Permit , r ELECTRICAL PERMIT
CITY OF TIGARD
° Permit #: ELC2010 00205
I
2 -` - COMMUNITY DEVELOPMENT
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/29/2010
T1GARl3 Parcel: 2S103CB01300
Jurisdiction: Tigard
Site address: 12355 SW JAMES ST
Subdivision: Lot: 0
Project: Tabor
Project Description: (1) temporary service.
Owner: FEES
TABOR, KRISTEN E Quantity Description Date Amount
12355 SW JAMES ST 1 ea Temp Services or Feeders - 04/29/2010 $59.36
TIGARD, OR 97223 200 amps or less
PHONE: 503- 807 -8789 1 ea 12% State Surcharge - 04/29/2010 $7.12
Electrical
Contractor:
JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
PHONE: 503 - 648 -5144
FAX: 503 - 648 -9723
Type of Use: SF
Class of Work: NEW Type of Const:
Occupancy Grp:
Total $66.48
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 -010.. 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: 4 �� � • Jy� " - Permittee Signature: �� L /e- - v
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.
04/27/2010 09:56 5036489723 JERMOE ELECTRIC INC , — PAGE 01 ci
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Electrical Permit Applicata 4 , I . °� � �
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City of Tigard /� p Received ..
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° 13125 SW !fall $Ivd„ Tigard, OR 972!3 R 2 7 2010 0 1 0 DmeB ; y bz9 /Q � � Permit L C�zO /D �DO a -05
No,
- d / x Phone: 503.639.4171 Fax: 503.598.1960 Plan Rtwie
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other P
DateBy t rrnje
V&A Inspection Line; 503.639.4175 CITY OF TIGARD Dale Ready/By: Juri
.see r ,;! Internet: wwwri and -nG oV See Pane 2 for
g 6 B1 JJL DING DIVISION Notified/Method: d/h4cthod: Supplemental upplement 1 tnformntian
TYPE OF WORK PLAN REVIEW
New construction ❑ Addition /alteration /replacement — Please check all that apply (submit ,I sets of plans w /items checked below):
O ro
Service or feeder 400 amps or more ❑Building over three stories
❑ Demolition El Other:
where the avnilnble fault current ❑ Mnrinas and boatyards,
_ • CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or U Floating buildings,
-and 2-family dwelling less to ground. or e>;cccds 14.000 ❑ Commercial -use agricultural
y g ID Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi - family ❑ Master buildcr LI Other: ❑ Fire pump.
0 Installation of 75 KVA or
ID Emergency system. large scparatciy derived syacm.
JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor load of
Job no.: ( Job site address: f Z SV V / ,l / J I0014P or more. occupancy.
Six or more residential units. ❑ Rccrcational vehicle parks
City /State /ZIP: ' i y ? O.° ❑ i-lca)ih -care facilities. ❑ Supply voltage for more than
U ❑ idaznrdous locations. 600 volts nominal,
Suitc/bidg,/apt, no.: 1 Project name: ❑ Service or ieeder 600 amps or more.
Cross street/directions to job site W FEE SCHEDULE
� - ___ Dmai Alen •r , Fee. Taint IO
New residential single- or mutt! - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Fa, add'! 500 sq. ft. or portion 33.92 1
Limited cncrgy, residential
DESCRIPTION OF WORK (with above sq. R.) 67.84 2
^ ' l p Q0 Limited energy, multi - family 67 84 2 _Jr �� C residential (with above `9 R.)
Se or feeders installation, alteration, and/or relocation
200 amps or less 100,70 2
0 PROPERTY OWNER ❑ TENANT _ 201 amps to 400 amps =N 2
1Vamc: 401 amps to 600 amps 200.34 2
-- 601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps ar volts 552,26 2
City /Blatt /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 .36 ''
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 Ell
intended for sale, lease, rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel _..
A. Fee for branch circuits with
❑ APPLICANT 1 ` CONTACT PERSON above scrvicc or feeder ice,
7.42 2
11011 ` Fee rancneirc
Business name: TI. - y� $. Fee for branch circuits
Contact name witho service or feeder fcc,
t>♦ ./ 01 .L first branch circuit 56 .18 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not i ncludadL
City /State /Zit;
Each manufactured or modular '
67,84 2
dwelling, service and/or feeder
Phone: ( ) I Fax:: ( ) Reconnect only 67 2
E -mail: Pump or irrigation circle _ 67,84 2
CONTRACTOR Sign or outline lighting , 2
r 1 4..
Business name: �' i a � t . Signal cire circuit(s) or limited-
energy panel, alteration, or
Address; a `7- extension. Describe: Page 2 2
City /State /ZIP:
•
� 5 ` DY 1.___012— Ci 3 Each additional inspection over allowable In an of the above
• Per inspection 66.25
Phone: (r 0 I al , -- 4A Fax: ���) , f 1 Investigation per hour (1 hr min) 66.25
`J•Z Lie.: W 8 ei Electrical Lc.: `at c; uprv. t-ia:�T� ✓ Industrial plant per hour — 78.1 ti
f� ELECTRICAL PERMIT FEES
�
Suprv. Electrician signature_ required: / .
Subtotal: i
Plan review (25% of permit fee):
Print name: bill / ID I ( Date. $ State surcharge (12% of rcrrnit fee): 'j'. f 2,.„_
Authorized signature: TOTAL PERMIT PEE: (0/p, t/
Thin permit application mires If a permit Is not obtained within IMO
Print !lame: Date: days after It has been accepted as complete.
• Number of inspections allowed per permit.
11Building TermitsTIX-PermitApp. 10/01/07 440.4RISTt1 /a$/CQM/wFR