Permit CITY OF TBC��4R® ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00571
Date Issued: 10/27/2009
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 /27/20 01200
Jurisdiction: Tigard
Site address: 10440 SW 69TH AVE
Subdivision: VILLA RIDGE Lot: 1
Project: Johnson
Project Description: Replace (1) 200 amp service
Owner: FEES
JOHNSON, DOUGLAS W Quantity Description Date Amount
10440 SW 69TH AVE 1 ea Services or Feeders - 200 10/27/2009 $100.70
TIGARD, OR 97223 amps or less
PHONE: 503- 977 -2714 1 ea 12% State Surcharge - 10/27/2009 $12.08
Electrical
Contractor:
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
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. 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 -0 00. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
D is
Issued By: I ' 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.
. Oct, 26 2009 4:35PM West Side Electric 503 - 736 -0656 p.1
Electrical Permit Application 1:01( ()l• FI ('t: 1 Sr. O\ IN
City of Tigard RECEIVE ceived
ECEIV s� ," PcrmitNo El ' n C �
Tigard Date/By: Ay,” G G �.4'or 4/V_�/ I
, ■ 13125 SW Hall Blvd., Tigard, OR 9 Plan Review
= Phone: 503.639.4171 Fax: 503.598.1960 OCT O C I 2 6 ZOO t DatciBy: other Permit •
tc ‘f 0
Inspection Line: 503.639.4175 Date Ready/By: 1 u ^ See Page 2 for
Internet www ttgard -or gov I F TI A rn(Ia otttied/Metttod: Supplemental Information r'
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New construction Additionlalterationlr laeement
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or fender 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
r l r exceed 10.000 amps er 150 volts or ❑ Floating buildings.
a r ' xr . s 9.y `. ,....�. _. s
k ., ;. Y y !!,. y• . / less to ound, or exceeds 1 4,000
g4 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
Muhl family ❑Master builder ❑ Other:
1 fe DAP Installation of 75 KVA or
> .. i F �n1 `- i fi 4 s t s t , t r �r t, r ❑ Emergency system. ❑ argk:r separately derived system.
' t£,. „},: h7 0 ....... t . ., N a�. _ . 4u, i rk:.. ❑ Addition of new or ad lo of !
Job no.: Jy 6/ 87 Job site address: /OYt-/ �w 6,g 1
�, y lam ' O more occupancy.
❑ Siz or MOM more ❑ Recreational vehicle parks.
i-'1 / ��'} ❑ Health-care facilities. ❑Supply voltage for more than
Ciry /S1a1eJ21P: �9 4 r V� �72 �� ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: d h `\ S pet OU
D9' ❑ Service or feeder 600 am or more
, t _ s .g {ifiglV' 1 1.h'f i' 1. i,r
Cross streetidirections to job site: ()aviation • I o tv r Pee l Torrt
New residential single - or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'! 500 sq ft. or portion 33.92 1
Tax map /parcel no Limited energy, residential 6'7.84 2
rrt ,1{ p x k 0 Og,h, :7. ' t�,;a: rt , ,{;s2 (with above s q. ft
_..:,�:&i.n t,F1.. 3 &r ,.x �i L. ;: 4a ., ..... . ., ,- .75.,, '.. 1. ,t• .
Limited energy, multi - family .
P Q`s / (1a, Vt residential (with above sq. ft.) 6'7.84 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 / 100.70 , /Ob LE. 2
x « .. P v. > r °, �t�,�,v r #J *ta) f e ,e - '
� t� car t 1
., �.. t ' (��'�.`�'� .r j x. }' r t;"! ,e }iS " 201 amps to 400 turps 133.56 2
Name: DO u J Oh iij O 401 amps to 600 amps 200.34 2
601 amps to 1,000amps 301.04 2
Address: / Q 7 f./0 _Ch./ 6 Q 1 - - - f^ Over 1,000 amps or volts 552.26 , 2
City/State/ZIP: d
oe / 1 ,. 3 Temporary services or feeders installation, alteration, and /or
7 relocation
4
Phone: (503) 9 7 -a y Fax: ( ) 200 amps or less 5936 1
Owner installation: This installation is being made on property 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 amps to 599 amps _ 168.54 2
Branch circuits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
a ;' k t above service or feeder fee,
t, r r Y r ? each branch circuit 742 2
Business name: B. Fee for branch circuits
wuhota service or feeder fee,
Contact name: first branch circuit 56.18 2 1
Each add'I branch circuit 7.42 2
Address:
_ _ 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
` 11 ,, . rl v 1 - •- o dj(TM t ;r _r.: r °. 141,; ..s,l 1'' Sign or outline lighting 67.84 2
Signal p a ne l,( a or t i o n ,
Business name: West Side Electric or
e panel, alteration, or
Address: 1834 SE Fe Ave. extension. Uesctibe. Page 2 2
Ciry /State /Z1P: Portland, OR 97214 Each additional inspection over allowable in any of the above
Per inspection 66.25 I
Phone: (S03) 231 -1548 Fax: (503) 736 - 0677 Investigation per hour (1 hr min) 66.25
CCB Lic.: 13306 /
Electrical Lic.: 26 -135C V I - Suprv. Lic.: 4654S ✓ Industrial plant per hour 78.18
Suprv. Electrician signature, required: 4 -... T Subtotal: /00 j u
Print name: Randall F Roberts Date: /f /2 7// 9 State review (25% of permit fee):
CJ /// ! e surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: / / Z 77 8'
This permit application expires if a permit is not obtained within 180
Print name: I Date. days after it has been accepted as complete.
Nwnber of inspections allowed pet permit
I lauildinglPermin'ELC- Permit App.doc 10 /O1,0n 4404615T(1 V05.'CO`1/WEB