Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00170
` . Date Issued: 04/15/2010
TIGARD,, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 1S134CA08800
Jurisdiction: Tigard
Site address: 11136 SW 118TH TER
Subdivision: FEHRENBACHER NO. 2 Lot: 7
Project: Lyons
Project Description: (1) branch circuit for heat pump
Owner: FEES
LYONS, KEVIN Quantity Description Date Amount
11136 SW 118TH TER
TIGARD, OR 97223 1 crt Branch Circuits 04/15/2010 $56.18
wo /Purchase Service or
PHONE: 503 - 734 -6261 Feeder
1 ea 12% State Surcharge - 04/15/2010 $6.74
Electrical
Contractor:
HILLSBORO ELECTRIC LLC
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 -439 -9666
FAX: 503 - 601 -3680
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 wit
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:
Permittee Signature: 'A-/ /97 / ! ° 6 7- (J/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.
CaII 503.639.4176 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.
From:Hillsboro Electric,LLC 5036013680 04/13/2010 22:21 #517 P.0021002
' 1 CEIVED
Electrical Permit Application APR 1 4 � , . ^ : � ,, * „ ,„
i � { ���C� ` . � r�C'tm. I . ^ I s I aka ' '� � 4 Ew*�t �. .
r iF City Of Tigard Received
CITY OF TIGAR 1 H aw s : �'
"""� 13125 SW Hall Blvd., Ti ?� �, J g/ R .Co20 4 - DD/
� , Tigard, OR 972 9 5 /0 ,��� Pamrt No.:
Phone: 503.639.4171 Fax: 503.598.15 ILDING DIVISI b la
� ,
i`'? �= w� Inspection Line: 503.639.4175 pate/B Other Olt:/`/ EC . 0 _ 1 • 3 J � 4':
o
Dam ReadyMy:
� i 6'ytdmiw4 Internet: www.tigard- or.gov Notified/Method:
11 • ®Sa P� 2 for
Sup ]nformatioe
TYPE OF WORK
❑ New construction ddition/aiteration/replacement Please check all that 1 PLAN REVIEW
app Y (submit 1 seta of plans whams checked below):
❑ Demolition ❑Other: 0 Service or feeder 400 amps or more 0 Building ova three stories.
where the available fault current 0 Marinas and wards.
CATEGORY OF CONSTRUCTION exceeds 1 0,000 amps at 150 volts or 0 Floating buildings.
Z§ and 2 dwelling ❑ Commercial/industrial 0 Accessory building let to ground, or s 14.000 El Commercial - use agricultural
amps for all other installations.
Multi - family 0 Master builder 0 Other: 0 Fire pump. buildings.
0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system.
13 Addition of new motor load of 0 °A
Job no.: ••1.2» "I -3",,
� 2U f Job site address: � . -Sk „ I C 1 ^ I r ( 6) 100 I•� or mime. occupancy. - -,
'
j / �r ^� 0 Six or more residential units. 0 Recreational vehicle parks.
City/State/DP: ` C ?�` / '2' *--- [ C L "C `2 0 Health -care facilities 0 supply J {6 upP Y w for more than
Suite/bIdg. /apt no.: I Project name: 0 Hazardous locations. 600 volts nominal.
0 Service or fender 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
naeADtbe 1 Qty. I Fee. J Total I •
New residential single- or multi- family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less
145.15 4
Tax map/parcel no.: Ea add'I 500 sq.11. or portion 33.40 1
DESCRIPTION OF WORK Limited energy, residential
(with above sq. ft.) 75.00 2
� - U r\t Limited energy, mu mitt'
residential (wiry shove aq. e) 75.00 2
Services or feeders inatallatloa and/or relocation
0
PROPERTY OWNER [] TENANT 200 amps or has 80.30 2
201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60
2
Address: 601 amps to 1,000 amps 240.60 _ 2
Over 1,000 amps or volts 454.65
City/State/ZIP: Temporary services or faders installation, alteration, and/or 2
Phone: ( ) I Fax: relocation
( ) 200 amps or leas 66.85 1
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 2
amps
133 2
Owner signature: Branch circuits — new alteration or extension, r panel
[] APPLICANT 1 0 A. Fee for branch circuits with
CONTACT PERSON above service or fender fee,
Business name: each branch circuit 6.65
B. Fee for branch circuits f0
Contact name: wt circuit
1 or feeder fee, 1 r
fast at branch branch ch circuit 46. 2
Address: Each add'1 brandy circuit 6.65 2
City / State/ZIP: Mlseellaneooe servlee or feeder not Indud .
Each manufactured or modular ■
Phone: ( ) I Fax : : ( ) dwellia :, servitx and/or fender 2
E -mail: irrigation Reconnect only 66.85 2
or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting al 53.40 2
Business name: HILI,SBOitO ELECTRIC, LLC Si m circuit(s) or limited -
Address: energy Pte, alteration, or
2118 5 NW EVERGREEN PKWY #110
eatensuon. 'be: Page 2 2
City / State/ZIP: HILLSBORO, OR 97124 Each additional •
pectioo over allowable in an of the above
P ( 503 ) 439 -966 Fa x: ( 503 )601-3680 Per 62.50
A ' VCCB Lie.: Electri Lic.: estigdion hour (1 hr min) 62.50 r J
13 4 4 81 3 4 — 4 9 9 Su prv. Lic.: 4 9 41 s � usirisi plant per hour 73.75
Suprv. Electrician signature required: ELECTRICAL PERMIT FEES 5 (v '
,( I � Subto tal: y 5
me: JOEY VITACCO l Date: C�...1 vt -I, Play review (25 %ofpermit fee): i II
Print name:
State lurch 12% of / r
Authorized signature: ( permit fee):
TOTAL PERMIT FEE :gg
Print name: I D om: This permit application eaplres it a permit is not obta „ .: 'thin 18 62".