Permit CITY OF TIGARD ELECTRICAL PERMIT
$ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00672
iT [GfiRL? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/23/2009
Parcel: 1 S 136CA04600
Jurisdiction: Tigard
Site address: 10990 SW 79TH AVE
Subdivision: FRIENDLY ACRES Lot: 2
Project: Combs
Project Description:
Owner: FEES
COMBS, TYLER Quantity Description Date Amount
10990 SW 79TH
TIGARD, OR 97223 1 crt Branch Circuits 12/23/2009 $56.18
wo /Purchase Service or
PHONE: 503 - 545 -4177 Feeder
1 ea 12% State Surcharge - 12/23/2009 $6.74
Electrical
Contractor:
DJ ELECTRIC LLC
PO BOX 90126
PORTLAND, OR 97209
PHONE: 503 - 882 -4933
FAX: 503- 828 -9904
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $62.92
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 acc• • - • -_ ' h_ 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. A TION: Oregon law requi = you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 through OAR 952 -001 -1 •0. Y•u m— •btain a copy of the rules or direct questions to OUNC by calling 503. 6.6699 or 1.800.332.2344.
I s . , - . By: _ Permittee Signature: r IM19/1)
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' fir r Date:
■111/.1..1•1■ r 7
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 FOR OFFICE USE ONLY
City of Tigard Received e : ®D � ra o 72
Permit No.:
• 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I GA R D Inspection Line: 503.639.4175 Date Ready/By: t � ;./ El See Page 2 for
Internet: www.tigard - or.gov Notified/Method: "" Supplemental lnformation
TYPE OF WORK PLAN REVIEW
❑ New construction 34 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 stones.
❑ Demolition ❑ 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
❑ 1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION � I ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.: Job site address: I0 'r^ 100HP or more. occupancy.
99 0 S w 79 ❑ Six or more residential amts ❑ Recreational vehicle parks.
City /State/ZIP: cp. 2, 2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ 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: -}. { q + Description 1 Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
ruvrt,4*, Limited energy, multi - famil 67.84 2
r�' fzC4 r� C-t—. , residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER f ❑ TENANT 201 amps to 400 amps 133.56 2
Nance: 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/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 antes to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ' ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, l 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: 1 Lci ( c_ LLG Signal panel, or limited -
energy panel, alteration, or
Address: PF 0 � ( 1 26 extension. Describe: Page 2 2
City / State/ZIP: 9 L o + R , —207' Each additional inspection over allowable in any of the above
t Per inspection 66.25
Phone: (6 g82._ - 4 ?33
vi/ j Fax: ( ,w, 28... (j'0 Investigation per hour (1 hr min) 66.25
"•19
CCB Lie.: i g 0 5 Electrical Lic.: C5 6 ,C Suprv. Lic.: 4? 2( S I ndu strial p lant pe r hour 78.18
,'o /, (, o ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 5( i g
( x • Ng'
Print name: I 1 i (.0 Date: r Z _2_3 C9 Plan review (25% of permit fee):
/ State surcharge (12% of permit fee): ( 7 y
Authorized signature: ,a, TOTAL PERMIT FEE: � � 4 `2
This permR application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.