Permit q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00619
';T j GA'RL 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/17/2009
Parcel: 2S 111 DC 13700
Jurisdiction: Tigard
Site address: 15845 SW OAK MEADOW LN
Subdivision: Lot: 0 •
Project: Pitkin
Project Description: Reconnect furnace and a /c.
Owner: FEES
PITKIN FAMILY TRUST Quantity Description Date Amount
BY NORMAN R/JOYCE F PITKIN TRS, 15845
SW OAK MEADOW LN 2 crt Branch Circuits 11/17/2009 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 11/17/2009 $7.63
Electrical
Contractor:
TRI COUNTY TEMP CONTROL
13150 S CLACKAMAS RIVER DR
OREGON CITY, OR 97045
PHONE: 503 - 557 -2220
FAX: 503- 557 -0919
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 9522 - 001- 0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Q r b / LL 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' �0 AO' Le Date:
LICENSE NO.
Call 503.638.4175 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 -16 -2009 03:00P FROM: TO: 5035981960 P.3
.
Electrical Permit Applicatiol ECEIVE I F , ;, 7 . , It I (/lt.(I1 I( I ( l � 1 r ,„, . . , 4 q!4 U
It . 'y> City of Tigard NOV' 16 2009 Received d ! J P e r mit No. d `+ _. , 1
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
'�'� ® Phone: 503.639.4171 Fax: 503.598. Da te/D : Other Permit: i V q •,`
em t, Inspection Line: 503.639.4175 i G r Y OF TIGARD Date Ready/13y: ® See Page 2 for
t �
' -A ,. Internet: www.tigard-or.gov BUILDING DIVISION NotifietUMethod: Supplemental Information
TYPE OF WORK PLAN REVIEW •
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit / sets of plans w /items checked below):
❑ Service or fe eder 400 tarps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
[Ell- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ID Master builder El Other: ['Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 - 3",
Job no.: I Job site address: 15=ms SY 1 CJa.i P4 _o11.10 W 141 100HP or more. occupancy.
❑
0 Six or more residential units. Recreational vehicle parks.
City/State/ZIP: `�/l 1�] Q 7 4 El Ha fcaiion . ❑ Supply voltage for more than
1�Wr �.l / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Nee.
1 Total
' New residential single- or multi - family dwelling unit.
4ncftrdes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 168.54 4
Tax map/areal no.: Ea. add'I 500 sq. ft. or portion 33.92 I
p Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. R.)
�/�'/� /� (. ,1 . - - "_ Limited energy, multi- family
pp
ike,tt 1 U O(�1 it r (J� V f is residential (with above sq. ft.) 67.84 2
Services or feeders installation and /or relocation
200 amps or less 100.70 2
X PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: PHi Norman 'ti 401 amps to 600 amps 200.34 2
1 f l(.li t 601 amps to 1,000 amps 301.04 2
Address: s Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation _
Phone: Fetjb ) « ( ( `r 1 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, er panel
Owner signature: _.- Date: A. Fee for branch circuits with
® APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit _
Business name: Same as contractor B. Fee for branch circuits
Contact name: Diane Mason without service or feeder fee, i 56.18 2
first branch circuit
Address: Each add'l branch circuit I 7.42 2
Miscellaneous (service or feeder not Included)
City/Stale /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
CONTRACTOR Sign or outline lighting 67.84 2
Temp Control energy panel, or t o n ,
Business name: Tri County or
Y energy panel, alteration, or
Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2
City/State/ZIT': Oregon City, OR 97045 Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: (503) 557.2220 Fax: (503) 557.0914 +. Investigation per hour (I hr min) 66.25
_ •
CCB Lic.: 72623 Electrical Lic ' 527 L `R Suprv. Lic.: - 11 industrial plant per hour 78.18 , • 11 (- ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal:
Print name: Dave Saiholm Date: 11(1(t/ q Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: ci kat:fZ✓ 17 ;y% TOTAL PERMIT FEE: 11
L This permit application expires if a permit is not obtained within 180
Print name: Diane Mason Date: O bl days after it has been accepted as complete.
• Number of inspections allowed per permit.
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