Permit « .,, 5e &Jet L.
<`� E LECTRICAL PERMIT
,;�EY: CITY OF TIGARD
O
m COMMUNITY DEVELOPMENT Permit #: ELC2009-00617
E GAR[ 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009
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Parcel: 25111 DB01700
Jurisdiction: Tigard
Site address: 15520 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 445
Project: Hess
Project Description: Panel change -out. 11/18/09, add (3) branch circuits.
Owner: FEES
HESS, KEN Quantity Description Date Amount
15520 SW ALDERBROOK CIRCLE
TIGARD, OR 97224 1 ea Services or Feeders - 200 11/13/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 11/13/2009 $12.08
Electrical
3 crt Branch Circuits w /Purchase 11/18/2009 $22.26
Contractor: Service or Feeder
SCOTT ELECTRIC INC. 0 ea 12% State Surcharge - 11/18/2009 $2.68
PO BOX 2231 Electrical
SALEM, OR 97308
PHONE: 503 - 931 -1649
FAX: (503)391 -8393
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $137.72
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. AT ' ION: Ore• •n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -01 -0010 through OAR 9' -001 • , Y• • may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
e".."' r
Is ued By: v. lr/ —./ u___....1..../ 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.
IN a CITY OF TIGARD ELECTRICAL PERMIT
Q COMMUNITY DEVELOPMENT Permit #: ELC2009 00617
T I GAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009
R
Parcel: 25111 DB01700
Jurisdiction: Tigard
Site address: 15520 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD N0.8 Lot: 445
Project: Hess
Project Description: Panel change -out.
Owner: FEES
HESS, KEN Quantity Description Date Amount
15520 SW ALDERBROOK CIRCLE
TIGARD, OR 97224 1 ea Services or Feeders - 200 11/13/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 11/13/2009 $12.08
Electrical
Contractor:
SCOTT ELECTRIC INC.
PO BOX 2231
SALEM, OR 97308
PHONE: 503 - 931 -1649
FAX: (503)391 -8393
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. ATTENTI on law 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 5 1- 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 46.6699 or 1.800.332.2344.
Issued By: \` -A d1 - 4 /K-4- 1 44 Permittee Signature: < < c--....,,...
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
Cs"
SIGNATURE OF SUPR. ELEC' — / ;c-"1/4---_ 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.
s .
Nov *2 09 11:54a 5033918393 p.2
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Electrical Permit A Itica = � ` .
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o rotor Line: 503.639.4 7S CITY O TIGARD O meaMei y: Suppternened tnfarinntirm
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a % d t Noti6c4UMetbod: t
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a Internet: www.t or.g
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Please cheek all that apply (ubmit a nets orpiese odium9 checked below)'
p New construction CS • i . trier /alterationlreplacement j] Service ce kretar 400 amps or more ❑ Building ova three aeries.
❑ Demolition ❑ Other: where the sralabte emu carman 0 Manors and boatyards,
excaods 10,400 en+pe et 150 volts or ❑ Flatting bmldiaa1.
Cn'tEGb)itY' [>p 'COTFSL7RillCtl less to pound, or exceeds 14.000 ❑ Commercial -me aerieohunl
- sad 2 family dwelling ❑ Commercial/industrial ❑ Accessory building annex tar all other inatenetioes. heitdMge.
� d Fitc pomp. ❑ tnemllntion of i5 K�/J� or
❑ MuIti•fasnily ❑ 4sriasier builds ❑ Other: OEmergency sweat. larger separately derived ystrm. •
JOB 611 '114114414411°114; OI ND tOC*T[0N ' - ❑ Addition of new Moto load of ❑ "aaaraxy 1 - T', "1 -3^
y 10010 et Inac.
lob no.: Job site address: A / .1 r• O gia or more residential trite. D keercareml ',chide pprire.
❑ Hanle - care facilities. 0 Supply voltage For more then
City /3tatc/lif � . f OHarmdeasfvicetiona- 600 vets naminaI.
12 Service or feeder 600 ear err Moro
Suite/bldg./opt - bldg./apt no.: Project name: f/ ____ =�
::..T., r-.• _ OerrdDtkn ___ Qty. 1 pes... 1 T oul ,F .
New residential single -or multi- family dwelling unit
Includes nttacherl garage.
Lot no.: 1,000 sq. B. or less _ 168.54 t 4 _
Subdivision: Es. add'1 s% fl. of portion p. 33.92 1
Tax mall /parcel no.: I limited energy. rcaideltial 67.84 2
D N.�'1 .. (with aboveeg
•
Limited energy, multi- family 6 7.84 2
4' • - ;, , " - residential (wilt shave sal. 0) , e
'` - _ Services or feeders inatalintion and/or relocation
200 amps or lent / 100.70 , 41/t 74.7 2 -
.Q..p : 4 : • • - • . Q IZN IN 201 amps to 400 wraps T 133.56 2 •
•
401 amps to 600 amps 200.34 2
ii1a 11r �
_ :""!; 601 amps to 1,000 amps 301.04 2
Address: .eL ". ' - 7 . Over 1.000 amps nr volts _ _ 55226 i 2
Temporary services or feeders imatallation. alters don. and/or
relatatitnt
Phone: ( ) 200 amps or tens 59.36 t
201 amps to 400 amps t 125.08 l 2
Owner ittttallation: ibis installation is being made on property that 1 avert which is not 441 amps to 594 amps 166.5a L 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449.670, and 70 1. • Branch circuits- arm, alteration. or extension, per pand
Clymer signature: e: A. Fee for branch circuits with
AriEIC — T above service or feeder fcc.
0 E0197ACT lE R19011F each branch circuit
Business name: 7.42 2
_ . � •1, - B. Fcc fax branch circuits
without service or feeder lice, 56.1 B 2
Corttactnlmte: A Ent b ranc h circuit
E add'1 branch circuit 1 7.42 2
Address: U r a Mlsuflarteora (service or Feeder not included)
City/State/ZIP: 0 '' - Bach manufactured or modular (,7.84 2
iiiiimit a Am� dwelling eer:yet and/or feeder -
I. . R cc0lmett only 67.84 Z
F.-mail: Pump Pump or irrigation circle 67.84 2
• CON:TRAM • ' Sign or outline lighting 67.84 2
Signet circuit(s) circuit(s) or limited -
Business name: energy panel, alteration, or
/ extension. Describe: Page 2 2
Address:
City /SearaZ*P: 1 / 1 1 ft Each additional inspection over allowable in any of the above
r
_ Per inspection 66.25
Phone: ( ) r Fax: ( ) - ! (0 Investigation pe, hoar (I hr min) 66.25
Suprv. Luc, r j J'j , !Mantis! plant per hour 78.18_
! I:E
- - LC1Ia<ICiR[..natr It .YErtisi'
ltPr" Electrician signature, required: Al .� ,..-=7... . _ r Subtotal: /UL) •70
,■
plan review (2$% of permit fee ):
r i1 el" Dote: - r Star surchar (12% of permit fee}:
• �J •
Authorized signature: •r ; - ,� — TOTAL PERMIT FEE: / /_ • �
� g ^ alert' e ttl, :t+ �'
f ` Thb peewit appmratic" �i.es if a permit is not ,a w
Print Mettle: Date: `/� J d.r , eRn k but beta accepted al complete.
r • rramlxr of irupeatione alttwed per emote.
1 ;511y 4h9s1Prrmi1d61t- de'mitApp.Aor ten)! 09 •40.4615T(e VORCQM/W0
Dec, 31 2009 7:07RVI PGE —PSC SERVICE CORD T -boa No, 3492 I P, 1
"`�, 12.5 g,�. �_ miner > z e E1ectrz lnstiilation In oc�t c t7
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A.. ! J unsd i c rio n •ad
� ly re•' r
` TO 40/Mt-14-7S y 3 D
aE0UES7'IN9 SUPERVISING ELECTRICIAN INI i 2 RMAT(ON'
Name of supervising electrician: -
- r'C:W Date of request; (j 1/81 U
Supervising electrician's license number: `5 Date install Ilion was completed: 1/ 'al 05'
Electrical permit no.: -- ( r . 7 /ja reinporaiy permit is paired ar ilia job sin , pleas& include a copy r{f it with tails form
- _ EMPLOYIN8 ELECTRICA CONT GTOR 1NfO RI1�A710
Name of eleeoieal cagtracwr: -- i> [ f
�r r/1 c �` License no.: X1.5 L
Business address: / 2 j 2 3 7
City: .� c)t �, _ - - - Scat. CJ /� `LIP; `j'73 __ Phone: V y' `3 - _ Fax: , c - . ' , ems
E -mail:
so• • q t • 1.44 CUSTOMER INFORMATION: -
Customer's name: € .„ M /2 ,4/rr - `
Customer's address: , p / 1 . CrL l� _ -
51515;2 City• d stmt.: 6,P ZIP_
Address of installation if differem than customer's address: -'
City, _ State: ZIP:
INSPECTING AUTHORITY 1NFORIVIAi'1(DN .
Authority having jurisdiction to inspect;
Phone: -
Address: -
-
City: State. ZIP:
RECE VI N'Q E LECTRIC UTILIT KIFORMATtQM -
Name of electric utility receiving request; . Phone:
Address: - -
City; — State; --
_ ZIP:
REASON F OFt REQUEST' ■ -
A, Restoring electrical service that was interrupted or disconnected because of either u;
Service change or ❑ Uncontrollable event, such as fire, flood, or severe weather;
or
B, Electrical service at a remote location needa to be:
Initialized ❑ Restored
•
COMPLEij N INSTRUCTIONS ' No SIGNATURE
Siipervisiug electrician Electrical contractor
Please note — After',eending this form to the electric Please no — l3y cl.x.e of business on the first business
utility named above, you must send a copy of this form to; day, following energizing of a completed installation in
(1) the „electrical contractor, (2) customer, and (3) the response to the above request, you mast: (1) notify the
ujsprcting authori - -> /-":„.I. authority having�urisd:otion that the installation has been
, �, - , j en�A�d, and request that the aut i nspect the
• rvkitte eke ictu4Anature
Dote colltpleted inatallanor.,
iii; ' MI
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