Permit J
.: CITY OF TIGARD ELECTRICAL PERMIT
II
COM MUNITY DEVELOPMENT Permit #: ELC2009 00638
, Date Issued: 12/01/2009
'1 GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1 S 135CC04100
Jurisdiction: TIG
Site address: 10121 SW ALYNE LN
Subdivision: Lot:
Project: KRAST PARK
Project Description: Provide new 200 amp service, underground.
Owner: FEES
MILES SCHLESINGER Quantity Description Date Amount
11455 SW SHROPE
TIGARD, OR 97223 1 ea Services or Feeders - 200 12/01/2009 $100.70
amps or less
PHONE: 503 - 968 -6500 1 ea 12% State Surcharge - 12/01/2009 $12.08
Electrical
Contractor:
PRECISION NW ELECTRICAL •
12020 SE ANNA
DAMASCUS, OR 97009
PHONE: 503 - 413 -9870
FAX: 503 - 594 -2873
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in - - - - - • e with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. AT' NTION: Ore! •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -.010 through OAR • • d 11 -11 ; ., You may obtain a copy of the rules or direct questions to OUNC by callin• : . • •.6699 or 1.800.332.2344.
Issue. :y: , 1) �� �4_'i _Y Perm ittee Signat � # . a.i � ( °
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' � � �/ Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
11/30/2009 02:29 FAX PRECISION NW Z003/004
Electrical Permit Application r- -� -i toll i i I i(t 1� l_ tit ( I s, ,, •
�� ^� �t� R,eeeive .
ipli ••,. City of Tigard , ; RECEIVED Date/B 'i 0f 7 ' Permit No.: f4.d.?A0�/...pa&5$
a • 13125 SW Hall Blvd., Tigard, OR 9722, Platt Review
V
tip DaicJBy: Other Permit:
Phone: 503,639.4171 Fax: 503.598.1960
T t i � F U Inspection Line. 503.639.d -acg4v 175 NOV 3 0 2009 Date Ready /(ty , ry°'� la See Page 2 for
Internet: www.tigaru Natifi / �� Supplemental Information ,
; i iIF 1 �i �' , 1 , { ' . ' , 'p �. � ;.. ' r Aq, 1 " , pa - II, i t 1�1 , ` ' '� , ro d,. .', ,.,-;,....,7..,,,,..4004,,, .
i; lit i, 1 ,, , i"9i .'ii I ��((gg}�, to 4 y "�'J{f } y{ i,tult.,c ' r I
, ,,,,( .1 � A" ,∎. , , ;!1 '' .,,,,, ,�,, , , n . a, . ,t' iitki'diS[ti7i ,� �l 1.74X11! 9,4 ,i � l ' l o-1 �'4 , Y .f4.' 11,4.00' � , � "'" '► , 7� 2 : , . - + 1 = , ,,, A 1 ' '114' I .A ^ L., l , il:
�( 7 1 PIease check all that , (submit sets ❑New construction ti Addition/altcr��rrld ! . • , • ! � apply p y (bi 2 f lans w /items checked below
' plans
Service or feistier CCU amps or store ❑ Building over three stories
❑ Demol ition ❑ Other: where the ;available fault Current ❑ Marinas and boatyards.
.it l Iyf Y l I and dwelling 0 4 " � : -a^i .•*• 4,0't ° a:r 1 - less t o 000 ground, r e xc xce exceeds volts or
14 0 El Commercial-use a
� �' � �" �` � r .-^S ^°' • •• ' � ` � 1 ' l� �It less to Ftmuti, or eedk S 4,000 ❑ atinctdr
' Commercial/industrial El Accessory building amp% for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other ❑ Fare pump. ❑ Installation o f 75 KVA Or
Ng A , w., t r� tiaR tr ' e .7 t.. El Lmergency system. inrger Reparately derived system.
,i., ,;I r,;r.fa >? " i,, Iry -mar tlrl+.�+'+Mtnl�ia' :..r.,,:.>»�rc;Rrh�l �rc'���(rrtt.. �r I 7._ 0Addition of new motor toad of ❑ "A» "E", ,,t_Z.. _
Job rte.: Job site address: 1 0 2 f p p � 100HP or more. occupancy.
Aid! '+ �'h'4 ❑ Six or more residential units. El Rocrentionnl vehicle parks.
City / State/ZIP: • y so () Cm_ o1 'L, L6 ❑Health -tarn facilities. (� Supply voltage for tnOrc than
1 I T � - + ❑ Hazardous locations. 6vu volts nominal.
Suite /bldg. /apt. no.: 1 Project name: Matti ❑ Scrvicc or feeder 600 amps or more. I
... l Ig . y '.irWEE A4IL, x, /1 : b : *1�Ali,,-r,
Cross street/directions to job site: Description Qly. Pct. Total •
New residential single or multi - family dwelling unit.
Includes attached garage,
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax ma steel no.: — Ea. add'I 500 sq. it or portion 33.92 I
NP Limited energy, residential
' '`
1 !'4' Fly 1' �o�il' , I . . A , 9 °!i idly - a ^,, Ytti,t��,,I }} * ithbv
,�, waoera n. 67.84 2
/ r .. � , , ., , � ,'11'. .!- { , .., r. r w, , �a�la � ��:�.��.a�,,�l'>r,�t.p„ s1 �il� ( i�
Limited energy, multi - family
67,84 2
Pv∎•Nrfj`_ re.- S ./, c.4." residential (with above so. a.) ,
Services or feeders instaliation, alteration, and/or relocation
L) N O`t' v tt A.. !A — 200 arnps or less 100.70 2
'( U, "ti a ° filit� r • a ; 17 4 .,yifka. I +' } "tm�) W. a�r e h i4ollitu"> 4. 20 amps to 400 amps 133.56 2
Name: 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 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
Branch circuits — new, alteration, or cxtension, per panel
Owner signature: Date: _ A. Het for brunch circuits with
+ pl I' - ' " Y " e' � { `�" t' M ' ^ t �' ' i n ' it rid, ' above service or feeder fee
,'Tito „ t,. r ni r , W) L' f 1 1► .a.`, ? .,a t•. v ICI .mi A roO . P. 7.42 2
each branch circuit
Business name: B. Fee fur branch circuits
Contact name: r without service or feeder fee, 56.18 2
first branch circuit
Address: Bach add'I branch circuit 7.42 1 2
Miscellaneous (service nr fccder nut irleluded)
City/State/ZIP: Each manufactured or modular
—^ dwelling, service and /or feeder 67'80 2
Phonc; ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: - _... ^ Pump or irrigation circle 1_.— 67.84 2
ii 'H I t't1ng E d" 7S7 . y T r ' ,r" TAZZ ; "tw "�tR�'Yr� il° Sign or outline lighting 67.84 2
' r r�� t ' � . t� 1,u, sv,?e:'t�A,ris�: lws, '`tlaL# � '�,w k,.._.'..{i ,�a"Gl�a _ �'
Signal circuit(s) or limited -
Business Warne: .c_c_A S% -0,4 1ti/1.,N. e1E,C C .4
Address: { Lem 2 V S energy panel, alteration, or
tvi
extension. Describe: Page 2 2
tv,p' �.Ai �
City/State/ZIP: O , vA s S i at_ q - d V Cl
Each additional Inspection over allowably in any of the above
�� Phone: (so-$.2. Fax" Per inspection 66.25
fi A4 s—qe 7 /' / rr (9j , )L5 j cI 4 15 1 3 Investigation per hour (1 hr min) 66.25
r Q CCB Lie.: (t 3,C� Electrical L _71 Suprv. Lic.: s)-3 5 ✓ Industrial plant per hour 7818
Suprv. Electrician signature, required' �� A.,/6 Subtotal (j ,'� _
Print name: {� �/'� Date: C Plan review (25 % of permit fee):
1 � Q � � `t,� � � V l Q 1 State surcharge (I2% of permit fcc):
Authorized signature:
" 1 ' C./
TOTAL PERMIT FEE: it -2 -1 oith
y ��
`, This permit apDtirrltion expires if a permit Is not obtained within 1
Print name: ,l L , �� A 0 Date: t ` -3 L1 09 days after it has been accepted as complete.
• Number of inspections allowed per permit.
1;\ Building \Permits \CLC-Penni;App.doe I NU1 /t' 440 4615T(I /05ICOM/W1 B
11/30/2009 02:29 FAX PRECISION N4/ j/ 1 L,C L 8 E 004/004
Electrical Permit Application — City of Tigard n Protective Signaling
Page 2 - Supplemental Information Other
LIMITED ENERGY PERMIT FEES: Total number of commercial systems:
�y ojiq It
, y l }}((,1 r y p , *No licenses are required. Licenses arc require,
�� „�}.� "dul. � » li• .f, �. �+�'itrW ils^7; � # P,,*
:UN
for all other installations
Fee for all residential systems combined.... • • • . $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
n Burglar Alarm
1 Garage Door Opener*
E Heating, Ventilation and Air Conditioning
System*
7 Vacuum Systems*
n Other:
f a
Fee for each commercial $67,84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
E Audio and Stereo Systems
n Boiler Controls
Clock Systems
I I Data Telecommunication Installation
Fire Alarm Installation
h HVAC
L Instrumentation
Intercom and Paging Systems
• Landscape Irrigation Control*
n Medical
I Nurse Calls
❑ Outdoor Landscape Lighting*
1 1BoiIdirto crm;rpr.t .GrecmiLApp.(loc. 11,/01/09