Permit CITY OF TIGARD
PERMIT
n Permit ELC2010 -00242
•� COMMUNITY DEVELOPMENT
Date Issued: 05/19/2010
Z•,t`G 'ARO 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S112CB14100
Jurisdiction: Tigard
Site address: 14845 SW KENTON DR
Subdivision: Lot: 0
Project: GORNICK
Project Description: (2) branch circuits for a/c and service outlet.
Owner: FEES
GORNICK, LEE Quantity Description Date Amount
14845 SW KENTON DR
TIGARD, OR 97224 2 crt Branch Circuits 05/19/2010 $63.60
wo /Purchase Service or
PHONE: 541 - 519 -6231 Feeder
1 ea 12% State Surcharge - 05/19/2010 $7.63
Electrical
Contractor:
GRF ELECTRIC
15460 S PARADISE LN
MULINO, OR 97042
PHONE: 503 - 829 -4146
FAX: 503 - 829 -5747
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. ATTENTI Oregon slaw requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 952=..1-0100. Y . • may obtain a copy of the rules or direct questions to OUNC by calling 503 766.6699 or 1.800.332.2344.
Issued B I • 0 / / /�- / / /c rb !/ Permittee Signatur • '- air,
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:
CONTRACTO INSTALLATION ONLY
SIGNATURE OF SUPR. ELE �. , r f rv�r— 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.
May 17 10 08:03a GRFELECTRIC 5038295747 p.1
Electrical Permit Application
R �� � ,, , � ' I �LS o�� "�,, ;i ,gyp „ , � ,,t „
� 4.% City of Tigard MAY 1� Received _ rv...r e , > '
a M',it�.�,�.,,v ,•: ',
s7t” q s M A Y 1 1 2010 D / 7 /0 Permi J O.: G /�
13125 SW' Hall Blvd.. Tigard, OR 97223 G 0. 0 /.Q -Q�p� ,2
1 1 3 Phone 303.t 39.4i ; ] Fax: 503 Plan Review
a r,.,, � 1i Date/ Other Permit: pie - /J 7 �n
tTlGis.RO: ]nspectten Line: 503.639. 4175 CITY OC TIGARD p ( /sue 01°tC.
CITY t I OF I GAR Date edA l t BY rfs: El See Page 2 for
�...r*r. < Internet: www.tioard or-gov 6 1 nl � Ne[iFed/R4eth Tu
U I G DIVISION Supplemental Information
E OF WORK
■
PLAN REVIEW
Please ch ck all tha: apply (submit 2 sets of plans w m
/ites checked below)
❑ New construction dditioniaiterati on/replacement
❑ Demolition El ni
Sece or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current
❑ Marinas and boatyards.
CATEGORY OF CONSTRICTION exceeds 10,000 amps at 153 vcl:s or ❑ Floating buildins.
and 2 famil dwellin r less to ground, or exceeds 14.000
Y g ❑ Commer ciaL Industrial El Accessory building ❑ Commercial -use agricultural
building amps for all other installations. buildings.
Multi-family ❑ Master builder ❑ Other: C1 Fire trump.
❑ Installation of 7: KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emerzeaey system larger separately derived system.:
❑ Addition of new: motor load of ❑ ".q " °E ", -•I_�" "I -3
Sob no.: Job site address: 1 LE R t S � Kr y •-j„ 100 HP crmore. occupancy.
I V ❑ Sir or more rZidential units ❑ Recreational vehicle parks.
City'$tate.tLIP: e ca. G 7 4
( A _ I r G . /� -/"` ❑ Health-care o s l ocati facilities r] Supply voltage for more that
Suite/bldg. /apt no.: Project name: r G 0 x �✓ l Hazard l 600 volt; nominal.
r L /11 Service or feeder 600 amps or re.
Cross streetidirections to job site: v =re.
SCFIEDULE 1
-- _ Description 1 Qrv- ( Fee I Total I •
New residential single- or multi- family dwelling unit -
Includes attached garage.
Subdivision:
Lot no.: 1,000 sc. ft or less I 168.54
Tax map /parcel no.: Ea. add 1 500 sq. ft. or 7onion 3342 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 67.84
Limited energy, multi - family
L residential (with above sq. ft.) 07.84 2
Services or feeders installation, alteration. and/or relocation
2D0 amps or less 1 :00.70 2
XROPERTY OWNER ❑ TENANT 201 amps tc 400 amps 133.56 2
Narne: � e C 401 amps to 600 amps 200.34 2
601 amps to 1,00D amps 501 04
Address: ( )/ 2
L
!` e ,. Y (of,.
Over 1.000 amps or volts I 552.26
City /State.'ZIP: 7 ` i 7 1-2•"-C)- Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5-I.1) �q r 1(0 3 / Fac: { 200 amps or less l 59.36 1
Owner installation: This installation is being made on propern that 1 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 a re to 599 amps t68 54 i - 2
Branch circuits- new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 742 2
Business name: B. Fee for branch circuits without l
service or feeder fee, first
Contact tame: branch circuit 56.:8 51 f
.Address: j Each adds! branch r.rcui[ 1 7.42 ..1‘L 2
Miscellaneous (service or feeder no, included)
City /StateiZlP:
Each manufactured or modular
dwelling. service and/or feeder 67.84 2
Phone: ( ) J Fax: ( ■ Reconnect only 67.84
Pump or irrigation circle 67.8=
ail
E -m:
CONTRACTOR __I I
Sign or outline lighting 67.84 5
Signal circuit(s) or limited-energy
Business name:
(.--7 j� 1` r L' Y L�l C ( anel.alteration, orextension. I 2
, . -/ y Each additional inspection mer allowable in any of the above
Address: p
> - ' % , . Additional. inspection (1 hr min) 66.25/ hr
City /State 21P: /l/I Investigation (1 hr min) 66.25/ hr
?hone: ( r i / � L ? � L% �( Industrial plant (I hr min) �J 78.18/hr
SIC. �i - . Fax: ( 5j > S" zv -- 5 t • Insaectrons for which no fee is
CCB Lic.: '� '� I Elect :cal Lie.: specifically listed ('h hr min) I 90.'DO/ hr
• '1 j - ti.5 4. C I S uprv. Lic.: 1 f cJ - 5 ELECTRICAL PERMIT FEES
Suprv. Electrician silature. required: ' a Subtotal / ? r ��
/ Plan revrew (25/o of permit fee): (p>
Print Warne: i V\,, 3!I1 • 61 inn z.-
'nenL Date: J (_ / / 6 permit fee;: 1 )- State surcharge(12 %of I J
TOTAL PERMIT FEE. k
•
Authorized signature:
This permit application expires if a permit is not ob j, d within ,I80
Print name: (Date: days after it has been accepted as comp . t"'
l ' Number of inspections allowed per permit.