Permit a CITY OF TIGARD ELECTRICAL PERMIT
` 2 COMM UNITY DEVELOPMENT Per #: ELC2010 -00415
T t GA R r) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued:
Parcel: 1S135CA90113
Jurisdiction: Tigard
Site address: 11044 SW GREENBURG RD 113
Subdivision: ASH CREEK CONDOMINIUMS Lot: 0
Project: Ash Creek Condominiums
Project Description: Replace 100 amp panel
Owner: FEES
JARRAD, JAMES C & DOROTEA Y Quantity Description Date Amount
11044 SW GREENBURG RD #113 1 ea Services or Feeders - 200 08/10/2010 $100.70
TIGARD, OR 97223 amps or less
PHONE: 1 ea 12% State Surcharge - 08/10/2010 $12.08
Electrical
Contractor:
ANDERSONS INTEGRITY ELECTRIC
18435 SW PACIFIC HWY STE D
TUALATIN, OR 97062
PHONE: 503 - 691 -6709
FAX: 503 - 691 -6709
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 i rdan h approved plans. This permit will expire if work is not started within 180 days of issuance, or o ' suspended for more the 180
days. ENTION: Oregon law . =qw >s you to follow the rules adopted by the Oregon Utility Notii• - -:• Centel •se 'rules are set forth in OAR
952 -0 1 -0010 through OAR 952-0' -0100. Y• may obtain a copy of the rules or direct questions to OUNC by calling 03.24•. • •99 • i c 32.2'44.
\ 1
Ise ed By: ■ . I P ermittee Signature: lrINEMII'I..� ......_
101.1111F w
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: g /47
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 protect.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application � ��� Re ceived FO lr OFF l C E USE ()NA 1
i
Cty of Tigard Date R B / Permit No.:
° 13125 SW Hall Blvd., Tigard, OR 97223 �� at, ` � ~�O /6--- Pleview
C, Phone: 503.639.4171 Fax: 503.598.1960 I. �. r 1 0 c E P n DateB Other Permit'
T 1 G A R b. Inspection Line: 503.639.4175 Date Ready /By: Juris 0 See Page 2 for
_ Internet: www.tigard - or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF W WLD1NG J)IVISiON PLAN REVIEW
❑ New construction % Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps 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.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ 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 ",
I=t- 1 (3 100HP or more. occupancy.
Job no.: Job site address:
l 1 U y y s-- 6.r acv,, (SO/ r e - ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP --- ‘ \\"., ❑Health-care facilities. 0 Supply voltage for more than
j name: ` T ,,��n�T'La'�,�(((/ /\ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: tL \ �3 Project ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. 1 Fee. 1 Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 7500 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Y (>Lw,Lc.._ \ no liNK-A P`At'.-3--< residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less I 100.70 1 cs0,1 p 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own whichis 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, per panel
Owner signature: Date: A. Fee for branch circuits with
• ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits lvirhout
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /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
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: .. panel, alteration, or extension. Page 2 2
�IQJP r50� S o.S C d 1 e C 44 , 1 L Each additional inspection over allowable in any of the above
Address: \ L, S s,,,,, 'p ( 4,,......
_ ' y Additional inspection (I hr min) 66.25/ hr
City/State /ZIP J & � 0.2 G 0 ( --e___
Investigation (1 hr min) 66.25/ hr
i Industrial plant (1 hr min) 78.18/ hr
Phone: (9 ) / _ G ( — G -7 0 of Fax�( ) inspections for which no fee is 90.00 / hr
l� /II i It specifically listed (%z hr min)
CCB Lic.: G ( q (p Electrical Lic.: 3 (4... ( L Suprv. Lic.: 37703 ELECTRICAL PERMIT FEES
5 /st4it `M// �o Subtotal: ( 00.1 D
Suprv. Electrician signs 0 J ( } < • e, required: r si Plan review (25 %of permit fee): � "'- Print name 0 Iv I ate: OF
li 1 (O (7.o1 State surcharge (12% of permit fee): 1 3—o
TOTAL PERMIT FEE: 11)„.18
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
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