Permit Support Document CITY OF TIGARDIN ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2021-00286
Date Issued: 5/22/2021
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Ft-fl!!1.
1 Parcel: 2S112CA06800
Jurisdiction: Tigard
Site address: 15374 SW THURSTON LN
Project: KEN-Dana-22621 Subdivision: ASHFORD OAKS Lot: 22
Project Description: New meter and panel due to fire. 12/7:ADD 18 branch circuits. 12/7: REPRINTED by HV to included changes
Contractor: CLACKAMAS ELECTRIC INC. Owner: DANA, MARC R& KRISTEN L
PO BOX 51 15374 SW THURSTON LN
BEAVERCREEK, OR 97004 TIGARD, OR 97224
PHONE: 503-969-5684 PHONE:
FAX: 503-632-2421
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 05/22/2021 $100.70
Specifics:
amps or less
1 ea 12%State Surcharge- 05/22/2021 $12.08
Type of Use: SF Electrical
Class of Work: ALT 18 crt Branch Circuits w/Purchase 12/07/2021 $133.56
Type of Const: Service or Feeder
Occupancy Grp: 16 12%State Surcharge- 12/07/2021 $16.03
Electrical(manual)
0 ea 12%State Surcharge- 12/07/2021 $17.95
Electrical
Total $280.32
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. 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 the
180 days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 throuah OAR 952-001-0090. You may obtain a cony of the rules or direct Questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Ho ay Vag De�nl29Pi Permittee Signature: 0w A
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 the next available inspection date.
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.
_ .. .
RECEIVED t-)
Electrical Permit Application DEC 6 2021 FOR OFFICE USE ONLY
Cilv ofligard 14.0,6,,ost\Alva \„\,)
tv—r. c-:.,.\C-Loti-ob-z tE3(0
, SW 11:411Filvil.Twin*.Ott 9791TY OF TIGARu
Ill
Phu Review
Itelmr.0 l'crrrii t,
; : Plume 10.73.2419 Fax: 303.iitilk4DING DIVISION DaioltY.
It64.4.,CtrOtt 1111C iti;Al 39.4 I 7 Wady Dorefir oco ic.- -1 a id Sc Pr ic arc 2 e
"FIGARD 1
. Ilarrniel Wift4ligitt41-44t,Stro N.0.0416,4‘t\-1VIA
V'''""-- Supprenrcertal Infurinaitivo
TYPE OF WORK PLAN REVIEW
0 NrCV1 00LlittlIAXICM IX Addilion4licralioNreplaccrneni P/Amerr 00.4 Of trru novo y t•54,irr4t II.‘ot OA 0-.L.'1.4'n''hoi.(01
CI v.,,,,-.1.;*or kwascr 000 win rr mutt 0 tunki IN nrrr them dam
IDik:froloion ri r hk-r, wherc be znailizic huh(matt 0 M11111:Xs Jail busiymnik.
q
1,1 CATECORV OF CONSTRUCTION csieciS MOO 41004 II 1511 Watts rr; 0 Fkr,41,41;to1ildin14
't Cil 1 Inc.0 2 fanuly chselrig U C'ectelit:r.:.-iut Indust:rue u Auuuuc,building 4,..}4 M13;0,0d fe tV;0141,i 4,0* 0 rVoszorcso-oor%potion'
Anus kr Al utter untallatrrrs
0 IV=Paul,. Dihuilltrip,
re 1.9)ILVA w
3014. SITE. INFORMATION AND LOCATION 0 anetrinii.y soles,.
CI kielio4o 01 rrrn WV,U140 141p24$4(4040),derivoi
spoon
5374 SW Thurston Ln rfilitiP ir wrorc 0•A.,"F.-1-2',
1 ' aiir.ur mum irrideriald multi. oncupiinty.CitY/S111417IP: Tigard, OR 97224
0
_ . 0 stoirdiews braises. Ro::oyso,s4
SuirehIdgl,*', 1 Project mum:: n,rAr4trir.r.Irearfro'. [7.4'pp iz*0 iJet !or rr,nr rho
,,.....„,,,,,,,,,, ., ,, !40 i Int,aprrrrul
-•
Cnitcs stroetidireelions to ja site: ,
FEE' ti(HEDE11- .
IIti.iesSurian -raii.r riii"--1-..-T,X;i1' 'S".
Subdivision: Lot Ji: New resodernal su umn ktk-or It,-banily ditching usu.
Includes attached garage.
I OK,ril or, ar Irso I MS 4.4 4
Tu systirOpwrod#
61.&if!±.01.1 sq.ft.or fOltql0 j.k.t12 1
--,........-o _ ,DESCRIPTION OF WORK lountal energy-,riskitnual
75.1X1 _
(wall 2y.4.4[N,....k) .
Rewire portion of the home due to fire daMageS.,_____ '77-"uiledeacrfly.untinAmily
73.00 2
Al?.P:rt) E LC-2.b2. ,1 "'" 00.L0E CD rcrillenizil(with*bow ra,ft) _
Renewal*Form CI Sht Paw 2
0 PRI/PPRII OWNER ,,,,, 1 LI TEN ANT Services or Steam toseillaties.obtrudes.ooletror relocaboo 4............
Nem:. Moms or less i(10010 2
..- - --r. --....-.
MI amps so MO amps 11336 2
Address: :
401 Ames so Winos 20034 2
CityiStatgaIP: 601 struts Ici I,C00 ruiroi 301.011 2
____----. ...---.-- ......
Phoor.( ) Fox-I i Ovci 1,000 murk ur vats
L-- 532...16 2
lorry survives or kl'41erSlostallaries,sideratiole.weeks
Entail: . reformisms
Conner installation:This inViallathro is being made VII property that I own which is WI ; MO arnPt.CC 1--a• '5401K; s
eniended firn see,/misc.rein.I.,t,,-KI:11:01g1r.:11:1:11/311111 ill ORS 447,449,670,and 7DI, MI arms no 4C0 arnr6 12:‘,1* 2
,
401 amps roo 2499 amp*, I ISE.54
t›tAL.'n!r Ci17111101'P' 1 Elle 2._..!
— ,,... PPLICANT Li co; TAtc-r ioN
! Breach stimulus-WON tottersidets,or essonision, pool
u AN rtzs
I A.fur fin tumuli(instils us&
iiii.:;ins...Y.ram.' 0.C4 4', K,C.L...v-v-t(4.C 6. II- 18 7.4: 133.56 z
,— 1 zilch bate.i;Ittfttat/
(4)1113:..1 tlat:nt!' B.14r..' Iteieloth toits',Minna
, hCCVIIX 41.kola'ler.fie.:
K
"Ire". i(CO1C) 4-S . .0 Le W61.44 kir.srch rarrirr 5tt IR "1
' Eses WWI bona mrriiii 7 4-2- z
City/Slasef73P- _C)r ef etto, a-logs-
,,,..)k,-- : allisetilueous(StrVile 441.feeder see lociudeed
PIK2L...t1§0 31 (231 - 2 47 kr--.., 4:nx:;54131 fc.,3 72 -?...44"2-I ' Each owe'.eiAriond or ruxeiler
67144 Z
dertIlaig,stroitt eodor leaky
..........
ErnMI:
itoetionco pub 0%34 2
,s
C ONT RAC I OW Pump nr rin/odium ultk 67.34 2
Sirs in ortline ROMs 37 34 2
BLINWCb3 Mailt:1,1).0 CkarY.Ict-5_,--- Elf..-Cetr-1--C-
-t- Signal rircuir4 r)or lirrairlrf 0 Sr paw 2
Address: 1 (0010 ,....j fle oleo%aitegrion.or otpcioAno.
._
CILY'IStatlant-0 reltih (4- it i)r,..j1a212A-C)tit c
1/ 1 Elea addiSpersal inertdos oror allooublt IS oily et_def.Jeker....,,
&Libitum!isimecliirs f t litr nun) 6611.
ral"--4 5V9 to°6`41-- 12-91'Le) l'""-(-D3) 409.'2 - '2_4 2-I Irrivoigelion(1 to neeI W01W1,
--.—.
trxliurtlial plant I I ler mini 78 I tir bit
Erne!: S er v, i U...
Oa L,Eka riel.et 5 e.,...i e r*kr I el, .I.-bilei inscek.lir which nu fer is
.rilo.r V Isr
CUB i.le_ 1(01 a.13 Licvmai Ls:. ..i. .. le"I lyu- ro.1........„r5e,,e,}is -,,,,I.-1,,1'5"e.'hr m'1
-- ILLECURICAL rkitNui TrEEN 1
SuFrv.Hes:Irk-ran swsature.require& l ...77- 1,J -.
•(4,,(yel
son.A.d: 133.56 .c
Prins mune: ST,D1± Jr)irk vl&-i-Dri 97eit:
i....1
Li Plan P,:-..Ice oteerol(25:14.ellf.Fsat
St.,lc%to itunyt(I 2%,ot perriur.IL.,:i. 16.03
i...................._.. ._,
ToTAT PLIIMII FEE..
149 59 Aualicuizixl sigstourtl, Ja. • c...t1/4„-_,
,,....,
_ T..WI's&apelitiMispf,(-Vitt)if 0 peretil I)Oporrbi;;;;;4 4.0040 lib
Prins nom:5 col.4. j:Dit rs Ir..,-,r1_1±......_ig: 4wyr air(it 1444 114441 af4v1;4•4 al.retards*.
1 r , -, -4.3-re .. • sortahrr nt unpochano allow:4m ncrent
iCtkilitrentroitO,Ftt Pnot41400 Flit V11:4 dre kn,iavi'VX,I4 4:1-441STi I 14tiAt411'Wttl
I