Permit CITY OF TIGAR® ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00253
7IdARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/25/2010
Parcel: 2S102AA03902
Jurisdiction: Tigard
Site address: 8915 SW COMMERCIAL ST 03
Subdivision: Lot: 0
Project: Cascade Mobile
Project Description: Repairing damaged service.
Owner: FEES
DAVIDSON, WILLIAM G & DIXIE L Quantity Description Date Amount
8915 SW COMMERCIAL ST
TIGARD, OR 97223 1 ea Reconnect Only 05/25/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 05/25/2010 $8.14
Electrical
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 - 419 -3300
FAX: 503 - 419 -3695
Type of Use: COM
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 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 co the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
-
Issued By• / Perm Signature: 6
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.
MAY -25 -2010 TUE 08:46 AM CHRISTENSON ELECTRIC, INC FAX NO. 95034193695 P. 01/02
Electrical Permit Application i'Oit oi'Fiui': USI ()Nil'
City of Tigard Data : ? Mr= Permit No.: —' ' _ s. ICJ 7 03.0
IN .----
M 13125 SW Hall Blvd., Tigard, OR 97223 ��^^ AY 2 5 '2010 Plan Review Other Permit:
II
Phone: 503.639,4171 Fax; 503•598,1960r� Datcl13:
inspection Line' 503.639,4173 Date Ready/By: 0 Sec Inge 2 for
Internet: I I t i AK l) 6 g CI OF TIGARD N o l i8erliMethod: ■� Supplemental Informat Internet: vvww.ti and -or. ov x � y` � ' ��
1 ,},. j , �y ,{ ��!''1i4 ..1,...I 'r" I - : '1 i ..414 .. * i !, -.. 1 11i
❑New construction C , Addition /tiltetation /replacemcnl
Please check all that apply (submit 2, sets ofplar's w /items checked below):
❑ Scrvice or feeder 400 amps or more 0 Duilding over three stories,
❑ Demolition ❑ Other: where duo available fault current ❑ Marinas and boatyards.
' 7 ' ' CATROORYrr 9F CONS 1'R jCTIION.: exceeds 1 0,000 amps at 150 volts Oe ❑ Floating buildings,
less in ground, or exceeds 14,000 0 Commercial-use agricultural
E] 1- and 2-family dwelling Commercial /industrial D Accessory building amps for nll other installations. buildings.
Multi- family Master builder ❑ Other: in Fire pump. ❑ Installation of 75 KVA or
❑ L- mergency r:ystem. larger separately derived system.
'
JOB S1T 0 INFAKMATION AND LO4TION • . : ' ❑ Addition of new mortar load of ❑ "A" ••L•" - 1 -' "," 1 -3"
�9�� JVV Six or oreresi occupancy.
Job no.: S - 1 '66 Job site address; (Varier. , ❑ Six I more residential units. a Recreational vehicle puke.
City /City/State/ZIP: -17,cUa L (� (� Q Fle:dlh - care facilities (] Supply voltage for morn than
V'- ` I 1 3 600 volts nominal.
1 ❑ N e aith our locatio
U4
— sal Project name:.. / 0 I mob W 6 �, a
Suite/bldg./apt. It o . . Service or Eb aler 600 amps or more.
_ _ :PEE $CHIDt LC
Cross street/directions t0 job site: Dominion I Qty. J, t 1 Total 1 "
— .^,
boo Ncw residential single - or tnulti- family dwelling unit.
5 ._ • ��� _. 36, Includes attached garage
Subctviston: Lot no.: 1,000 sq. It. ur less 168.$1 4
_ .. Ea. add•I 500 sq, ft. or portion 33,92 1
Tax map /parcel no.: Limited energy, residential 67.84 ,
DESCoPT1ON'OF WORK' `. (with above s
Limited energy, multifamily 67.84 2
„, j iL � i residential (with above sq. II) `'� Services nr feeders installation, alteration, antUor relocation
I t 200 maps or less 100.70 r 2
O'P ROPgRTY OWNER ' Oi.')".tNA.NT.
2013111P:1 to 401) amps 133.56 2
401 amps to 600 amps 200.34 2
Name; 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
— - Temporary services or feeders instalialion, alteration, and /or
City/State/ZIP: relocation
I- . h a ( ) _ 200 amps nr less 59.36 I
Phone; ( ) 20 1 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 549 amps 16854
_
intended for Sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or exictisionocr panel
Owi er signature: Date: A. I'ee for branch circuits with
• above service or feeder fee, 7 42 2
❑ APPLICANT . . 0 - CONTAC PERSON, each branch tin tit
B. Fce for branch circuits wiihnur
Business name; service or recdcr Ire. first 2
_ s6.la
Conlacl nantc: brmlch circuit
Each add'i brarich circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
.. Each manufactured or modular
67,84
City /State /ZIP: dwelling, service and/or feeder -
Reconnect only 1 67.R4 (pi,�`5/ 2
Phone: ( ) Fax:: ( )
_, _,. Pump or irrigation circle 67.84 2
-mall: - Sign nr outline lighting 67.84 2
.,:CONTRACTOR ,, Signal eircuit(s) or limited - energy
— isi - * "" � , 1
_u'1na1, alteration, or extension. Page 2 2
Business name: _I A— 1E06 1E06 additional inspection nvcr allowable in any of the shov
I,- e
`p � 0 Additional inspection (1 hr min) 66 25/ hr
Address:
1 1 • ` i Lk. Investigation (I lir min) 66.25/ hr T
C.ily /State /21P:k /' t I l_J j� industrial plant (l hr min) 78.18/ hr
l'honc: ` .1 —3 4 . , ~65 (Awl ,—,10
• i f Inspections for which nn ice is 90.00 / hr
/ J s ieciticully listed (A hr min)
CCI3 Lic.: I Electrical Lic. •� a L, Suprv. Lic.: 52,155 FLI.CTRICAL PERMIT FEES „ I , U `
— Subtotal:
Suprv. Electrician signature, required: ,
Print name Plan review (25 of permit fen):
I i e .� ( �� nu ' ~w� 7 \ State surcharg (12 %n cif penis it fee): --
�L.'� f (� —_
f TOTAL PCRMI PE 1 L-)113 AullloriZed signature: This permit application expireY If a permit 6 not Obtained within td
' days niter it lia been accepted as complete.
Print name: - Date: • Number of inspections allowed per permit.
1 - iOi 11ng\t'e, mil5\111.0- PrnniuApp doe 1 noel ',no 4.10 - .ril vIl 11ln5lCOM /t1't
May, 28, 2010 4:40PM PGE -PSC SERVICE CORD FAX NQI119503419369ENo,5248 P, 1/1 0��0� n. _pm - 3 -cuiu tllc uc,'4c ru vnRla .ivavir LLCAil til I
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May, 251 2010 2:45PM PGE- PSCf,SRVICE CORD f o/U —c.20.25
Request to Lace u e an Elec trlc�il Installation
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+:v � ' � ' , REGi11E3TIN :
:,,,r 'i`r ;,. ;; : „ ,.,.. �_ �—�- Date of request: 10 ntc of aupervishtg electrician:
icense number: ,521 Date ins Iletion Was completed I
Supervising electrician's It I ,,
c a copy v if with this form.
Electrical peril* la; -1 .0 1 temporary penift t: portal at the jal `sire, phrase b hug► try f
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Name of elect 1c utility revolving requa -ECs1 ,. .._ . --°-- ��
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. REQUEST " t.: •.:..
A. Restoring � =meal se►vIc4 that ,' : interrupted or disconnected bccau , either a:
e event such i s'fire, flood, t, a re weather;
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Q S�:rvic� change or gl Unc lrallnbl r '
ii. L+l ceir l eil l service at a rent 1 IC i dn needs to he:
0Initialized ❑ ReS ' , I (�N A� - ° "' , i'z - Sili Fk ^awl =' �:�:�1'
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' N �tvs rRVCTIONS.M u .
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Supervising eivetrlcian Electrical contractor
Please > . c Ma Sending this for t to the electric Flense note
By olosa of business on the first business
utility ttm; + above, you Mut send a copy of this form to: clay, following energizing of a cernplcted installation in
(1) the ; u:ttl on or, (2) the cjlstpl]1Cr, and (3) the I her y hating t� ei request, t11 t th mat Ilakuo�t has been
ins bcan
ltect' 14 } . ,,
I • jl energized, a d' (2) request that the aEriltvrily inspect flit
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