Permit "I4" VI/ // CD
c ? ELECTRICAL PERMIT
I CITY O TIGARD
° G; a
" ; COMMUNITY DEVELOPMENT Permit #: ELC2010 -00083
T (G 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/18/2010
,,.,.psoi.4 .
Parcel: 2S102AB00602
Jurisdiction: Tigard
Site address: 12095 SW LINCOLN AVE
Subdivision: Lot: 0
Project: Porter
Project Description: Reconnect service after meter repair.
Owner: FEES
PORTER, VALERIE Qua ntity Description Date Amount
12095 SW LINCOLN AVE.
TIGARD, OR 97224 1 ea 12% State Surcharge - 02/18/2010 $8.14
Electrical
PHONE: 1 ea Services or Feeders - 200 03/04/2010 $100.70
amps or less
0 ea 12% State Surcharge - 03/04/2010 $3.94
Contractor: Electrical
DYNALECTRIC
5711 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7720
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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. ATTENT a .. • re. • aw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -00 : through OAR 952 -01 -010 •u m- obtain a copy of the rules or direct questions to OUNC by calling 503. .6699 or 1.800.332.2344.
Issue By: 1 1 1 / Permittee Signature: ( C_,_,LI
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' __--r �_ — t , 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.
+ t 4 CITY OF TIGARD ELECTRICAL PERMIT
I 1
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00083
T[GA .b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 02/18/2010
Parcel: 2S102AB00602
Jurisdiction: Tigard
Site address: 12095 SW LINCOLN AVE
Subdivision: Lot: 0
Project: Porter
Project Description: Reconnect.
Owner: FEES
PORTER, VALERIE Quantity Description Date Amount
12095 SW LINCOLN AVE.
TIGARD, OR 97224 1 ea Reconnect Only 02/18/2010 $67.84
1 ea 12% State Surcharge - 02/18/2010 $8.14
PHONE: Electrical
Contractor:
DYNALECTRIC
5711 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7720
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 'rf 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 1 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �� J k. V .l1 PA 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:
.App CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' 1[� . Date:
LICENSE NO. ��'t 't
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.
Electrical E ,A 1 1CatiO ECFIVE htift Ot FIC:F. 1itih, ()NIA.
®f Received /� Permit No. Eo �CI Z/•/. k
City Of Tigar Date /By Vet) 1rJ . • •"
11, 13125 Sw Hall Btvd., 'Tigard, OR 97223 P
u lan Rev iew
Other Permit:
. Phone: 503.639.4171 Fax' 503.598.196 EB L Date/Bv:
Date Ready /By herb: Hl !. ee Page 2 for
T 1 t; A 1, 1) InSpecli0u Line: 503.639. s up dementat Information
Internet: www.tigard- or. gOV CI TV OF Notified /Method:
1 . ,�.��.�� , ry ( ,;, I6 'il��, ? (I( ,ii l} ! I; ! {4 q1 t , i f 1 , . lj E:i l ° t��.' I j� vl I� I{' ;0 'T ,
i 11y,ij q{ i �i� 1 (i r' i' ,.... 5;i m iii i ;4 ' � a Yti . Eli' i�l! , { J; ;I "!.! P'�iijl ¢.!' 1i 11 p. It I , : 'titiiaAii) e)u ,c ,a,,, of .,;.LL ,
„, Lrt.. , ! -. Please check all that apply (submit 2 sets of plans ,ditems checked below):
❑ Ncw construction ❑ Addition /alteration /replacement
El Service or feeder 400 a+nps or more ❑ Buil ,ing Over three stories.
Demolition Other:
where the available fault cummt ❑ Mar +aF and boatyards.
::, , , ar '.4;', iPt <; °'( 1 t' 1:,G ,q i t,i r ( exceeds 10,000 Amps at 150 volts or Q Floa in z buildings.
.0E04 11,!tj;b I' i i,' I ",, 'l, I( " t• B ! q . , {1 ; , {it ,ifii i i 1 II'!,; 1t I t ; h : j l ?1',.li,, less to 6 Duna. or exceeds 14.000 D Con mcrcial -u?e a' n autucal
1' ,. r, ! 61,6! :.,, .. 0 ! t; � i I 1 , ., , ., •, 5 j a c i s � h tk r d
A 1- and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building ❑ amp for all other installations. CI ❑ Multi family ❑ l. haticn 75 KVA or
Master builder II tar r separately derived system.
w r t p J 1,i L mergenc system. b D >'
ii i . ii , ! 1(1 a "°" ti t Vim! : J: i, 11 (1111 1 !.11, 1 y
„i .. ( 11 ° d .., tl 1 � ' #,,', 1 , ? i a. ' i, 0 Addition of new motor load of ❑' A ,. , .. 1 .... 1 - _ a „
a , { f t 7tu n a e° 100HP or more. oce, panty
Job no. : /I/ '" 9. 9 Job site address: /631.0 ❑ Six or more residential units 1 Rec eational vehicle parks.
r - ❑ Health - pure faeiI' ' ❑ Sup fly voltage for more t
City /State /ZIP: ;IT - #, — G� ❑ Hazardou location 600 volts nominal
El Service of feeder 600 amps o+ more.
Suite/bldg. /apt. no.: Project name: mot. J : , I Agaran It .(I ,„ '1:0!;.;;
!,gill; : s19���J� 1:( l 1!1( . �
Cross street /directions to job site: neacri.e tt rcc. 1 l Toral [
New residential single- or multi- family d ,veiling unit.
includes attached garage.
1 Lot no.. 1,000 sq. 0. w 1033 168.54 , 4
Subdivision: _ Ea. add'1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: ited energy residential 67.84 2
Lim sid
g, n m ur , , 9f ,! f , p� �i� hbr It -IJ' (with above e
I !!� � 1 { 1 l) i �` 1 p ilil) , 1 5,4. R. )
't 'i ! „liiC ii i', ' l ,` i ` i J ! !'rT ""lhytS , n ' ,ZI , 1' '( 'f , ! 1 b i ,, i i� =1 H —
f ! r ,l n� t , h,i ;,,, , Limited energy, multi- family 67.84 2
y �" /i J am • I,'1 - residential (with above so. ft,)
_ r . CJ[ Services or feeders installation, alteratit n, and /or relocat
or , iied 200 amps or less 100.70 2
..,. ..,. i.% ,, , , ,.,. , � •1111 n; , l i ll IN 1 33.56
I t' Pg. iis
I I ln , r. �y� 71 i ,, J "'i ` `I jl t , i ii . li 1 1;I, 'I � i 1' 1 1i( li : mi, i .a, i•l ,. J , 201 a to 400 am 2
` {li:i,i dI iJli.„,„ ; ;.., , ,. " ,. , I Ii f1 (., ∎7Wiz I
ii:, �, , ,,,.,,,1 , . ,.,i,mo. ,,i,..,EI 200.34 2
i w 401 amps to 600 amps s
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 _ 2
Temporary services or feeders installa6 )n, alteration, and /or — 1
City /State /Z1P: relocation .
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps i- 125-08 2
Owner installation: This installation is being made on property that i own which is not 401 amps to 599 amps 168.54 r �2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670. and 701. Branch circuits— new, alteration, or ex tnsion. per panel
A
Owner signature: A. Date: Fee for branch circuits with ' Y
! i i t. ilai i n . .; , l ,.. . , i(iliai(; a , "i ' ;.(; "'r ''T :1,.TrI I't � I f it above service or feeder fee; 7.42 2
, a3_;, t,y(s ` 11 I (f MIL- r 111 l 1, b
1:x.1. 3 ' m�lllf hii (il + !III i i ' ' Il!,,, . {�1 it . t, iartsain :ir . i '
„ ! each branch circuit
, , , lt ;.... .. , .. ,.,,, .c, u••:.... ,{.1...11 1 {..., it �!s , 1111) ,,,, .�
Business name: B. Fee for branch circuits
without service or feeder fee,
56.18
Contact name: / a.- y first branch circuit
Each add'I branch circuit 7. 2
Address: Miscellaneous (service or feeder not ini luded)
City/State/ZIP: Each manufactured or modular T 67.84 7
dwelling, service and /or feeder
Phone: 0 ) 7 7 93. 4,415— Fax:: ( ) Reconnect only y / 67.84 d77 2
E -mail: Pump or irrigation circle 67.84 2
t,,; t: r ilI 7 , tl I !' f' ' 1 „ 1 IIpiL,`:' ;'i „ o...If¢t {1!1tli(1 Sign or outlinelighting 67.84 2
€i J1�i;�t : 1' Jilt�'( 1,- �:�! i;
• , ,t:l�11 ;,,, i� 0'.:���!��1r��. 111111, iii ;j. {1iP,l.'`1t1,1,11� i� 't i:rll g B
Signal circuit(s) or limited -
Business name: 4, _ .. energy panel, alteration, or
CO �`—! extension. Describe: Page 2 2
Address: �J W/ s eti /j i 1
City /State /ZiP: ��,,„.",,, d Q 9 7613,7 Each additional inspection over allows ale in any of the above
Per inspection 66.25
Phone: ) e • 4,77 Fax r_ : 7.. M Investigation per hour (t hr min) 66.25
dustrial hour 78 18
CCB tic.: _7 Electrical Lie.: ad2 Sups'. Lic.: , 1 ,- ,,, In 1lr ", plant per ° »at: nr1,.. h o ... , ' , ,
♦r( f U:!()�1a' ; ;ilillr (11 {Jt � � ' 1r{1fA,n r ':(I /M;i.', j i� , y,lc
Suprv. Electrician signature, required: I � t :. Si total: , 7 • Plan review (25% of perry t fee):
Print name: i): e: a / J
t u �� ' Sta su rcharge (12 °io of pem .t fee); T
Authorized signature: i / � - j� J J TOTAL PERMI' ' FEF.; 7 70
' ' This permit application expires if a permi is not obtained within 180
Print name' • A , _ Adi pate: �. Clays after it has been nccepte 1 as complete.
" Number of inspections allowed per permit
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