Permit
` CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2009-00574
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/29/2009
Parcel: 1 S135CD03300
Jurisdiction: Tigard
Site address: 9660 SW LEWIS LN
Subdivision: Lot: 0
Project: Orr
Project Description: Add/alter (5) branch circuits for kitchen remodel.
Owner: FEES
ORR, LYNART Quantity Description Date Amount
9660 SW LEWIS LN
TIGARD, OR 97223 5 crt Branch Circuits 10/29/2009 $85.86
wo/Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/29/2009 $10.30
Electrical
Contractor:
PACIFIC NORTHWEST ELECTRIC INC
PO BOX 310
OREGON CITY, OR 97045
PHONE: 503-657-1188
FAX: 503-722-9058
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 through OAR 952-001-00110010. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permittee Signature: ZIV- `~~,'06 / C4-70 ,,V-S
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' Date:
LICENSE NO.
Call 503.639.4176 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
c, FOR OFkCE USE ONLV
00
,6 l0 Received
City of Tigard ^
113v: ~y/, Fermi Kn.:
P13125 SW Hall Blvd., Tigard, OR 9722 Q° n Review
Phone: 503.639.4171 Fax: 4_-03.598.1960 lDaare.B : Other P wit:
s Inspection Line: 503.639.4175 ;lG~ Date ReadylBy. icri ® See Pnge 2 for
Internet: %%WgCtieard-oI.goV No:iticc ~te:hod: oel Supplemental lnrormatlon
TYPE OF FORK PLiLN REVIEW
❑ New construction Addition/alteration; replacement Please cineck all duet apph• (subtnil 2 sels of plan=-- wjitetns checked bclo•.v):
I❑ Service or feeder 400 amps or more ❑ Building over three s:ori_s.
❑ Demolition ❑ Other:
where dte avai[ah,o_ fault current ❑ ]Marinas and boatyards,
CATEGORY OF CONSTRUCTION exc.cds I C,000 amps at 150, olts or ❑ Floating buildings-
less to ground, cr exceeds 1 000 ❑ Commeretal-use agricultural
1-and 2-family dwelling ❑ Commercial/industrial E] Accessory building awpsforalloth.erinstallations. buildings.
Multi-family' ❑ Master builder ❑ Other: ❑ Fire pump. ❑ insinuation of7'_ KVA r
JOB SITE, INFORMATION AND LOCATION ❑ Emergency system. larger sepa alely derived system.
❑Additionofncwrnoicrloadof ❑-'A","E'•,'•I-Y',"1-3",
Job no.: 1 ]017 SitC address: IDMI1or more, occupancy.
" LOis E] Six or more residential units. ] Rec-eztional vehicle parks
City/State/ZIP: f L] Flealth-care facilities. ~ S.rpply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitetbldg./apt. no.: Prgjeci name: ❑ Service or feeder 60C' amps or more.
FEE SCHEDULE
Cross street/directions to job site: ue«rl Lion n•. Fca To al
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168 54 4
Tax map/parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK 60111 above sq, rt.)
Limited energy, multi-family 67.84 2
residential (with above sq- R.)
Services or feeders installation, alteration, and,'or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ~ ❑ TENANT 201 amps to 400 amps 133.56 2
Name : ' r1C{~ ~ r 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
.Address: Over 1,000 amps or volts 552.26 2
City/State/Zl P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) sr 2~ Fax: ( ) 200 amps or less 59.36
_3
Owner installation: This installation is being made on property that I awn which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, -cnt_ or exchange, according to ORS 4477. 449. 670, and 701. 401 amps to 599 amps 153.54 2
Owner signature: Date: Branch circuits- llcw'. alteration. or extension, pp Panel
A. Fec for branch circuits -,With
DIAPPLICA.NT ❑ CONTACT PERSON above scrvice or feeder fee.
h n,- each branch circuit T~2 2
Business name: [j - let `TTx ~ t -~'L B. Fee for branch circuits
Contact name: ~y.t-x (LtA 1'►11 rQ Z without service or feeder fee, 36.18 S(D f tj o
first branch circuit 0
Address: PO QJ'x 3)0 Each add:] branch circuit 7.42 2
n_ Miscellaneous (service or teeder not included)
Cit};'State'ZIP: Or (~2 -1Q~~ Each manufactured or modular
dwelling, service and;or feeder 67.84 2
Phone: Fax:: (~b3 )17-2- - a $ Reconnect only' 67.84 2
E-mail: h, Q C 1• -6pc;- c Ct} r t Pump or irrigation circle 67.84 I 2
CONTRACTOR Signor outline lighting 67.84 ?
Business name: Signal circuit(s) or Iir„iied-
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State/LIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
rhonc: I/ Investigation per hour la utiu) 66.25
CCB Lie.: Electrical Lie.: Suprv. Lie-: Industrial plan: pcrhour 78.18
ELECTRICAL PERMIT FEES
Suply. Electrician signature, required: Subtotal:
Plan review (25%ofpermit fee):
Print name: 3-6" rn i Ae 27 `j
State surcharge (12% of pemtit fee): 1J0 , 30
Authorized signature: TOTAL PERIv11T FEE:
~ lD
Print nainc: S~wj This permit application expires if a permit is not obtained within 180
F-~~l• 11',1 f L'2 Dat2' days after it has been accepted as complete.
Number of inspections alloyed per permit.
I',Buildine_'•1'zrmii?ELC-Pemin4pp.doc Ai01/09 440-e6 t5T(11:05iCONU1t'EB
Z•d 6088£ZL809 buigwnld PueIIJOd eZ8:80 60 LZ 100