Permit , •;r{ V{ CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2010 00400
•t ' ,t Date Issued: 08/03/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
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Parcel: 2S114BA01500
Jurisdiction: Tigard
Site address: 16200 SW GRIMSON CT
Subdivision: PICKS LANDING NO. 2 Lot: 124
Project: Cline
Project Description: (3) branch circuits for A/C.
Owner: FEES
CLINE, JOAN D Quantity Description Date Amount
16200 SW GRIMSON CT 3 crt Branch Circuits 08/03/2010 $71.02
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/03/2010 $8.52
Electrical
Contractor:
TYLER ELECTRIC LLC
PO BOX 807
MULINO, OR 97042
PHONE: 503 - 829 -2498
FAX: 503 - 829 -5747
Type of Use:
Class of Work: Type of Const: •
Occupancy Grp:
Total $79.54
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 `et forth in OAR
952 -001 -0010 through OAR 952 - 001 -0100. You m- • • - • - • • o •l• ______r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: — t Permittee Signature: ' ®'L . . _...-...L..1.46.–...."
'il:
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.
2010 -07 -29 16:47 GRF ELECTRIC 5038295747» 50359 1960 P 1/2 2.
Electrical Permit Application ry ' �� t ' I � ► R (,1 i it• 1 i ,.1 _ Y
eceived
City of Tigard , �,,, :" " 0 p R 7 �` 0 mu , — v — O tJ i t(1i`
DateBy:
i e 13125 SW Hall Blvd., Tigard, OR 9 123; el Plan Review
S W Other Permit: , i n v
Phone: 50 - 639.4171 Tax: 503.598.1960 `�� l,�`f�ateBy: F-�� l0 "!' 7
':
J ,': "2 r‘• See Page 2 for
' Inspection reset Line: 503.639.4175 ..�" JNoto Ready/By: Juris. t fed/Method: � Supplemental information
' Internet www.tigard-or.gov ^ � u� � `�?. �� '
-- TYPE OF WORK ,�,� ��� PLAIT REVIEW _
Please check all that apply (submit 3 sets of plans w /items checked below) -
Now construe[ ion Additionlalteratiottap acement ❑ Service or feeder 400 amps or mile ❑ Building over three stories.
❑ Demolition ❑ Other: w the available fault current 0 Marinas and boatyards.
CATEG OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
^
less to ground, or exceeds 14,000 0 Commercial -use agricultural
1 and 2 family dwelling 111 Commercial /industrial 0 AcceSSOry building amps for all other installations, buildunsS.
O ❑ Fire pump. 0 installation of 75 KVA or
El Multi family ❑ Master builder ❑ Emergrncy system. larger separately derived system. .
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A' . " 1 -2 ", "1 -3 ",
100HP or more. occupancy.
Job no.: Job she address: I 2_00...._..5...4...4L64 O ❑ six or more residential units. ❑ Recreational vehicle parks.
^ ❑ Health -care facilities. 0 Supply voltage for more than
City /State /Z1P: � �k, 6 11 7--/-- 7--/-- h - f ' T ❑ Hazardous locations, 600 volts nominal.
t ❑ 5ervu a or feeder 600 amps of more.
Suite /bldg. /apt. no.: Project name: C, e, _ FEE SCHEDULE
Cross street/directions to job site: nereriptloa 1 Qty. 1 F0° 1 Total
residential single- or multi- family dwelling unit.
_ Includes attached garage. _
�_ Lot no.. 1,000 sq, ft. or less 168.54 4
Subdivision: _ Ea. add'! 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above se. R.) _-,
Limited energy, multi- family 67.84 2
G r - • . - - id residential (with above sq. R.) / Services or feeders installation, alteration, and/or relocatio
Off_ -_ . , ..4 200 amps or less _ 100.70 r 2 _
F PROPERTY OWNER ❑ TENANT _ 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: i o , 601 amps to 1,000 amps 301.04 2
Address: s 0 ei 2 -Ci Co) en f --; '; 6 ,, ) 6i - • - Over 1.000 amps or volts 552.26 2 _
I Temporary services or feeders installation, alteration, and/or
City /State /ZIP: 1 ,
f ,,,.7)1 _ : ( ) relocation
Phone: ( ) Pax: ( ) 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 1 own which is not 401 amps to 599 m s 1 68,54 2
intended for sale, lease, rent, a
or exchange. according to ORS 447, 449, 670, and 701. Bunch circuits a new, alteration, or extension, e:r panel
Owner Signatlue: _— date: — A. Fee for branch circuits with
❑ APPLICANT [ - ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: H. Fee for branch circuit~
without service or feeder fee, r 56.18 1 (Q 2
Contact name: first. branch circuit 1
Address: Each add'! branch circuit 2 .14.714
- Miscellaneous (service or feeder not included)
City/State /7 -IP: Each manufactured or modular 67,84 2
-- = dwelling, service and/or feeder
Phone; ( ) I Fax: : ( ) Reconnect only _ 67.84 2 , D /3 / II)
E - mail: _ Pump or irrigation circle 67.84 2 D / •
CONTRACTOR Sign or outline lighting __ 67.84 2 i 7'
- Signal circurt(s) or limited -
Business name: r, 11C. (l . C..- energy panel, alteration, or
extension. Describe: Page 2 2
Address: _ f7 X _ _ —
City /State/ZIP: 14 / t 6625
•
, � Each additional inspection over l allowable in any of the above
Per inspection .
Phone: (5Q 5) If L 9- { ` ( ;,o Fax: � ; ') b zAt ^ ' 1 7 ` 7 6 p
Investigation er hour I l hr min) 66.25
CCB Lic.: 1 q. `- 0 c( c Electrical Lic.; - 3 Li. CE ri • Suprv. Lie.; 7 0 G(5 Industrial plant per hour 78.18 ,
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , - Subtotal: Ste/ tf+l '"7 I • t'/-
Aa
-- "` r Plan review (25% of permit fee); ass
Print name: r :L 1 G / . ' IA i r ' 1- te: / � ( �� State surcharge (12 °'0 ofpermit fee): $• 3
signature: f 1. 7 rtyrAL f•CRMIT fG[:: 'r� Z f 7' $'(
--- —, This permit applicnaian expires If a permit 4 not obtained within No f
Print name: , b Date: J days after it has been accepted as complete.
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