Permit -rrl CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00174
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 04/15/2010
Parcel: 2S 112CC20000
Jurisdiction: Tigard
Site address: 15714 SW 81ST AVE
Subdivision: GAGE FOREST Lot: 7
Project: Labert
Project Description: (1) branch circuit for A/C
Owner: FEES
LABERT, JEFF Quantity Description Date Amount
15714 SW 81ST AVE
TIGARD, OR 97224 1 crt Branch Circuits 04/15/2010 $56.18
wo /Purchase Service or
PHONE: 503 - 348 -8285 Feeder
1 ea 12% State Surcharge - 04/15/2010 $6.74
Electrical
Contractor:
FARWELL PERRY ELECTRIC
2536 NE 10TH AVE
PORTLAND, OR 97212
PHONE: 503 - 890 -2352
FAX: 503 - 760 -8498
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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: Ze Permittee Signature: 4A/ : f / c-/ ( X0/1,! /
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.
L.dtl V CU
APR-1,5 -2010 11:55AM FROM - p T -402 P.001 /002 F -710
irdiru ,I lt tt 3i, 1 �a u>taa n ..- .... -- R 1 5 2010 �.� -40
10.,1. a o fis . [received V Per,nit No.: / 0/ , O /
« = 44: City of A and nateJB
� '` 13125 SW Hall Blvd., Tigar Olei OF TIGARD Plan Revi
ether !'crmit:
r �ls Phone_ 5 03.639.4171 Fax: 5p D IVISION ma y:
1 ' Date Ready/By. urit ED Sex Page 2 for
r a Inspection Linc: 503.639.417 y1 & Supplemental Informs
:4:1 \ I ()! I
Notifced/Method: ) �n?r, „;:S�X:E!,:;� Internet www- tigatd -0r.gov
r • E OF WORK • PLAN RE
❑ New construction 0 Add
ttion/alteration/ Iacement Please check all that apply (submit b sets of , inns w /items checked be
❑ Service or feeder 400 apps or mom • Building over three star
❑ Demolition ❑ Other: where the available fault current • Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or P Floating buildings.
Tess to ground, er exceeds 14,000 r Commercial -use agricul
211 and 2 family dwelling ❑ Commercial/industrial Q Accessory building amps forall other installations. h of 75
ICVA
O Multi- family _ ❑ ID Fire pip
Master builder Other: ir
❑ F p. system. larger separately KVA •
JOB SI'Z'E INFORMATION AND L O C A T I O N D Addition of new motor load of • "A” "E ", - I -2" "1 -3 ",
' 1 1001•!P or more. occupancy.
Job no.: Job site address: 5 �- '-1 5 W . 1 S� Ate' 0 Six or store residential units. . • Recreational vehicle pw
❑ Health -Quo facilities. • Supply voltage for men
City/Slate/ZIP: ` �� r �f* c ❑ Hazardous locations. 600 volts nominal.
Project name: 0 Service or feeder 600 amps or more.
SuitePoldg. /apL no.: Pro FEE SCI•IED LE
Cross street/directions to job site: Descr,oli°n Iru gi MEM TWO
New residential single- or multi-Cam ly dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 s4. R, or less 168.54
LS, 2,dd'I 500 sq. ft or portion 33.92
Tax map /parcel no.: Limited energy, residential 111 67.84
DESCRIPTION OF WORK with above . t. ft,
Limited energy, multi - family 1 67 -84
I. residential (with above sq. R�
C.U� Services or feeders installation, site anion. and/or reloca
200 amps or loss 100.70
❑ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56
401 a mps to 600 amps 200.34
Name: - 601 amps to 1,000 amps 301.04
Address: Over 1,000 amps or volts 552,26
•■ Temporary services or feeders In :Batton. alteration, al
City/State/ZIP: relocation
200 fps or less 59.36
Phone: ( ) Fax: ( ) 201 amps to 400 amps 125.08
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168,54
intended for sale, feast, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits - new, alteration. o extension, per ' ant
Owner signature: _ hate: — A. Fee for branch Circuits with
CONTACT PERSON above service or feeder fee, 7.4Z
❑ APPLICANT each branch circuit
B. Fee for branch circuits without
Business name: service or feeder fee, first 56,18 '
branch circuit
Contact name: _ _ Each add'I branch circuit 7.42
— Address: Miscellaneous (service or feeder n ■ t included)
,_ Each manufactured or modular 67.84
City/Stait:/ZIP: dwelling, service and/or feeder
Reconnect only 67.84
Phone: ( ) Fes' : ( ) Pimp or irrigation circle 67.84
E Sign or outline lighting 67.84
CONTRACTOR • • • Signal circuit(s) or limited - energy
panel, alterdtion_or extension- Pa e 2
Business name: i4R-w 4i.-- ?1=r .LT E Lcarg L L Each additional ins 1 • coon over allowable io an of the
Address: 4/5 is Ns_ I / 1
n Additional inspection (1 Ihr min) 66-25/ hr _
p � t
investigation (1 hr m 66,25/ hr _
City /S(ate/ZEP: 'Pog.:r 44 14.),E) � I Industrial plant (i hr min) 78.18) hr
Phone: ( 5 81 0- 23 Z- Fax: ( 21/- inspections for which no fee is I 90,00/ hr
cifically listed 05 hr min
,/ CCB Lic.: 1 i ` 33 ✓ Electrical Lic.: - . �', Suprv. Lic.: 49 ( ELECTRICAL P RMIT FEES
d � Subtotal: 642
Suprv. Electrician signature, required: Plan review (25% of . • it fee):
—
Date: State •
Print home C� �,(, }? ' / / 2.
J TOTAL rE '1.1i�`
Authorized signature: This permit applimtioa expires if a rmit b not obtained wi
days alter Haas been a • pled as Goluplelau V /
Print name: Date: • Number of inspection& allowed per .4, it
1:1aud d ina1P ,:mi:w1Q.IG1'cm1 Mp P-
Joe 10/01/09 440- 4615T(1 t /a3 /COMlwES
Wl rah .n