Permit b 'lwn CITY OF TIGARD ELECTRICAL PERMIT
D °t:.. :'- COMMUNITY DEVELOPMENT Permit #: ELC2010 -00165
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/13/2010
'I GAV At 4 9 Parcel: 2S103BB06000
Jurisdiction: Tigard
Site address: 12580 SW 124TH AVE
Subdivision: BROOKWAY Lot: 60
Project: Maag
Project Description: Panel change
Owner: FEES
MAAG, WAYNE H Quantity Description Date Amount
AND ALTA L, 12580 SW 124TH
TIGARD, OR 97223 1 ea Services or Feeders - 200 04/13/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 04/13/2010 $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: l7t' L-(I it Permittee Signature: i 1 / ..* l"-/
/
11
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.
Apr 09 10 04:10p Case's Plumbing 5032628251 p.l
Electrical Permit Application �� �, „ " ' °t� � ” �� t ° �
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MO' City !)1 T!g`slll ° 13125 SW Hall Blvd., Tigard, OR 97223 APR 0 9 2010 d Received Permit No.: / O - '( o(4, s
, r J D an Review
Date/By:
Plan
,+n + ; Phone: 503.639.4171 Fax: 503.598.1960 DatclBv: Other Permit:
, Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/73y: Jul • `C� H See Page 2 for
ail rwswint Internet: www.tigard- or.gov
BUILDING DIVISIO Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/alterati0n/replacement Please check all that apply (submit 2 sets of plans wlitems checked below):
❑ 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.
.o - less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
PI - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
AN Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
CI Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "£ ", "1 -2 ", "I -3 ",
Job no.: Job site address: a.,. 3 J `'a ' p ,�, 10011P or more. occupancy.
"`�+C, ❑ Six or more residential units. ❑ Recreational vehicle parks.
-- V City/State /ZIP: ❑ Health -care facilities. 0 Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg.lapt. no.: roject name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site:
FEE SCHEDULE
Description LQ ty. I Fee Total
New residential single- or multi- family dwelling unit.
"\Gt-.P c dd Q (I) S S 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
Limited energy, multi- family 67.84 2
It . /..__! • J. a. _ residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less I I00.70 tot 7d I 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: eh 401 amps to 600 amps 200.34 2
1 , ``` 601 amps to 1,000 amps 301.04 2
Address: `'ae «� C �`� QL\Ac`' - \ Over 1,000 amps or volts 552.26 2
City/State/ZIP: -..-\ Temporary services or feeders installation, alteration, and /or
relocation ___
Phone: (.21d , 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 extension, per panel _
Owner Signature: . Date: A. Fcc for branch circuits with
$APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: c`� �tY 0` '1.„.a.:-:‘-- C ,
,, B. Fee for branch circuits
` ` without service or feeder fee,
Contact name: :_t 1
C`. L1'l - \ - C)r 1 first branch circuit 56.18 2
Address: �. ' - C .•C:-1 Each edd'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
pr-�- QCIL- Each manufactured or modular
City/State /ZIP: `0i1 G� n 1 ' 67.84 2
dwelling, service and/or feeder
Phone: P1 -1C, _Fax:: (,3) _ a .1 � t Reconnect only 67.84 2
E -mail: C Dr y .I rac -I- (P eas -e - 9 f { . LUNI r t Cl < f'\\ Parnp or irrigation circle 67.84 2
CONTRAOR Sign or outline lighting 67.84 2
Business name: 1 1 P ) ' r te ( i % t ! f „ lrlC, Signal circuit(s) or limited -
�lJ. '1 energy panel, alteration, or
Address: 0 s `X extension. Describe: Page 2 2
,
b City/State /ZIP: 1 - Ck.fi c 4
1 rr _ — �^�[ lcj Li Each additional inspection over allowable in any of the above
1 Per inspection 66.25
Phone: ,-y r el ! L Q Fax: .
X11 ) 2 -n1"'4 " " 7 4 b f CY ^� �'� - 53,) l `
Investigation per hour (1 hr min) 66.25
o CCB Lic.: }y - Electrical Lic.: C 7l _: Suprv. Lic.: LO 195 Industrial plant per (tour 78.18
C, ■ - ` ° ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: J, (... / " /fib
i � Subtotal: /0
Print name: ->a 12_ ,,.. h---.-0 VI Date: 4:/f i (�j Plan review (25% of permit fee):
( State surcharge (12% of permit fee): ) b g
Authorized signature pf i� L� - �j TOTAL PERMIT FEE: f ( a , "7 g
Print name: 1 , e 0 r k i.e. L eh ` f /j This permit applica aspires if a petwit is not obtained within 180
Da te: ✓ days after it has been accepted as complete.
• Number of inspections allowed per permit.
L1 BuildinglPemrits \ELC- PermitApp.doc 10!01!09 440- 4615T(11 /05 /COMJWEE