 601 amps to 1000 ams 240.60 2
--- —""�— Over 10(X1 amps or volts _ 454,65
Name: Reconnect only J 66.85 L Sr,,V 2
Address: Temporary services or feeders-installation.
CII /StatelZl alteration,or relocation: p
21X)amps or less 66.85 1
Phone: Fax: 201 amps to 4W ams 100.30 2
APPLICANT CONTACT PERSON 401 to 60Os 133.75 2
— --- -- Branch circuits-new,alteration,or
Name: _ _ extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee,each branch circuit 6.65 2
-0t /State/Zip: B.Fee for branch circuits without purchase of
— service or feeder fee,first branch circuit 46.85 I
Phone. Fax: Each additional branch circuit 6,65 2
E-mail: Mise.(Service or feeder not includedt
CONTRACTOR Each pump or irrigation circle 53.40 2 1
Each sin or outline lighting 53.40 2
Job No: y 7 5 Signal circuits)or a limited energy panel,
Business Name: f S, r� alteration,or extension Pae 2 2
n �, (�R A,t! f t j Yr �'`•C- Description f,
Address: r,� Z3o -4
City/State/Zip:/State/ZI U T F.ach additional ins ection over the allowable In anv of the abme:
t r Per inspection r hour(min. I hour) 6_2.50
Phone: - � Fax: t•e t- - I'l A� Investigation fee
Uthet _
CCB Lic. #: j ;c Lic. #: ?y - >!� ; C Electrical Permit Fees*
Supervising electrician4
Subtotal S t
si ature re aired: = _ Plan Rcview 25%of Permit Fee) I 5 _ ;r
Print Name: A F, Lic, #: %yb )`- State Surcharge t8°'o of Pemnt Fee) S ?S
_TOTAL PER
Authorized Notice This permit application expires Ira permit is not obtained within j
Signature: _ Date.`_ 180 da-atter it has been accepted as complete.
•Fen•rnethodofog,t set by Tri-County Building Indostry Sertice Board.
(Please print name)
i`Dsts\Permit Fotms\ElcPermrtApp.doc 01103
s
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PFRMIT FEES:
RESIDENTIAL WORK ONLY:
Feefor all systems............................................................ 575.00
Check Type of Work Involved:
LJ Audio and Stereo Systems*
nurglar Alarm
❑ (iarage Door Opener*
I eating,Ventilation and Air Conditioning System*
Vacuum Systems*
Other___
COMMERCIAL WORK ONLY:
Feefor each system.................
ISI.e OAR 918-260-2(yo)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Flock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ IIVAC
Instrumentation
❑ Intercom and Paging Systems
EJLandscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor landscape Lighting*
❑ Protective Signaling
❑ Other
`_Number of Systems f
* No licenses are required. Licenses are required for all
other Installations
i',Dsts\Permit FormsTJcPermrtAppP f.2.dcx 0103