Permit °' CITY OF TIGARD ELECTRICAL PERMIT
' 13 ...:!, - . COMMUNITY DEVELOPMENT Permit #: ELC2010 -00267
t GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/02/2010
T
: t ;,.' ,, ,• Parcel: 2S115AA07800
Jurisdiction: Tigard
Site address: 10544 SW TITAN LN
Subdivision: Lot: 0
Project: Belair
Project Description: Installing (4) branch circuits.
Owner: FEES
BELAIR, GREG C & NANCY H Quantity Description Date Amount
10544 SW TITAN LN
TIGARD, OR 97224 4 crt Branch Circuits 06/02/2010 $78.44
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/02/2010 $9.41
Electrical
Contractor:
3D ELECTRICAL SERVICES INC
PO BOX 173
OREGON CITY, OR 97045
PHONE: 503 - 657 -9173
FAX: 503- 655 -7140
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 - 41110 les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By. �� Permittee Signature: ' 421 :.� .p.,..,‘
/�
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.
JUN- O1- 2010(TUE) 12:44 3D Electric (FRX)5036557140 P. 002/002
Electrical Permit Appli > q to F i / E, D ,..,,,,o,,,..,.,.: 1 tsi ONLY
Received
!� I31 H 1 a ad TIg&d, OR/ z 3
- 1 2010 Date/B , i _ ,1
Plan Review
Phone: 503.639,4171 Fax: 503.396.1960 Date/9 : Other Per nit:
T t r " li I :) Inspection Line: 503,639,417C' OF Ti DAR D Date Ready /ay
Internet www tigard or go i I n! i of C+IO1 Notified/Method: Supplemental aen
2 Information
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❑ New construction , m Addition/alteration/replacement Please cheek all that apply (submit j seta of plans w /items checked below):
❑ Service or feeder 400 amps or morn ❑ Building over throe stories.
❑ Demolition ❑ Other: where the available built current ❑ Matrons end boatyards.
1 .1!,,i; y ` j , ' 61#66ity , 60: C NSTRIJtr 614 !! w 1 exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Cotnmcrclal -use agricultural
®l and 2 -family dwelling ❑ Commercial /industrial 0 Accessory building ampa for all other lnetallationa. buildings"
Q Multi family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of 75 KVA or
y l +� , TM c ♦ `I ,, l s +;,g ❑ Emergency aystem, larger separately derived system.
t ) t i iii ° y ',,,::!1 ' .:i r l �1' OB SIT r OR 1 14 Q A �,1 Yk 'I' 1 "� r�� 1 h 1 II'i'1 1 I : , . .
❑ Addition of new motor load of' ❑ "A" "E" "1 -2" "1.3"
Job no.: 24661 Job site address: 10544 Titan Lane 100HP or more, occupancy.
❑ Six or more roaldontlel units. ❑ Recreational vehicle parka"
City /State /ZIP: Tigard, OR 97224 ❑ Health -care bcilltles. ❑ Supply voltage fbr more than
❑ Hazardous locations, 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 'd D Service or feeder 600 lin or more.
i De I a r Irr . 1. rt t ::' . I t t�t',. S t 'y1JL`R b w tn �u n.E� � d l �' . : , .
Cross street/directions to job site: Deurtpeon I UM I Pet: 1 rotor
New residential single• or multi- family dwelling unit
Includes attached garage.
Subdivision: I Lot no 1,000 sq. ft. or leas 168.54 4
Ea. add'l 500 eq. ft, or portion 33.92 1
Tax map /parcel no
Limited energy, residential
C r:;, r Ire! �.OS l I n 7A;in 'i+,c 1• 1� bF 0 � '. , )' 7: 3 * k r , ' .r, (with above ft, 67.84 2
Limited energy.multi•famliy.
67.84 2
Clean up existing electrical and add circuits. residential (with above 8 ft)
Services or feeders inatallatfon and /or relocatOn
200 amps or leas 100.70 2
�y t . t t, r^. �r: r ,
;�4ry� *� F+ ��� #�+,,��� #l„ 1', � Sri - ` is +r�r,11f �`�, i;: t { ° :; {�. 201 amps to 400 amps 133.36 2
µ�,.+:r a;. , „ . . +t . ,� � eA'� � - � q **� i 7 u .L, ?1 P
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: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
201 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 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, —
Branch circuits Owner signature: Date: A. Fee for branch circuits alteration, or extension, , er penal
with
�'' 1 I t' ; k , 11 . '�,, " + rf ; , . boice or fee der fee,
",� -�� tSn,�,xi. , ���, .., ' a1 � �y, , ��, ,i,,l� CO;YTrACT P)�algd'IX,,.,+ ;.y[ ? a
:' eaahbve serv 7.42 2
Business name: 3D Electrical Services, Inc. B. Fee for branch circuits without
service or feeder fee, first 1 56.18 5818 6 2
Contact name: Keith Dier branch circuit
- Each add'l branch circuit 9 7.42 22.26 2
Address: P.O. Box 173 Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City/State/ZIP: Oregon City, OR 97045 dwelling, service and/or feeder
Phone: ( 503 ) 657 -9173 I Fax:: ( 503) 655 -7140 Reconnect only 67.84 2
- Pump or irrigation circle 67.84 2
E-mail: keit1t @3deleotrIC81 Com
s :. rk r w x r 67.84 2
Sign or outline lighting
i. «w,.,�q , ''' l i," ' ,+., a ,w,.� .., ON I'R,.+,CTq t' i , .3.,i , I4 . ai't'�.a ∎ , ,li '. , Signal circult(s) or limited- energy
Business name: 3D Electrical Services, Inc. motel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any dam above
Address: P.O. Box 173 Additional inspection (1 hr min) 66.25/ Iv
City /State/ZIP: Oregon City, OR 97045 investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.19/ hr
Phone: ( 503) 657 -9173 I Pax: ( 503) 655 -7140 inspections for which no tee is o �� 90.00/ hr
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CC Lie.: 1352 ap2clflCal listed (
Electrical Lic,: 3-460 1 ) Su rv, L.ic,: 3793 S
r Suprv. Electrician signature, required: e--- 1 / • l6 / ' it Subtotal: 78 "44 - I , y w
re Plan review (25% of permit fee):
Print name: Bill Dutton Date: 6/1/10 State surcharge (12% of permit fee): 9.42 el • V/
Authorized signature: "�. TOTAL PERMIT FEE: 87.88 '' 7.85
a.+ This permit application expires Ira permit is not obtained within 180
days after It sae been accepted as complete,
Print name: Bill Dutton Date: 6/1/10 • Number of Inspections allowed per permit.
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