Permit :Iii CITY OF TIGARD n
ELECTRICAL PERMIT
ors COMMUNITY DEVELOPMENT Permit #: ELC2010 -00110
Date Issued: 03/10/2010
•T tGA kO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
•,,, k , 47,q Parcel: 1 S 134AD04400
Jurisdiction: Tigard
Site address: 10670 SW BLACK DIAMOND WAY
Subdivision: BLACK BULL PARK
•
Lot: 2
Project: Audette
Project Description: (2) branch circuits for sunroom addition.
Owner: FEES
AUDETTE, BONETTA T /DAVID L Quantity Description Date Amount
10670 SW BLACK DIAMOND WAY
TIGARD, OR 97223 2 crt Branch Circuits 03/10/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 639 -8901 Feeder
1 ea 12% State Surcharge - 03/10/2010 $7.63
Electrical
Contractor:
FRAHLER ELECTRIC CO
11860 SW GREENBURG RD
TIGARD, OR 97223
PHONE: 503- 639 -4627
FAX: 503- 639 -4673
Type of Use: SF
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. ATT •• ON: Ore" • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-:010 through OAR 952 ' ' . 0. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1 800.332 2344.
Iss . d 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:
`NTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' i Date:
LICENSE NO.
CaII 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 Permit Application FOR OFFICE USE ONLY -
City Tigard Received
o n
`J g Da R _ "/ e' Permit No.:�AZ/4O /O "'676) /a
74 a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
• Phone: 503.639.4171 Fax: 503.598.1960 Other Permit:
Date /By:
Inspection Line: 503.639.4175 Date Read /B Juris:
TIGARp Ready /By: 0 SeePage2for
Internet: www.tigard- or.gov Notified/Method: rap Supplemental Information
t . TYPE OFlyORK
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition p Other: where the available fault current ❑ Marinas and boatyards. • Ct#"TEGOR:7( OF' CON ? exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Ej 1- and 2- family dwelling ^ ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Emer system larger separately derived system
:JOB SITE , NFOAI�IA'T,ION A
AND LOCTION t load of
t
-, - .,.r _, new oa o
.� .,.. . _. � .. .. . . . - <: 0 of ❑ .. ,, ,. ? ., ,, 3 „
Job no.: 67397 Job site address: 10670 SW BLACK DIAMOND WAY 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: TIGARD OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: AUDEI'I'E RESIDENCE ❑ Service or feeder 600 amps or more.
,
Cross street/directions to job site: - ` ` . FEES St410 — CALF
I Description I Qty. I Fee. 1 Totol f •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
energy, —
Limited
N :DESCRIPTION WORK . , , • 3 -,, (with abo e residential 67.84
Limited energy, multi - family
ft.) 67.84 2
TEST WIRTNG OF PORCH AND MAKE ANY CORRECTIONS r esidential ( with above sq.
Services or feeders installation, alteration, and /or relocation
NECESSARY 200 amps or less 100.70 2
Y ' ' ® :PROPERTY OWNETL . TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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 2
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
,. r APP.iIC►NI above service or feeder fee,
�❑ GO3'dTACT<'3'ERBOI*i� 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 1 56.18 56.18 2
first branch circuit
Address: Each add'l branch circuit 1 7.42 7 _ 62 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
67.84 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
�, r; ,„ CONTRACTOR , Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: FRAH,ER ELECTRIC COMPANY energy panel, alteration, or
Address: 11860 SW GREENBURG ROAD extension. Describe: Page 2 2
City /State /ZIP: TIGARD, OR 97223 Each additional inspection over allowable in any of the above
Phone: ( ) F ( Per inspection 66.25
503 639 -462 503 639 -4673 investigation per hour (1 hr min) 66.25
CCB Lic.: E lectrical Lic.: Suprv. Lic.: Industrial plant per hour 78.18
37410 34- 3C p 1816S
Suprv. Electrician signature, r ed: ��i��GZi� EL ECIRICA)J�RERSu Subtotal: _ . .'-
Su
p subtotal 63.60
Print name: Date: Plan review (25% of permit fee):
R—W. FRAHLER 03/10/10 State surcharge (12% of permit fee): 7.63
Authorized signature: TOTAL PERMIT FEE: 71.23
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per pennit.
P . \ Building \Perntits\ELC - PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB