Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009-00624
i T I GARL7 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/19/2009
Parcel: 1 S 133DA02100
Jurisdiction: Tigard
Site address: 11043 SW SUMMER LAKE DR
Subdivision: Lot: 0
Project: Bank of New York
Project Description: Add /alter (4) branch circuits to correct electrical safety issues.
Owner: FEES
BANK OF NEW YORK TR Quantity Description Date Amount
BY RECONTRUST CO, 400 COUNTRYWIDE
WAY SV 35 4 crt Branch Circuits 11/19/2009 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/19/2009 $9.41
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $87.85
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 cppy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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' Q Q •1 , ,t 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.
- '
CE1VED
Electrical Permit Application NOV 1 9 2009 t�'w °OR,° w r , ' �y
-,-., City Of Tigard Received
''" ° 13125 S W Hall Blvd., Tigard, OR 972EITY OF TIG A RD - ,� •' ' i
i a Plan Review
i Other Permit: y Phone: 503 - 6 39.4171 Fax: so3.59�1�g DIVISION Date/13): T�1 G R ^ ' Inspection Line: 503 - 639.4175 Date Ready/By: - ®Sec Page tal 2 for
tbaprkafr:a -t Internet: www.tigard- or.gov Notihed/Melhod: ` CI Supplemeolnformanon
• TYPE OF HARK PLAN REVIEW
❑ New construction cif Addition/alteration/replacement Please check al hal apply (submit 2 sets of plans wlitems checked below):
❑ Service or f- . 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other where the a ilable fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION • exceeds 10,4 t t amps at 150 volts or ❑ Floating buildings.
i - - less to gro ., Ofe'rr',r 14,000 ❑ Commercial -use agricultwal
0.1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for an .then itt_stallations. buildings.
❑ Multi - family Q Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
['Emergency , stem. larger separately derived system.
108 SUM INFORMATION AND LOCATION
. . ❑ Addition of ewmotorloadof ❑ "A ",`E'.`I 2 ", "I -
Job no.: Job site address p ii 100HP or m. re. occupancy.
l L t5 YYl1� ✓ lake. D ✓- ❑ Six or more :. idential units. ❑ Recreational vehicle parks.
City/State/ZIP: i 1' 7 cot
G ❑ Health -care chilies. ❑ Supply voltage for more than
❑ Hazardous I . ons- 600 volts nominal.
SuitelbldgJapL no.: Project name: ❑ Service or f• - .er 600.amps or more.
' FEE SCHEDULE
Cross street/directions to job site: Description ) Qnv. I Fen, I_ Total [ •
New r at single- or multi - family dwelling unit.
' Includes a ., bed garage.
__
Subdivision: _ ^- .- T -. - --~ __ _,- ._._..-__ ___.--
Lot no.: 1,000 sq. ft. r less 168.54 4
Tax map /parcel no.: Ea. add'I 501 sq. ft_ or portion 33.92 , 1
Limited ener . residential
67.89 2
DESCRIPTION: OF WORK • • (with aboN - - . 0)
�} ! Limited ener • . • multi- family 67.84 2
CO lr v e Lt rile Tr r ' a ( « T ; S w S' rescdentia wish above sq. (1. )
J Services or I eders installation. alteration, and /ur relocation
200 amps or , - s 100.70 2
D PROPERTY OWNER . I ❑ TENANT 201 amps to 00 amps 133.56 2
Name: 401 amps to 10 amps 200.34 2
----- 601 amps to ,000 amps 301.04 2
Address: Over 1,000 .. ps or volts 552.26 2
City/State/ZIP: Temporary ervices or feeders installation, alteration. and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or ess 1 59.36 1
Owner installation: This installation is being made on property that l own which is not 201 amps to ; 00 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to .99 amps 168.54 2
Branch circ , its- new, alteration, ur extension. per panel
Owner signature: Date:
--- A. Fee for br nch circuits with
❑ APPLICANT . .1 ❑ CONTACT PERSON . above se ice or feeder fee.
each bran circuit 7.42 2
Business name:
B. Fee for b nch circuits
without S. ice or feeder fee.
Contact name: - - t 56.18 s( t g"
_ first bran. circuit
Address: Each add'I b ch circuit 3 7.42 2 2. , .(01 2
Fliscellaoe. s (service or feeder not included) -
City/State/ZIP: Each manuf tured or modular •
67.84 2
dwelling, se ice and/or feeder- ,
Phone: ( ) Fax: : ( )
Rcxonnect O •ly 67.84 2
E -mail: Pump or irri ation circle t 67.84 2 '
. CONTRACTOR • • • . . • . Sign or oath .c lighting 67.84 2 1
Signal circa . (s) or limited -
Business name: 5i ,,,1 c5cr L. k`-f -p•t ca_ 1 C, , „ , S Tr''t,G a.. energy pane alteration or
Address: a t [.k.s tU M •D 1 a( of S- - C extension. 1 be. Page Z 2
CitvtState/ZIP: 1� c 1 � 1 Z g Each additi , nal inspection over allowable in any of the above
1/1/1 G I /l 11 1 t°
( Per inspecti . n 66.25
Phone: (9) 3 ) -7-2__ 2 Fax: ( LL , 5 - Co l nvesti au. 1 S
S�JO g per hour(I hrrain) 66.25
CCB Lic.: j 33 T n_, Electrical 'c - ' - � �.1 Suprv. Lic.: gj Q 3 5 Industrial pl. !per hour • 1 78.18 .
.. ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: _ J Subtotal: 'T g,4 +
Print name: i� r C Date: ! t f (4 i Plan review (25% of permit fee): f`
L n rn Jl f�50� . sure �
harge(12 % of permit lee): 9; 'it
Authorized signature: t TOTAL PERMIT FEE: g `1'9'5
Print name: Date: This perms application expires if a permit is not obtained within 110
days after it has accepted as complete.
' Number o inspections allowed per permit.
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