Permit = l CITY OF TIGARD ELECTRICAL PERMIT
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" = COMMUNITY DEVELOPMENT Permit #: ELC2009 -00600
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/06/2009
TIGARD Parcel: 2S111AC00900
Jurisdiction: Tigard
Site address: 14655 SW 91ST AVE
Subdivision: PINEBROOK TERRACE Lot: 50
Project: Friend
Project Description: (1) 200 amp service panel upgrade and (2) branch circuits for A/C and furnace.
Owner: FEES
FRIEND, CHRIS Quantity Description Date Amount
14655 SW 91ST AVE
TIGARD, OR 97223 1 ea Services or Feeders - 200 11/06/2009 $100.70
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 11/06/2009 $14.84
Service or Feeder
1 ea 12% State Surcharge - 11/06/2009 $13.86
Contractor: Electrical
ELECTRICAL CONTRACTORS & DESIGN
150 NE VICTORY, STE A
GRESHAM, OR 97070
PHONE: 503 - 666 -9358
FAX: 503 - 667 -7965
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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 0 952 -001 -r 194. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued 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:
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.
Nov 05 2009 4:O1PM Electrical Contractors & 503 - 667 -7965 p.l
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Electrical Permit Application Y a . FOR (►1111 l (l l ti l t ►� r;, Fg �, s, .
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�. { �.' 1 City of Tigard NO NOV V O 5 2n 14 1e ,� y: j% f /VJ 1 t Permit No
lig n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review � � j
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Phone: 503.639.4171 Fax: 503.598 1960 CITY OF TIGA '. 'y: Otter Per m1y ECo�I/ d 7 (� �!/f� ��7 �7ir/
r j � i . w ' a' t ID Inspection Line: 503.639 . eReadyt8y: )uri Pt See Page for
,_ . Internet: www.bgard- or.gov
BUILDING DIVIS , t.N emfe thod: : i 11 Supplemental Information
Vi c ,: ai ra r p r �t nt t { 1 11 -
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�cv 1R. ”- �.� � ti .. _- � ,:.` � � i a � `— : ,. � :°� <, � �; _ . � � � 4 x e Uf pMs. . n� * � 1 i : _ �.
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r „r' f alai -- Please check all that apply (submit 2 sets of plans wtitentis checked below):
❑ New construction i Addition /alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
'- , o -i li t c g d 1. ,- 1 „ r r g - # )111, _,„ L. exceeds 10.000 unps at 150 volts or ❑ Floating buildings.
� - •- less to round, or exceeds 14,00(1
g ❑Commercial -use agricultural
1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 15 KVA or
r ,� r s ' t ''''''':41.4-14K7''-----11,-----=''''”' t ;�- El Emergency system. larger separately derived system,
- - ;' , :rte ll - i r ' � t - re . _ - 1 s [f ir,, CI Addition of new motor toad of ❑ .. „) _ ,) �..
Job no.: 62,35"- Job site address: !� t j - 9 / s--74- IOOHP or a res occupancy.
/ /� ' ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Slate /ZIP: J'�� 12 Health -care facilities. ❑ Sapp)) voltage for more than
✓ `; /� ❑ Hazardous locations. 600 volts nominal.
❑ Service or feeder 600 Suite/bldg./apt. no.: Project name: amps or [Wore
Cross street/directions to job site: V Descripton Qty. — 1 Fee. 1 Total 1
New residential single- or multifamily dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1.000 sq 0 or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.92
Limited energy, residential
. ? _. a-V �� 67.84 2
��� le a .. �-. .ao.�.l.+"x_� "E !. (w ith a
r Limited energy, multi-family 67.84 2
a el , 9 /"c / � 4-Fe1 , e , c.a..�/'1. residential (with above sq. ft.)
6 � Services or feeders installation, alteration, and/or relocation
200 amps or less / 101170 jed, 7b 2
- y t -+ s t � ,." » 4 I ' w , y ;: a 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
-= -- x " above service or feeder fee, lOy 2
each branch circuit a 7.42
Business name: B. Fee for branch circuits
Contact name: witho service or feede fee
first branch circuit 56.18 2
Address: • Each add'I branch circuit 7.42 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. 2
E Pump or irrigation circle 67.84 2
t . .�. .____ --_._ . a - 1'" ,� ., I t Sign or outline lighting 67.84 2
Business name: ,c�E'G e ,i 4,, 4,, / , ,, S !` , �J Signal circuit(s) or limited-
� ✓ 44'Sl� energy panel, alteration, or
Address: /$9 /1/t L r t C �Y 5)4S extension. Describe: Page 2 2
City/State/ZIP: a. � �,,�,,,
,.„. 0 , ?p-' 0 Each additional inspection over allowable in any of the above
Phone: ( 3) 6 935- Fax: (53 67- Per s tigati iou 66.25
Investigation per hour (t hr min) 66.25
CCB Lic.: 1/7 7 a tu ie � Electrical Lic.: 26- y " � 6 Suprv. Lic.: 5 Industrial plant per hour 78.18
Suprv. ElectriE T , required: � r '
�j-•m, Subtotal: it ,_5"
Print name: rr/ ( a 'Mal Date: / /s•/o9 Plan review ( 12'5 of permit fee):
State surcharge (12% of permit fee.): J3 , g6
Authorized signature TOTAL PERMIT FEE: 119 ye) ✓
Print name: Date: 'Ibis p ermit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
* Number of inspections allowed per permit.
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