Permit 1
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U CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2009 00358
; Date Issued: 07/21/2009
; 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
TIGARD
Parcel: 25111 CD01400
Jurisdiction: Tigard
Site address: 15606 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Malone
Project Description: Hook up NC and furnace and misc. electrical in kitchen.
Owner: FEES
TOPOLSKI, CHARLES F Quantity Description Date Amount
15606 SW SUMMERFIELD LN
TIGARD, OR 97224 2 crt Branch Circuits 07/21/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/21/2009 $6.42
Electrical
Contractor:
OAKLEY ELECTRIC INC
11500 SE SUNNYSIDE RD APT N -15
CLACKAMAS, OR 97015
PHONE: 503 - 855 -4712
FAX: 503 - 855 -4723
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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: M AV Permittee Signature: ' Lt A P 1 L,.7r L peT.SU N
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.
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r Electrical Permit Applicat t � ' T of 1 11,! J'�1 td! �l� T�VJI•i 51rM "1 - �{ Sr� {y • t i!` V � VF J � ' k 1♦!
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a� City of Tigard Received Pemrutr N°': E L c -z , j, r
! ' ]3]25 SW Hall Blvd., Tigard O1 97223 PlanRcvicw
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A 3 Phone: 503.639.417] Fax: 503.59SJ 4 17 2009 Data 19y: Other ]'ermir.
4 www tigard or gov Ins ection Line: 503.639.4175 Date Read /By: luri::
Milli Al Ct P
`.ar£.c Internet: N otified/Method: S See Pent l Information for
CI OFTIGARD s ,emeatn1
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❑ New COnStruction Add /rep Please check all that apply (submit 2 sacs of plans w /items checked below):
inj ❑ Demolition El Other:
El
or feeder 400 amps or more ❑ Building over three stones.
7 o u s +' 1 ! i k {Y a It yrnr where the available fault current 0 Marinas and boatyards.
r t k 1 i aT { f tY9 Q ,96Y t e u let^, ? ' u { �,{l M3tra^, i ki y { '•1.. P 1 F exceeds 10,000 amps at 150 volts or
1 all :.' ..{ rSla�l ' 11% �1!k d1d=_ m.riLtti .;;I #l{tl . #, f iaii L t2> ikkk tliTJl n" tl.: i. Ili 1 P ❑Floating buildings.
1- and 2- family dwelling 1:1 Commercial/industrial ❑Accessory building l ess in round. or exceeds 14,000 l=1 Commerc -use agn
❑ /✓laic/ -(emit c amps for all ether installations. buildings.
Y ❑ Master builder ❑ Other ❑ Firc pump. ID Installation of 75 (CVA of
RI i 11 t `#: -" l { i')'t��; ( li 1 t i 7 i r , 1 tt ��:s.rk k k 7 �tts +t �•i- + c , ty 4wt d I ,�t ❑ Emer enc s tern.
kti ,I' ira s td i r> m 1 ,i�u:iGiwSnr; o,a,n hiss /. fv r � u l #?� }3� �, i l ' r � 4 S 11 { r rear g Y Ys larger separately ", "-r, derived system.
-+ . " ,, „L l., ii .4,11 . I L h ❑Addition of new motor load o1' ❑ 'A", ::F >: "1 -2" "1 -3"
Job no.: rob Site address: 15606 SW Summertield i.n. IOOHP or more. occupancy.
❑ six or mote residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health - care facilities. ❑ Supply voltage for more than
0 Hazardous Iocations. 00 volts nominal.
Suite/bldg. /apt. no.: Project name: Carmen Malone ❑ Ser - lice or feeder 600 amps of more.
• - , ;; , J I; a. � . , �t - �{ ,"'�' 7ll f{'k'r � � i ;� �fo�7 r Na � [� � p '_
Cross street/directions to job site: t 1 k " �•x: <$ � "'n laa«r ofn riu slt9�uw } r �#1E Total 1�11#1
Descn. ties _ try, Pee. Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
1 Subdivision: Lot no.: 1,000 sq. ft. or less _ 145.15 ' 4
Tax map/parcel no -: Ea. add'l 500 sq. ft. or portion 33.40 0
1{ { Limited energy, residential 75,00
n" r 4�'tl } }I�}11Q.' - } u 1 { t F I ` ��' 1 ,, ' � f #� k 1 nkuntw,�vult3 :,� }�m_vzlt+ n? >ng ,,{ ��. �1 {l y tf tt - g�!� , �a ,7 y� } x q � t , (with'h
�
., 1r1 i T t i,# v t l;lillf.Lrli i ' ''ri airtriti.tiL ,c iiri�'uZ14.1.1:.P1 J, Q t9fll I ��� §i1 211 4 . i�.1'l l' � +3}it � Fif}tll ave " ft
Limited energy. multi - family
Hook up A/C and Furnace Misc Electrical in kitchen
residential with above •q. 0.) 75.00
Services or feeders installation alteration, and /or relocation
200 amps or less 80.30
R a i ��(}�uF�l )?091 {1 �� >;i iYf, r � a qn r , vra , qr ; g 2
' 1;; 4 t b " } 141, 6 ' ':' i 1 4 : 111 } ( r+r (6�f� 1 "�I' r n . a
. uitL,IklFc e.„141.airili;!i r u 4. IR : i y „'i.x i , i, ;a,yli r ,0. - 4 201 amps to 400 amps 106.85 �
Name: Carmen Melone 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps I 240.60 2
Address: 15606 SW Summerfield 1m. Over 1,000 amps or vole 454.65 2
City /State /ZIP: Tigard, OR 97224 Temporary services or feeders installation, alteration, and /or
relocation
Phone: (503) 560 -7114 Fax: ( ) 200 atnps or less 66.85 1
Owner installation; This installation is being made nn property that I own which is not 201 amps to 400 amps 100.30 El
intended for sale, lease, rent, or exchange, according t0 ORS 447, 449, 670, and 701. 401 amps to 599 amps 111. 133.75 Ell
Owner signature: Branch circuits - new, alteration, or extension, • er anel
Date: A, Fee for branch circuits with
� {I t i I��!!n l,r+{E9'1}Itro il l (� } t t' h i + d$ w r k1 +S ^z• M' above service feeder f
l l[ � 1Ni` i � ! �� t i , k � �t�{". �' ������� ��u��. t u& 1 �' �d�> it, <,t�,rm;�:,t���dr).:��.�_�th'� � ce or eeer ee
~•, , :N11, + u.. �� ?,z ,tt ti ,r, -_ia t•r.4z' 6.65
Business name:
each branch circuit
B. Fee for branch circuits
Contact name: without service or ±feeder fee,
46.85 46.85 2
first branch circuit
Address: Each add'I branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 94.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E-mail: F y�py i Pump or irrigation circle 53.40 2
{ ' l 11 j 1 ' �1 tc # i {`IS ITMlll l'�' ') 1 �yrir i ,m if y,�, 1 11�at+,i V , r il i 1��x1� {y(r yi{. f ,u i� ( { fI'1� I lighting
: n, ' r�l�t #ITf - }ti „#,1f1#ti�11�1I1d : i 11t -1.+� {- Il�.#.. dL.e�n.nl,lefnLt,r af a:.'���u���y ,fllili(?. ��:illll!}':'it !�i1t:1.1lllt_�.Otbl{�M �L'..1 � sig. � or outline 53.40 2
$usiness name: Oakley Electric, Inc Signal circuit(s) or limited-
energy panel, alteration, or
Address: 11500 Se Sunnyside Rd. extension. Describe: Page 2 2
Cir' /State /ZIP: Clackamas, OR 97015 Each additional Ins • ection over allowable in any of the above
Phone: (503-) 8 53 4712 Per inspection 62.50
(- ) Fax: (503) 855 -4723 Investigation per hour (1 hr rain) 62.50
CCI3 l,ie.: 184315 Electrical Lie.: 5176S I Suprv, Lie.: C456 Industrial plant per hour ®,.,
r 1 y n . � P k1 r�r ,. 1 3 i,n h ,. r! �' �."'k r
Supra +. Electrician signature, required: 1 111 ., E a .,�..,s,r.um' rs �:,.,.i .t.R.:R11�:N .
Subtotal: 53.50
Print name: Troy Fisher Date: 7- 17-49 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
Print name: Troy Fisher This permit application expires if a permit is not obtained within 180
y Date: 7 -17 -09 days after it has been accepted as complete.
' Number of inspections allowed per permit.
1 : 1EuildinpPermits lELC- PermitApp,dos G5 /23/06 440.461ET(1I/05/COMrl4'G11