Permit CITY OF TIGARD ELECTRICAL PERMIT
` C f COMMUNITY DEVELOPMENT Permit #: ELC2010 00249
T j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/20/2010
>, Parcel: 2S103BB04500
Jurisdiction: Tigard
Site address: 12475 SW KATHERINE ST
Subdivision: Lot: 0
Project: Ballard
Project Description:
Owner: FEES
BALLARD, CAROLYN JEAN Quantity Description Date Amount
12475 SW KATHERINE
TIGARD, OR 97223 3 crt Branch Circuits 05/20/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/20/2010 $8.52
Electrical
Contractor:
PRECISION NW ELECTRICAL
12020 SE ANNA CT
DAMASCUS, OR 97009
PHONE: 503 - 413 -9870
FAX: 503- 594 -2873
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OA' 952 - 001 -0100. You may obtai• - • • • 'the rate- or direct questions to OUNC by calling 503 246.6699 or 1.800.332.2344.
Issued By. L Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project
Approved plans are required on the job site at the time of each inspection.
05/19/2010 22:16 FAX PRECISION NW Z002/002
Electrical Permit Application �q �• w J, a furl�lrr^ta.�r r� ��° *t-� ,�, ro t
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., City of Tigard . , :\ ,!Ai t i :4--I - �4 >� 4 4M- illAilitk
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- � y' q 13125 SW Hall Blvd,. 'Tigard. OR 97223 '� � , "'� ' ; ���
a '''" �Q� Plan Review B Other Permit: m^" - 1.3
'' "'� " N �a��w Ins ect Linc: 503 639.417503.59$.1960 � � 0
Date/B
ell l <`rn' Vt' I )t p M� I • '•r Ready/By: i td See Page 2 for . -
ticierr� azt Internet: www.tigard- or,gov -c\G, it 6, .. athod: 1.1 6 1 i.-14-9 Supplemental information
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u,.s � �t ul. ,Mf �1.,,.,. 1F . .b Yar._.r dn�suuul rwal u�a s li - id +.. etkswu,., .1!At +�w,fi.. ti F,. Ilw:.t,•,w^�r�; l!,`"r v?rrtr�M1.:,r,s rr: ° r ^l hrhn J' G � :W J
❑ New construction '..7 Addition/alteration /rep $,��� " nt Please check all that apply (submit a seta of plane w /itoms checked below):
❑ Service or Roder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other he the available fault currant ❑ Marinas and boatyards.
l<V r. d b 5 � u1 i i , a r..w.. r 3 i 'lf:1 x r } I S A i wr k 117 r • /i l F: �F r r at exceeds 10.000 amps al 150 vnll s or
' 1t . Li A . " tai Ih f a a ' f r• r 1 1 i ;, } F Li Floating buildings.
. f s.•W..� { ! . 1, ; _.... s t. ".s leas to ground or excrrda 14,000
rl - and 2 dwelling El Commercial /industrial Accessory building ❑ bui lncrcial - se agricultural
❑ A �' bildi g amps for a0 other installations. buildings.
❑ Multi family 0 Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
i l avJ +^t •, ,rriz",a {T. l{ it � tta r rr i1 fa?T I14 J,mr wvem a rr a tar v Q4 qr, s , rr ❑ Emergency system. larger sepatntely derived system.
0.2110114 i .4„!I. i re{ .rl y r q, 7 { ' 1 (p} ti n i .1 lr 4 P P .Jr
�A1 a"wl , ". ��„! � ,t131, �, ..4. �ai7.�diw"•'r1 -� t u, m l 1 � a� n c ik J : a c�, c �" ` m , t , .
a ,.u. ty, s{.:.�.,nrY, r, in,'.l�'.. „�,3, e!h.��, -1 ❑Addition of new motor load of ❑ ` .. t;•• .. 1.2 ^, "1.3
Job no.: Job site address: l 1' c' ( 4 �� 5 t001IPof more. occ
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP; ,0 0 • ❑Heahh - cam facilities. ❑ 5 volts for more than
- �� ['Hazardous !mations, 600 volts nominal.
Suitc /bldgJapt. no.: Project name: _ - -- / - ❑ Scry ice or fder 600 amps or more y������ ( j���yy t
'� - ` � N4 F. :� 4v..7z {tg ee t ttry�lail8..ltL�iC �:,u,��,:..� «:, S ; 1V{fftS 'fit .k44dlr'i{ ltl`Jf191
Cross street/dircctions to job site: Description Qty. Fee. Total •
New residential single- or multi - famly dwelling unit.
Includes attached garage.
Subdivision: Lol no.: 1,000 sq. ft. or leas 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92
t Limited energy, residential
% w aV � �1�l �A iy! l ...n l l !'7.' � .� 1 h, :ri u � �r {� '`w" � III.,.w ��3 7¢ I k `V I I ' y 7 k l .,: ir�y with above • f . lt. 67.
�^� ,mil Limited energy, multi - family
t( V h N- ' L 0 5 1• residential with above s.. ft,) ■ 67.84 =El
Services or fredcra installation, alteration, and/or relocation
CP....) T1 _ -- l 0 go
AAr,A A- � -T 200 amps or leas I= 100.70 _
�1)
�rO + + � `(fir yr 3 ti �m" '�, "ii aA `r� "�4 �, �i?t � M 1 w f , Rr a 1 � , ,�,q P iflP�lx f
K.a!a f� t _ w ; :!1 : li t ' tar t lu cxrrJS>rt r :T ' ti Ag ' , 145 Z I . M s > �r rV st ?r t Fl ` .'.r i ,,. ` �r � i w Vj 201 amps to 400 amps 133.
Name: - 401 amps to 600 amps 200.34
r la , 601 amps to 1,040 amps - 301,04 El
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is rot 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch clrcults- new, alteration, or extension, per panel
Owner signature: , __. Datc: A. Fee for branch circuits with
(: l i, , g Ip 'P 1 apa� t n ; , S •G a t, rr ri t ut,m - !G .. a a
, L ,� ' lrt j� 7 a 1Jpr - ": y ?. J °{ ( � a17fAF7S t .n .f ��n r I�i.� 1� "�ii,.r.r , 1 �.r nr r tJ Yl a l above service . or feeder fee,
Tut 7eneloYe,:;i a � 1M : f n,}r ' 'E xab{t, ut.,,.,.•.i4 111u4,442it4 each branch mean 7.42
Business name: 13. Fee for branch circuits without
service or feeder foe, first M .
Contact name: branch circuit 56.18 i ( 2
Each add'I branch circuit ' 2 7.42 i ' .,'
Address: Miscellaneous (service or feeder not included)
Each manufactured or dular
City /State /ZIP: dwelling, service and/or mo 67,84 2
Phone: ( ) Fax:: ( ) iteconnect only 67.84 2
Pump or irrigation circle 67.84 2
{� fr' il a �L :sa
* `t +.+..r -• 4-m r r , . �'• Sign or outline lighting 67,84 2
pll� E � :1f cfI tJ wyn 7 yiYr , , i r i .i t ki-
I Y 'fir rl J rV] Jt ' [r #.110 ! - 3 7 4.7 ,1 r l r �r gar
t6�. egi1aRig�; fi�,.r�wami fPJlBlunr•.,:a: i.l::iigt:�.sif.*Z..h.r` ,...4Y ¢,t,r... d .u._ 44.. i,,,, _..:,�, Signalcitcuit(s)orlimitedtnergy
-met. alteration or =tension. ■ t 2
Each additional inspection over allowable in artof the above
Address: ('it-Lt S 6 NNi A co W Additional inspection (I hr min) 66.25/ hr
City/State/ZIP: , o� [j( 1 r Investigation (1 hr min) =I 66.25/ hr -
C. S industrial plant (1 hr min): 78.181 hr E Phone: ) r • i * `�- - Fax: ( 'S ) £q4 -t 1 3 Inspections for which no tee is 90 hr .
gr ifical hated S4 le f } �
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iyf.:7.n. , �nZ�i�., 4 1
n: Si'L' 7
. •i�?:a .I�,:.!r 11e1A
CCB Li Electrical l.ic.: C , Suprv, tic.: _ , { "y�
Subtotal: - MINS
Suprv. Electric's si• a rc, required: . 41 10 AL Plea review (25% e o permit fee):
L _'
Print name: t 1/4.0 1/4 4 _ .� : i) Date: r - % State surcharge (12 °/n of permit ft c): g. S
TOTAI, PE:kMiT FEE: - 1 0 i , • '
Authorized Signature: -
. a .• ate .A. -... t This permit application expires if a permit is not obtained within 180
days after it has been accepted as commie.
, Date: -1 -r` • Number of inspections allowed per permit. --/q.
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