Permit V ; --1 -' - -'a CITY OF TIGARD
ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00652
I T t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
Parcel: 1S134DA09100
Jurisdiction: Tigard
Site address: 11380 SW THUNDER TER
Subdivision: Lot: 0
Project: Fannie Mae
Project Description: Electrical reconnect.
Owner: FEES
FANNIE MAE Quantity Description Date Amount
12725 SW MILLIKAN WAY #100
BEAVERTON, OR 97005 1 ea Reconnect Only 12/10/2009 $67.84
1 ea 12% State Surcharge - 12/10/2009 $8.14
PHONE: 503 - 936 -5752 Electrical
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 a • • - • - ith 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 -w -•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 9� 1 -010s. • may obtain a copy of the rules or direct questions to OUNC by ca :ill! r .246.6699 or 1.800.332. • 44. * •
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Is sued By: / � . d 1 Permittee Sig • re: e! ' . % �����V i �
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.
12/09/2009 14:02 FAX 5036265137 CB BSSP BEAVERTON Lj001 /002
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.erectrical Permit Application �` City of Tigard
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NED Received By �� 7 l `.3 J�0�s/�-
��� 1 1 ILL Permit No.: Lr, B�
° 13125 SW Hall Blvd., Tigard, OR 972 ECE Plan Review [[[ ` (is..),
:•'' ti 1 ' Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
Inspection Line: 503.639.4175 DE C 0 9 2009 Date Ready/By: un
y: Jun IA See Page 2 for
tfl D P •i: Internet: www.tigard or.gov Notified/Method: 17 a Suppleme
�4 4 i ' t _.t., - i t `t a" n � .v ( 1, �s.ls � �R.�� - � ., .�s'�(�: t 1 � a vw " - - a' k u � , ve -S , la rrn�+• u ' ; .t t r .J p k d t' G � . ,' a3
1 o- - - z.1 1s '43 'J -'h?' ` ,f, .: K i ' i x " ' 1?a4A.4.1 ' * 1 �. t .. mouir. m i! ,,,, ,�v . u., at1:. 'vpd., i . .
❑ New construction ID Addition/alt:!.. ti " . , , .1 . ' Please check all that apply (submit 2 sets of plans w liter is cbedced below):
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❑Service or feeder 400 amps or more ❑ Building o m three stories.
❑ Demolition r:' Other: where the available fault current ❑ Marinas as d boatyards.
�y¢ ; R c� .r ' < U c�7*�'�15 ; f r; : + IM tarry M (', "' 't' r . q � �, • exceeds 10,000 amps at 150 volts or ❑ Floating In uldings.
+ WI .tNb tlillatG:. ieilksT.t�f e' - , �fi�J'7i tP.5 a?.'....l S i t , 1, SPly 'L-.ra: ' � i'.4' :'.:-
less to ground, or exceeds 14,000 ❑ Commerei tl-use agricultural
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installatiot of 75 KVA or
,+ 1y f p , 73 C ��� 1 T. @. t F s z � a r ,, ❑ Emergency system. larger se rately derived system.
g�, i. gili s.la: 4 .;, ' .
n : ( ?t; l„)�„ � . F j ( a 1 { •'"i v•:,a r_ �;4' p: Addition of new motor load of ❑ `A 6 > 1.2 1.3"
. .z _hni � li fX1.XC17a2 :;Zb ni 10011P or more. occupancy
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Job no.: Job site address: // ? 6 U 5a) 77,1ifia'/r1 den ❑ Six or more residential units. ❑ Recreatior al vehicle parks.
City/State/ZIP: ❑ Health -care facilities. ❑ Supply vo tage for more than
ty /State/ZIP: �/ t�ij t f CJ� y 1 ' ['Hazardous locations 600 volts 1 ommal.
Suite/bldg. /apt. no.: �! I Project name: ['Service or feeder 600 amps or more
oo . Qty. . Fee. � „ :• 1 ...
job site: fDrt/ ! � o& / hi 2/ 7 � Description
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Cross street/directions to rata! •
r /• New residential single- or multi - family dwellttig unit.
(A 7/2(1 TeiG'm 2`1 1D f � t ,&)? /7) Mina24 fMtr Includes attached garage.
Subdivision: I a/0 fQ �CI�S I Lot no.: 2 Lii 1,000 sq. ft. or less 168.:4 4
Ea. add'! 500 sq. ft. or portion 33.S 2 1
Tax map /parcel no.: a 71/ ,....,_ Limited energy, residential
e .lt rip i twt , �; s ref',Fi �r .t n ` "r" a a� r44.1r 67.1 2
0? 1sa : ;�` sgli ri 4 e ig tact! ::: -, � . ; b ( with above sq. R.)
Limited energy, multi - family 67.14 2
b e 7 f ) ? ��D(- CI- -isir /ga '1 1 residential (with above sq. R.) _
r�-x C ! i ri � J -,C Services or feeders installation, alteration, any I/or relocation
200 amps or less 100.'.'0 2
'• 4 I ` 16_ }_i . . 201 amps to 400 amps 133.: 6 2 4.
Name: & Heil th T J2/21./ t7)Ga/ 401 amps to 600 amps 200.:.4 2
601 amps to 1,000 amps 301.14 2
Address: JO ' Z 5 510 /99//1",1471 Ali UZ Over 1,000 amps or volts 552.::6 2
City/State/ZIP: f aC a ✓P art v q ? 5 7305 Temporary services or feeders installation, al aeration, and/or
relocation
Phone: ( ) 9.z, - 9,5.- a 1 Fax: 66.5)53q - --7.--e--4i 200 amps or less 59.:16 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125!18 2
intended for sale, lea , rent, o exch ge, a ord ng to ORS 447, 449, 670, and 701. 4 401 amps to 599 amps 168.:
Bra nch circuits - new, alteration, or extension, per panel
Owner signatur • 4 Date: A. Fee for branch circuits with
{ 1 , M ,. F T , n z T "r l :1' c t r t . r` () a bove se rvice or feeder fee,
is t �� �l u 7. 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 56.18 2
Contact name: first branch ci rcuit
Address: Each add'I branch circuit 7,12 - 2
Miscellaneous (service or feeder not included 1
City/State /ZIP: Each manufactured or modular 67.34 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only ( 67.14 2
E -mail: Pump or irrigation circle 67.34 2
tv k' L r-,N -, ' 7:igiam Sign or outline lighting 67.34 2
Business name: circuit(s) or limited - ()17- energy panel, alteration, or
Address: extension. Describe: Pagi:2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 78.18
, � � eYi -'-• � �9TITE V >" SH a� ._ - ;, i '..' 4s .rr , >. � a�I,'`r
Suprv. Electrician signature, required: t Subtotal: 401 , (.1
Date: Plan review (25% of permit fee):
Print name: 1 State surcharge (12% of permit fee): k' l y
Authorized signature: TOTAL PERMIT FEE: 7.5 q
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as cot apiete.
• Number of inspections allowed per permit.
I :\Building\Permits\ELC- Permit App.doc 10/01/09 440 - 46157(11 /05 /COM/WEB