Permit CITY OF TIGARD ELECTRICAL PERMIT
_ 2 . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00389
Date Issued: 07/30/2009
T i GARj? 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S110DC00700
Jurisdiction: Tigard
Site address: 11205 SW SUMMERFIELD DR
Subdivision: Lot: 0
Project: Summerfield Golf Cart Storage
Project Description: (1) service and (10) branch circuits.
Owner: FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/30/2009 $80.30
amps or less
PHONE: 10 crt Branch Circuits w /Purchase 07/30/2009 $66.50
Service or Feeder
1 ea 12% State Surcharge - 07/30/2009 $17.62
Contractor: Electrical
BULL RUN ELECTRIC INC
44715 SE PHELPS RD
SANDY, OR 97055
PHONE: 503 - 668 -4800
FAX: 503 -668 -5045
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $164.42
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 •AR 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.
,1
Issued By: v ''' • �J 0 \� . r , Perm Signature: �lX App
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.
07/27/2009 14:13 5036685045 1 1 BULL RUN ELECTRIC PAGE 01/02
. - . .
Electrical Permit Application R F C FI\/ ' FOR OFFICE 115E ONLY
City f Tigard J U L 2 7 2 r� eeiY�d -? a �� ,j Permit No : E ��_ V; �
INI tY Daie,l3
13125 SW Hall Blvd., Tigard, UR 97223 D n Rcv ;cw
Phone: 503.639,4171 Fax: 503.598.1960 CITY OF TiG A. i y;
Other Permit: .
T 1 r 61 R D Inspection Line; 503.639 BUILDING DIVIS I pcad y /13y, I vrls I 1 1 See Pnrc 2 for
Internet: www.tigard- or,gnv cd/Mcthod S • information
TYPI✓Or *'oRk ,; , 4, P1'WAl'+1 'R>C V ..;.
0 New construction ® Addit .ion /altcrati0n /replac Plcnsc check All that apply (submit sets of plan w /itemt checked below),
0J Service nr feeder 400 amps or morc C_1 l3nilding ever three stories.
0 Demolition ❑ Other: where the available faith current ❑ Marinas and boatyards
CkTF i:blti'I Our; CI T C i exceeds 10,000 amp; nt 150 walls or ❑ Floating buildings.
1 - an 2-family N ' '' ..: less to ground. or exceeds 14,000 12 Commercial-use nr_nc
12 y welling E Commercial /industrial ❑ Accessory building amps f all nther installations. buildings.
rc pump ID Installation 01'75 KVA Or
❑ Multi-family ❑Master builder 0 Other: nergenc system larger separately derived system
❑i_i y d
; JO SITE tNII:O MATION AND .ifliC A PION , motor toad o
. . ❑ Addition o f new i ❑ "A" "F" "1 .
I Ot)FfF' or mare. occupancy.
Joh no.: 1 ,fob site address: 11205 SW Summerfield Dr.
❑ Six or more residential units. ❑ Recreational vehicle parks.
Cit ' /State /71P Tigard OR 97224 El Fleapit -core facilities. ID Supply voltage for more than
y g 000 volts nominal
❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name; Golf Cart Charging Statio ❑ Service or fecdcr 600 turps of more.
Cross street /directions to job Site: Deception l vey. Pe. TMaI •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: __ Lot no.: 1.000 sq. ft. or less I 145.15 4
Ea. ndd'l 500 sq. 1). or portion 3•,40 1
Tax map/parcel nn Lirnitcd energy, residential 75,00 2
il DD d L FJAN tyF "VOR , „ :. , i : ' (with above sq,11)
Limited energy. multi - family 75.00 2
200 a 208/120v service and (10) 120v 20 a charging stations residential (with above oR. 0.)
Services or feeders installation, alteration, and/or relocatio
200 amps or ICSS I 80.30 80.3 2
"0 PR'orER O'i is ' , , ,eil; t , , , ,' , , , . � '. 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Nam(, 601 amps to 1,000 amps 240.60 2
Address: Over 1.000 amps or volts 454.65 17
City/State/ZIP: Temporary services or feeders i nstallation, alteration. and /or
., _ relocation
Phone: ( ) 7 Fax: ( ) 200 amps or less 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 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670. and 701, 401 amps to 599 amps 133.75 2
Branch circuits - ncw, alteration, or extension, per panel
Owner signature: Date: A,Fcc for branch circuits with -
APPL1f6.ANT ;i; L. I IN L `RSON ' or feeder fe e. 6.65 6G,5 2
CI,' . ' G
above scrvic I
• ' TAC • ' each branch circuit
Business name; 13. Fee for branch circuits
— without service or feeder Ice. 46 85 2
Contact name: first branch circuit
Address: Each midi branch circuit 6.65 2
r Miscellaneous (service or feeder not included)
•
City /State /ZIP: Each manufactured or modular 90 90 2
dwelling service and /or feeder
Phone; ( ) Fax: : ( ) Reconnect only _ 66.85 2
E -mail: Pump or irrigation circle 53.40 2
,.; CONTRAC1()Ft ' ' Sign or outline lighting 53.40 2
Signal circuit(s) or limited-
Business name: Bull Run Electric Inc. energy panel, alteration. of
extansinn. Describe; Page 2 2
Address: 44715 SE Phelps Rd.
-
City /State /ZIP: Sandy OR 97055 Each additional ins ection over allowable In an of the above
- Per inspection 62.50
Phone: (503) 668 -4800 Fax: (503) 668 -5045 Investigation per hour (1 hr mm) 62.50
CCB Lic.: 173152 1 Electrical Lic.: C233 Suprv. Lic.: 5244$ Indus trial plant per hour 73.75
ECE, CTRT,C #1 ,,1�,E12M T :,FE
— t
Suprv. Clcctrieian signature. requited: K subtotal: � 146 8
i Plan review (25%ofpermit fee):
Print name: Kyle Ruthardt Date 7/27/09 State surcharge (12% or permit fec): 17.62
Authorized signature: IL _ 0 , -- TOTAL. PERMIT FEE; 164.42
This permit nppllcatlon cxpirm if a permit is not obtained within 1S1)
Print name: Kyle Ruthardt Date: 7/27/09 days after it has been accepted ns complete.
w Number of inspections allowed per permit.
! I.C- PCrmltApp.doc 05!25/06 4,10.16;ST(II /05 /COMOVrn