Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00169
Date Issued: 04/15/2010
T1GARD` 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110AB00600
Jurisdiction: Tigard
Site address: 14295 SW 112TH AVE
Subdivision: COLE'S ACRES Lot: 7
Project: Wolfers /Morris
Project Description: (2) branch circuits to reconnect gas furnace and wire for A/C.
Owner: FEES
MORRIS, LELAND G & URSULA W Quantity Description Date Amount
14295 SW 112TH AVE
TIGARD, OR 97224 2 crt Branch Circuits 04/15/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/15/2010 $7.63
Electrical
Contractor:
ENGELMAN ELECTRIC INC
PO BOX 451
HUBBARD, OR 97032
PHONE: 503 - 981 -8041
FAX: 503 -981 -4026
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. /
Issued By: " ' / Permittee Signature: t9N �, Lie-4 1- 77 0 f∎/
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.
CaII 603.639.4175 by 7:00 a.m. for an inspection that business day.
Thls 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 Applicati FOR (,rrlcF USE ONLY
C ity o f Tigard D E CEIVED Di CW "' ed PermitNo.: GG D — > /6 n 1 3125 S W Hall Blvd, Ti gard OR 972
Phone: 503.639.4171 Fax: 503.598. ]in 1 3 !• r. DateB Other Permit:
T I GARD ins Line: SU3,639 n Date Ready/By: fr1 See Page 2 for
Internet: www ngard - gov Notified/Method: EMI Supplemental Information
1. Typr PLAN. REVIEW:. , ...
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (suhmit 2 sets of plans wlitams checked below):
0 Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: d .
,i:a:i i < CAOGbRY ; CONSTRUCTIOI\I exceeds 10,000 a arnpe at 150 150 or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Cotntucroial -ttse agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑Accessory building amps for all other installations buildings.
Multi- family [] Master builder Other: less
ptunp. ❑ Installation of 75 KVA or
y
„r r. I° ❑ Emergency system. larger separately derived system.
9B : e#,E 7 2,401:***ION AN 15 LO- 1 �1 ° '
❑ Addition of new motor load of ❑ "A ", "E ", "1.2", "1 -3 ",
Job no. Cob site address: �/ , 1 / , V � - 100HP or more. occupancy.
�L/✓ / 1 / ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: f' 0 (� ❑ H azard cnre fatuities. ❑ Supply voltage for more than
I J�1./'' 0 locations. 600 volts nominal.
Suite /bldg. /apt. n Project name: ( ) , e rs i c f ❑ Sct or feeder 600 amps or more.
It
CroSS street/directions to job site: nests teen Inv. Fee. I Total •
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'1 500 sq. ft. or portion 33.92
Tax map /parcel no C) , 13 A-3 OQ ( a) Limited energy, residential
i i d rl ` WPfti ■ 67.131
` .. '.' J .� i� V/ES�li 11QN �'.�9 \' hJ ' H � �;i :7';'0,;,i':,,':..,•,: with above s. ft
(�- CO i mited energy, mult - fam 67.84 2
t 1 No � S Cyr ) ace (, ,ire Cl) C.2 residential (with above sy. ft.) ,
/ C t f Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 I 2
❑` PRO !ERT ovir R „ ,• 't 1` r r" ❑ TENAWT' i ;x' 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: /`1 d/ /S, 7.41 '{ Gt ig5c61 k ,
60t amps to 1,000 amps 301,04 2
Address: , 6— 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 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature; Date: A. FCC for branch circuits with
' `r 0 4P 'ICANT "` "(; r i .:1; ;❑,!CONT PERSQN ` f ; above service or feeder fee, 7.42 2
; : each branch circuit
Business name; B. Fee for branch circuits without G
service or feeder fee, first I 56 l 8 .5- , � D 2 Al' r Q
Contact name; branch circuit _ 0 V
Each add'l branch circuit i 7,42 7,11;4. 2
IF Address: Miscellaneous (service or feeder not included) A
troth manufactured or modular 67.84 i r k iV"
dwelling, service and/or eeder
r
Phone: ( ) F :: ( ) Reconnect only , 67,84 2
E or irrigation circle
'4,`r', , . • . .l? ONTIYA O$ w:.'., a Sign cis outline lighting 2
Pump o rrigat on I 84 p
S OP
I
� Signs] cimuit(s) or limitcdtncrgy ■
Bu Warne: �/ I elks panel, alteration, or extension. Page 2 2 I
1 7 4p11� r� 0 E / el 1 { C, fob r, Each additional ins t ection over allowable iu anv of the above �(
Address: ! Additional inspection (1 hr min) w 66.25 / hr • t
City /State/ZIP: ,� ' Investigation (1 hr min) 66.25 / hr '9°1 �-1t�.� 1 0 �i lndustrisl plant (1 hr min) 78.18/ •
hr •
'hone: t aril Insp• ec t ction s call for which stcd (/a hr no min} I
fee is
It /!l �. ,� y (I► / s El 90.00/ hr II 0
j7�, fi h
'\ CCB Lie.: r = i J Suprv. Lie.: _ n ,' • ELECTRICAL'',PERMIT'.PEES
Suprv. Electrician signatur- , q , fired. I. 1��� ' A /0 p _ ' e permit , 0
t.4-.: (
Plan review 25 �o of omit fee
Print name: `i 1 EM MEN" Date: `--t,- I — State surcharge (12% of permit fee): rf , G
Authorized signature: TOTAL PERMIT FEE: '7
This permit application expires if a permit is not obtained within 180 L- ----
Print name: days after it has been accepted as complete.
Date: + Number of inspections allowed per permit.
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