Permit QQ9c\(\--‘
CITY OF TIGARD ELECTRICAL PERMIT
J Y .
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00655
T [CAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
D
Parcel: 2S102CA00226
Jurisdiction: Tigard
Site address: 13165 SW ASH AVE
Subdivision: VIEWCREST TERRACE Lot: 19
Project: Ford
Project Description: Add /alter (2) branch circuits. 12/29/09 ADDED (1) 200 amp service.
Owner: FEES
FORD, HARRY Quantity Description Date Amount
13165 SW ASH AVE
TIGARD, OR 97223 1 ea 12% State Surcharge - 12/10/2009 $7.63
Electrical
PHONE: 503- 709 -4898 1 ea Services or Feeders - 200 12/29/2009 $100.70
amps or less
2 crt Branch Circuits w /Purchase 12/10/2009 $14.84
Contractor: Service or Feeder
MR ELECTRIC OF CLARK COUNTY 0 ea 12% State Surcharge - 12/10/2009 $6.23
14300 NE 20TH AVE. D102 -313 Electrical
VANCOUVER, WA 98686
PHONE: 360 - 574 -7200
FAX: 360- 546 -2158
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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: Permittee Signature:
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' Q O n l na A 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.
•
WEL-- Dec. 17. 2009 9.49P No. 2211 P 1
Elcctrital Pe snit Application , : ?, ' olevi(L U_E ONL_' 4 4,:1 _ ., °a
T Received
y , , City of Tigard 9a 1 V E Received — Permit No.: G Ly - 40(
a 13125 SW Hall Blvd.. Tigard OR Plan Review
1 c 6 _ Other Permit:
iR ' , % Phone: 503.639.4171 Fax: 503.598.1960 1 2009 Date/By: _
1' 1 1 1 t Inspection Lim 503.639,4175 DEC 1 Date Ready/By: 'uric: til See Pop for
eiii Internet: ww'w.tigard- or.gov R� Notifled/Method: Sup Information
TYPE OF Ithi 1N°f IJ W 1SI0N PLAN REVIEW ~
El New construction �AdditioNaltPi_ l cement Please check all that apply (submit h sets of plans w /items checked below):
I Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14.000 0 Commercial -use agricultural
rind 2- famity dwelling [] Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family 111 Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION • 0 Emergency System. larger separately derived system.
❑ Addition of new motor toed of 0 "A ", "B ", "1-2",
� � : l" S S 2], f
Job no.: 1 4 Job site address: c� (g f t� 10011P or more. occupancy,
❑ Six or more residential unite. ❑ Recreational vehicle parks,
City/State/ZIP : ' (1f) a 1 1 ^7 ,7 eLr� ❑llealth -clue facilities. 0 Supply voltage for more than
1 ! Y' r ti! ❑ Hazardous location. 600 volts nominal.
Suite/bldg. /apt, no.: l I Project name: cyA ❑ Service or feeder 600 amps or mare.
,FE • SCHEDULE
Cross streetldirections to job site: So.) r-I • ; � 1 S DeretiptIon 1 Oh- 1 Pet. 1 '0,1 0 I •
1 New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax lea / arccl no.: Pa. add'I 500 sq. ft, or portion 33.92 1
p p Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
i Limited energy, multi- family 67.84 2
M e t1 . i I .. j [' r f L residential (wish above sq. fl.)
P r-- � '2-00c) r Services or feeders installation, alteration, and/or relocation
44 V1�1,1J'C L: 6 200 amps or less l 100.70 (WIC) 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: '31/1_00 07C7 1,01D Vnive fK LO 55 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: L._ ...'s\,,t— Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, andlo
relocation
Phone: ( ) Pax: ( ) 200 amps or less_ 59.36
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT f ❑ CONTACT PERSON above service or feeder fee,
7.42 ,n 2
Business name: each branch circuit ( - 7
B. Pee for branch circuits
Contact name: without service or feeder fcc, 56.18 2
first branch circuit
Address: Each add'I branch circuit I 7.42_ -1 y2_— 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone ( ) µ Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump Or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: I i, ��� ��� o( 1 Signal circuit(s) or limited-
t r A/ energy panel. alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
n+
Per inspection 66.25
Phone: (�/d 5 �
l 7 Fes: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic.: Electrical Lic.: l Suprv. Lie.: _ I p lant per hour 78.18
ELECTRICAL PERMIT ]FEES
Suprv. Electrician signature, required: / ��- Subtotal _/ l6.6-M
Print name: l ff Date: Plan review (25% of pemrit fee):
V1tiQ ! l — , S -�'—�" ' /n" State surcharge (12% of pemtit fee): _ ji .g(.,
Authorized signature; - TOTAL PERMIT FEE:
r Date This permit application expires If a permit Is not obtained within 180
Print name:
(:.1Z _) x __,, c -- � i z , (1 1 Ayer days after it has been accepted as complete.
• Number of inspections allowed per permit. 68. i
1: trtuild ing1hrmltsELC- PcrmItApp.doc 10/01/09 440- 4515T(II /OS /CO6N1v6B v
V„\ ,e, Sec-
• 'It
CITY OF TIGARD ELECTRICAL PERMIT
14 COMMUNITY DEVELOPMENT Permit if: ELC2009-00655
l G'ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/10/2009
Parcel: 2S102CA00226
Jurisdiction: Tigard
Site address: 13165 SW ASH AVE
Subdivision: VIEWCREST TERRACE Lot: 19
Project: Ford
Project Description: Add /alter (2) branch circuits.
Owner: FEES
FORD, HARRY Quantity Description Date Amount
13165 SW ASH AVE
TIGARD, OR 97223 2 crt Branch Circuits 12/10/2009 $63.60
wo /Purchase Service or
PHONE: 503 - 709 -4898 Feeder
1 ea 12% State Surcharge - 12/10/2009 $7.63
Electrical
Contractor:
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
PHONE: 360 -574 -7200
FAX: 360- 546 -2158
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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: �0 cj&r lX l � Permittee Signature:
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' i APP. 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.
Pi
Dec. 10. 2009 8:38PM No. 2158 P.
Electrical Permit Application RECEIVED - k, o- - ,bs I.)It oleff I e E USElONLY ' ` ? V a;=
'f .� ". Received
;, -. r Cit f Tigard Date/il : / PennitNo.:
13125 SW Hall Blvd.. Tigard, OR 97223 DEC 1 0 2009 Plan Review
till �'�" -�O
6'wr :. ` - Phone: 503.639.4171 Fax: 503.598.1960 D Other Permit:
PI l \ It4) Inspection Line: 503.639 CITY OF TIGARD Date Read Jun:: la See Pope 2 for
4:a Internet; www.ligard- or,gov V Supplemental Information
BUILDING DI , ��
No tiFedlhlethod: IS —
. TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply (submit $ sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three Stores.
❑ Demolition ❑ Other; where the available fouls current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -uso agricultural
T- and 2- family dwelling ❑ Commercial/industrial ['Accessory building amps for all other installations. buildings.
0 Multi- family 0 Master builder ❑ Other: ❑ Fire pump. CI installation of 75 KVA or
Ej Emergency system, larger separately derived system.
JOB SITE INFORMATION AND LOCATION • ❑ Addition of new motor load of ❑ "A ",
Job no.:e- I (LIZ_ I Job site address: 4 t 100HP or more, occupancy.
(3 S S� t L �Q ' ❑Six or more residential write. 1D Recreational vehicle parks,
City /State /ZIP lcl ( - d 1 7 , Z `? S ❑Healtti -care facilities, ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 0 ,(- 0 Service or feeder 600 amps or more.
`, FEE SCHEDULE
Cross street /directions to job site; S L, t"l , \1 5k De,criplian 1 0. 1 rte. I Tour 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision; Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF ,WORT{ (with above sq. ft.)
Limited energy, multi - family 6784 2
L' LA) A.(;) 3v .
residential (wish above sq. A.) —
Servlces or ers installation, alteration, and/or relocation
200 amps or less 100.70 2
. VPROPERTY OWNER -- ❑ TENANT 201 amps to 400 amps 133.56 2
Name: u Yr' F� 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: \ 2 1 , S S LA 6<;1.A. Over 1,000 amps or volts 552.26 2
City /State /ZIP: --c Ck ( CK, -1 223 Temporary services or feeders installation, altera(ion, and / Or
relocation
Phone; (g) ) '70c1 _ l{sC'r g Fax; ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 lz
Owner signature: Date: Branch circuits - - new, alteration, or extension per panel
A. Fee for branch circuits with '
.PPLICANT ❑ CONTACT PERSON above service or fccdcr fee, 7.42 2
each branch circuit
Business name: ArkVCA" 1 P d..,,i r - J \ ( ow_ze De ►4 nn.- I -10 ( - B. Fee for branch circuits
Contact name: ` f tvifhoul service or feeder fcc, 1 56.18 s' lc:, 2
t L first branch circuit
} Erich add branch circuit 7. 42
Address: `L1 2, 0 r} Z�`�" .__..� �NR � � aZ�� E
�� 1 i7 • ''I 2-1 2
Miscellaneous (service or feeder not included)
City/State /2I1': \ c v ' L C J � j A 9 �p (jj Each manufactured or modular 67,84 67.8a 2
V dwelling, service and/or feeder
Phone: (3(00 )S 7q _ '72a) Fax; : g(GD) 574 /, —Q151 Reconnect only 67.84 2
E -mail: 1t ‘ t1,4 e.4 k (a C Ql,Q ce L . L Putnp or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting _ 67.84 2
• Business name (� Signal circuit(s) or limited -
1nC11/GV1C 0!� �Ie.t t r t (r�vt« i) CBA !Y) r it - - 4 c (- n Cenergy panel, alteration, Or
Address: t_!.?al)`1/C_ Z dtt RV '�I 02._`313 extension. Describe: Paget 2
City/Statc/ZIP: V aVICah, W o "( aQ 8 --) Each additional inspection over allowable in ag of the above
Per inspection 66.25
Phone; g 60 ) c 71-/ - Fax: g6)0) S •• Z / SI Investigation per hour (1 hr min) 66.25
Cal Lie.: l (9 g ,� '2_1I Electrical Lic.: * 7 Suprv. Lie.: L/s - 5 8 s Industrial plant per hour _ 76.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: tin 3 . (gy
of per
Print namt -64_4 c� pC�. {� Plan review (25
1 S r D ate: 12 / 1 D l O permit fee):
(- State surcharge (12% of permit fee): - 7, (0 3
Authorized signature; TOTAL PERMIT FEE: ri I , '.
Date: l2 This permit application expires if a permit Is not obtained within 180
Print name:
J � 1MZ,S A to (, C � 0 10? days after it has been accepted as complete.
• Number of inspections allowed per permit.
1: 181d1dIne ■Pcrmits\BLC- PcrmiiApp.dcc 10/01/09 (I(/ �Q 44a 4615T(t1/05 /COM/WEE
S CI„' C ' �� L3 "v � (d'(- -