Permit q CITY OF TIGARD ELECTRICAL PERMIT
f; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00057
T 1 G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/03/2010
Parcel: 25111 CC04000
Jurisdiction: Tigard
Site address: 15990 SW CENTURY OAK CIR
Subdivision: Lot: 0
Project: Thomson
Project Description: Ground electrical.
Owner: FEES
THOMSON, NOREEN KAY TRUSTEE Quantity Description Date Amount
15990 SW CENTURY OAK CIRCLE
TIGARD, OR 97224 1 ea Services or Feeders - 200 02/03/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 02/03/2010 $12.08
Electrical
Contractor:
METROS BEST ELECTRIC
PO BOX 30075
PORTLAND, OR 97294
PHONE: 971 - 563 -9418
FAX: 503- 262 -8251
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 -0100. 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: C �0 fl Q� Permittee 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' ^ Date:
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.
Feb 03 10 12:29p Case' {I 1 WD 5032628251 p.1
Y
Electrical Permit Application i•,' i ` r . FOR O b``" • • - f ° n ° ' 4 ` - z °
R FFI 11 ONLY "' r ,- 9
k l:' City of Tigard FEB 0 3 2010 Receiver/ t Z :r a '/ t � /� Q „' .�
c . 1 and Date /By: C te201,V b � ,/� Permit No.. . 13125 SW Hall Blvd., Tigard OR 9 Plan Review � Ph one: 503.639.4171 Fax: 503.5980 OFTIG/�RD Dale/Bv: Other Pcrmit:pQm7/\t/9
lns s ection Line: 503.639.4175 Date Ready /By: lvris Se Pa e 3 l JJ �J� kJ
T�IGARD I BUILDING D IVISION , rot
Internet www.tigard- ar.gov Notified/Method: Supplemental information +
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit 2 sets of plans checked below):
❑ Nev construction ddctton /alteration/ replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other:
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
dwelling less to ground, or exceeds 14,000 ❑ Commercial-use agricultural
1 - and 2 -famil
y g ❑ Commercial /industrial ❑ Accessory building
Multi- family ❑Master builder ❑Other: amps for all other installations. buildings.
❑Fire pump.
❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑'71 "E ", 't -2 "I -3 ",
Job no.: Job site address: le�190 Sw ( 4 C , /ei OC t00t[P or more. occupancy.
/ J L i Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: �r 1 c � � � �� ❑Health -care facilities. ❑Supply voltage for more than
G( ❑Hazardous locations. 600 volts nominal.
Stc ire /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description Qty. Fee. 'total ^ --
New residential single- or multi- family dwelling unit -
m a.p r-c4 D s " 7 Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ti. or less 168.54 1 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
C /7 e' L _ r , Limited energy, multi - family
IF .C/►i� •C.. /� 4 ukt d residential (with above sq. fl.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less , 100.70 2
pPROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: �/ U,,,LS____ 401 amps to 600 amps 200.34 2
r v _ s �1 �J 601 amps to 1,000 amps _ 301.04 2
Address: f c l 0 .3 C.er/ fie r Oak (4 , -e-Le
Over 1,000 amps or volts 552.26 2
City /State /ZIP: J t/ q72 Temporary services or feeders installation, alteration, and /or
��� /// relocation
Phone: (%) 5--6. / Fax: ( ) 200 amps or Icss I 59.36 t
Owner installation: This installation is being made on property that I own which is not 201 amps 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
Owner signature: Date: . Branch circuits - new, alteration, or extension, per pane
-- A. Fee for branch circuits with
PLICANT
• AP J ❑ CONTACT PERSON above service or feeder fee,
Business name: (N - each branch circuit 7.42 2
-- V 1N Cc -) ` - F-\ :--LC Gw"i C-. 13. Fee for branch circuits
Contact name: withal service or feeder fee,
-w '`t el•-k_9"1 1 Cr\ first branch circuit 56 2
' ;Address: 1 • C! . Z,. `C - S I Each add'/ branch circuit I__ 7.42 ; 1
ILL x _
7 . Miscellaneous (service or feeder not included)
City /State /ZIP:
`C= •1.
- - \ - \ 0 CC G -Q__. Q C. Eachmanufactured 1
t dwelling service and/or or feeder modular 67.84 2
Phone:
111 473 i 61 Fax::(Jy� )
� ;--
Reconnect only 67.84 2
•
E- mail: (' 0(1 Cu': F ('QS 67.84 2
s _ _ 1 • y • � � ,y P ump or i rr i gat i on circle
CONT' 1 OR Sign or outline lighting 67.84 2
Business name: \i\ e t_ .,)' � � Signal circuit(s) or limited-
1 v( energy parcel, alteration, or
Address:
0, x tx c-i=5
extension. Describe: Page 2 2
City/State/ZIP: � --
` _. a C� C ( 41 r ''c' i • Each additional inspection over allowable in any of the above _
Phone: (G I 5 .6 1 Per inspection 66.25
11 �) - C L i Fax: (6 - Investigation per hour (1 hr min) 66.25
CCB Lic.: le.._\ Electrical Lic.: C_y'1 Suprv. Lic.:;y i cis f Industrial plant per hour 78.18
^�i ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: / /,_ .
Subtotal: %DO• - JO
Print name: �, ., , (-6,...,1,- 1 � r o Date: �. •Z w Plan review (25% of pennit fee):
r! Y- � s/ /• ✓ State surcharge (12 %ofperrnit fee):
Authorized signor e: OY�. GGiri`/'_- _
_ TOTAL PERMIT FEE: I l 7
Print name: • '.L - ale kuea' - Date: • .. /d This permit application expires if a permit is not obtained within 18D
days after it has been accepted as complete.
I.V3uildingTermitstELC- PennirA p.doc I0/01/09 ` Number of inspections allowed per pennit.
440 -4h I' T(1 1; 05 /COMAVED
6 'i. QQ.A.4