Permit n CITY OF TIGARD ELECTRICAL PERMIT
' . ° COMMUNITY DEVELOPMENT Permit#: ELC2009 -00183
.T.I,GAD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04 /28/2009
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Parcel: 2S 103BCO3400
Jurisdiction: TIGARD
Site address: 12330 SW ALBERTA ST
Subdivision: CANOGA PARK Lot: 8
Project: Ginia
Project Description: Install (2) branch circuits.
Owner: FEES
FINCH, PETER M & GINIA L Quantity Description Date Amount
12330 SW ALBERTA ST 2 crt Branch Circuits 04/28/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/28/2009 $6.42
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
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1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677 •
Type of Use: SF
Ill) Class of Work: ALT Type of Const:
Occupancy Grp: •
•
HI
•
G'Pack N 06 ll • Total $59.9
Required Items and Reports (Conditions)
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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 a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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'N 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.
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12330 SW ALBERTA ST
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Property Owner Info
Tax ID Number: 2S103503340C,
Tax Acccunt Number: R-173339
Site Address: 12330 SW ALEERT.a AVE
Site City:
Site ZIP: 97223
Owner Address:
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CITY OF TIGARD ELECTRICAL PERMIT 11 1 - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00183
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/28/2009
Parcel: 2S103BCO3400
Jurisdiction: TIGARD
Site address: 12330 SW ALBERTA ST
Subdivision: CANOGA PARK Lot: 8
Project: Ginia
Project Description: Install (2) branch circuits.
Owner: FEES
FINCH, PETER M & GINIA L Quantity Description Date Amount
12330 SW ALBERTA ST 2 crt Branch Circuits 04/28/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/28/2009 $6.42
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 952-001-9.100 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332 2344. 1
Issued By: �l O ,l Permittee Signature: Q . "C cat )
( Y\
OWNER INSTALLATION ONLY 1 '
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'N 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.
1Q,(2&4
lcctrical Permit Application L Z y. 0.„ .FOROFFICE USE ONLY ' - .
City (�f' )(L'LL'IVL'lI r � ,
11-Iii _ ^ I) :Ili- /Hv. permit No.: I
= N 3125 o 11' ,stud.. riy ',ar<I, Or( 9'722 c ". y ' f ` -� `CZ� • 00
� plan I(rviaW
I'llunc: 503.639.4 1 71 lax: 503.598.1960 l)air/1tY :, Other I'cruut. • TIGARD inspection Line: 503.639.4175 Dale Kt:tidy /liy: - JVtIK f� ,`(•e )'l'4 1 Fie
!Memel: WWw.tigard- oc,gov Nnlined /Method: ..... 'T C' Supplenu.anll Ii 0 Ormo6011
TYPE or WORK 1'I.AN REVIEW
hel
N ew Construction all Mai tinny (suhnul 2 sets Lit plain W/ItrliO checked uw):
❑ Addition/alteration/replacement Please cheek
❑ ,SerVrcc uI Iccder 40 amps or more ❑ Iuildillg over duce .lung::,.
❑ 1 )entrtlll Ion ❑ Other; wlirre the avadahlr I;IU l'Un enl
❑ marinas huatylyds,
('A'I'ECOIIV OF CONSTRUCTION cxcLLLls 1(1.000 amps al ISO volts or ❑ fluatinE bu A;tm
I csx to ground, or exceeds 14,000 ❑ ( 'uminarcial"u'nc auk neal
I - and 2-family dwelling mercial /i rdustria! Accessory
y g �• ❑ ❑ II
amps ltl all mho mho hlalalgllrl`I. buildings. D Master builder C] Other: ❑ ['ire pump. ❑ livitalluhoil or 7? KVA m
.. ❑ Iituerl;ency system, lusger •',cparaicly tlrrivtd system.
JOl1 SITE INFORMATION AN(5 LOCATION ❑ Ad <tllion nl new motor loud of
Job na.:3 7 I Job site address: I 1 3 7 C (y &I ti , c p low h'of MOIL. ncrup :ulry.
v 1. 1F 7 ^ ❑ '450111 lulc textdcunat ,Initu. ❑ RLicro :uien;ll vrltielc parks.
('Ily /:State /7.IP: C C C ry �� Cj .._.__ ❑IIcallh- c :vclucitiiira, [� supply volla)et iq ' Ilhnrtlsln
r c J �: r _
0...„..„„.,,,,,,,, n 600 volt OUnun.d.
SuitC/bI<1g. /apt. 11Lt.: I I'IO `L `,� J
FEE SCIICI
L )L,l r f].tinrvlr,L : L,rI l.,r LdlO n l„p , , rntoir.
f
- - - ICILE
Cross street /directions to job rile: no.rr� ttlou fro. r,•.•, r'_'i..nu
- -" -' New residential viugte• ur multi-family dwelling unit.
- - I ncludes attached garage.
1
Subdivision: I 1 •ot no.: 1,000 54. 11. Or Tess - ". 145.15 4
- -- - -- - Ea. ail<I'I 100 sq 11. or portion 33,4(1 I
tap /parcel nu.: __.. Limited energy, residential
75.00 2
DESCRIPTION OF' WORK (with above sq. ft.)
/ \ / . . Limited energy, multi - funnily L
Cz `1y�'(.4.1 t is <t 1 ..- . 4 f k . "C 1i •t :;rt 1'I ( .I.) 73.00 . .
g _ L residential with ow,vc !.0 . It,
Services or feeders inslali,ltloo, alteration, rind /or relocation
200 :imps ni IONS 80.30 2
I'120P1?12TY OWNER ❑ TENANT 201 amps to 4(1)1 amps 11)1,.85 ?
Namc: / /_/�_' , t 401 amps to 000 amps 16(1.011 2
- - 001 amps to 1,000 amps 240.00 ?
Address: - e ' Over 1000
.(,l_4 ` _ ver , amp, ur v ol 45405 2
volts . I - ..,;
City/State/ZIP; Temporary services or feeders installarton, alter :160o. atl<I /ur
relocation
Kane; ( .cp',) 5 r� (% _ 3 2 W Fax; ( ) 20(1 amps 0r ic 00.8.5 I I •
- 201 amps to 400 amt,
Owner installation: This installation is being tondo on properly that I own which is not l l 1 ?
intended for sale, lease, rent, or exchange, according to ORS 447, 44x), 070, and 701. 401 mops to 599 amps 133.75 2
Branch circuits new,
Owner si gnaturC: ,;ateralion, or extension, per panel
} _ . _. Date: -- -- --
A. Pic for branch cireluts noll
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
6,65 2
each branch circuit
Rosiness name: 13. Pee for branch circuits
Coolest n: ; -.. wrllund souk': or rc<•dt•r rem, 46.85 (f :..>C
11 rid branch circuit /6"
Address! larch add'I bra nch circuit j_ 0.05 •f�, .C. S. 2
____ __ -- ______ . - Miscellanrous (service or tgetler not included)
City/State/ZIP: IL,rcb IOSII1LfactLLin:d or dul, r
Llwcllinit ,e
.a'vicc and/or feeder 711.90 2
Phone: ( ) Fax: 1 ( ) It 2
) Reconnect only 66,85
1'. Pump Or irril;in circle 5:4.40 2
- (ONI'RAC" 1'OIC Sign or outline tiphtin }'. 53,40 2
---- Signal cireini(s) or Ii red..
IRusincss name: WEST SIDE ELM :1'12.1C ('.O.' _ -- energy gn alteration, or
Address; 1834 tif, 8 I11 AVE. extension. Describe: Page 2 2
-
City /S1:)tc / %IP: PO12'I'I,AND, OR 97214 I nIj add iliunal inspection Over allowable in any of rho :lhmv
- - _.. -- I'cr inspection 02,50
I'lu)nu: (503) 231 -1548 hear (503) 73(x0677
Investigation Il!:1(ulrl per hour (I Ill' 111111) 61.50
C'CII Lie.: 13306 1 :lcetrical Lie.: 20-135C Supr'v, Lies; 46545 Industrial plant per (hour 73.75
-' "' "'" ELEC'I'IRICAL I'ERM11 FEES
Soprv, Electrician signature, required: L (r f
• _- ( O I L t ti - Subtotal: L�
C.; .4
L.. '
L -I /?1:-//b 5 Plan review (25% of permit fee):
Print n:u RAN))AI,(, IZUI31iIt'fS [)etc: (( j --
- -- -. Stale surcharge (12'% of permit lee)' 6J-(2
Authorized signature: 'TOTAL 1 PRIi: 6i r .rr L.
PP ,• - ._ -_ - -" 'thin p< :rrnit Hpplicatioil ecpires it permit is not obtained within I)t))
I ) tot mote. ---... Dale d,ryc after It Itn.4 been accepted as complete.
-- ' -- --- ` Ninnnnlner nil )lip' lilnilt LLIOWL'd CI 151111)1.
1• uul,U:L<' P.nnllnuu,,lnc 01l2.0er, 4404011'1( 11511)1'IMlwl.11
z•d LL90 9EL ICOS) '03 0IJ 0ai3 a pTs 'sa0 eLZ:OT 60 bZ -Idd