Permit , CITY OF TIGARD ELECTRICAL PERMIT
ph COMMUNITY DEVELOPMENT Permit #: ELC2010 -00424
Date Issued: 08/18/2010
TIGAFLD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103CB01300
Jurisdiction: Tigard
Site address: 12355 SW JAMES ST
Subdivision: Lot: 0
Project: Tabor
Project Description: (1) branch circuit for septic control panel
Owner: FEES
TABOR, KRISTEN E Quantity Description Date Amount
12355 SW JAMES ST 1 crt Branch Circuits 08/18/2010 $56.18
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 503 - 807 -8789 Feeder
1 ea 12% State Surcharge - 08/18/2010 $6.74
Electrical
Contractor:
RANDOLPH WAYNE ARTS
PO BOX 731
SUTHERLIN, OR 97479
PHONE: 541 - 580 -4100
FAX: 866 - 283 -2928
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 52- 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: �� /9 L! 0' "
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.
Fm:Aerobic Septic Systems To:City of Tigard (15035981960) 08:51 08117/10GMT-07 Pg 01-01
.: .•
' ) ' • •
AUG 17 2010
Electrical Permit Application ,-.-. v ' ' • - ' , '
,„ ,.. ....,,. iLd itw.,,
itii'llti". • p 1 Per • City of Tigard . ,. .., . , • ,; , - ,.; , , 0,-,f; {{ iteceiverl nj N 62 , C old/0 -- a0
X49
i,i' 144%! q 13125 51 1-1rill Tigard. OR 97213
Plan Review
,,.....,,, e4 Ph :min 503.639.4171 P; ix: 5r./3.5(4,..1960 1);:!.....,'F.y: 1 (>111cr PernA57 0006
i lasp n oclio Lin: 593,63 Da ea • 9.4175 le Rdy:13:i. 1 El See Page 2 ror 1
...„ ___RHONR:D,l• , 1 1 CC
atire.cilig(gOif 1:11eniet: IA ii.(i)v.tignr d •or v :. ; Supplemental information
: ..;:... • ' '.'• j; ••••••• • li , . 1 ",....1: 'i . :".i • i• •"•.....' ".i.. T:YPE . OF WORK .::•••,.) =' . ':= • . ''. • =••• =:' • •.= . .:.: ..• • ''. ,....... : :=: , ::"...,... • ....:".... • " i : : : ... I'LAN.::REVEAV. .. I.' :::.=,:::, '1. •: :. :..., : ......:::,, .. !:
kr New construction 0 AOLlition/alteriotionireplticernent --77---777 1 rkase Check ,•.11 ;ha: apply (submit 2 :air:, 0:lphri.i ei•• nem:, ehed(ed bele:vs/.
1 0 Serv.Le iiii lei:de:4(1 ainps O1 rOOlt 0 th 0,t
lildora rillICC Slot ICS
0 1:)M10111b11 0 Other 1 o';I:to, lilt' ■0 ditablO raull. 0.11,01. 0 Mil;!1,1:, and bita,.0 ds.
1 :•••:: : •• • ;•'•• •: . ; " • • , ==CATECORY• QV CONSTELT.C.I.10.N. , .. .... • . . 27771 e„,..„1,1+:..Orui ampii ro. 150 yells or 0 Fling buildings
1•••:- . ___; 1 ies ai ground 17 lt•SCCOth 1-:,(r)0 0 , ..OMMerL;a; - usi, rgrietilinini
1 r4 I - and 2 dwelling, EI Conintercia,/indo.ostnal 0 Accessory building 1 I amps c,-;;,{111 (ithei instaliaior,s buildings
1] Multi -fainoly 0 Master builder 0 Other I 0 Fire ;:iump 0 lni•naliailen , 1 - 7: 1. 'VA in
,„ n !....,,,, system larcer ferinrilielv derived system j
., • •••rj, :i i . ' il• ' - . i.lOW:ITI,i:. 'INI.ilORMATION ' 'AND: LOCATION : :. - ': . ' ". ....• . : : : , .: i n „_,..,,,, ;.,,. n ..,„. mom ,,,,,,,,,,.
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1 , I inn IP •ir in,we inciting
Job no.: 1 Job site address: / 2 3 4 ,- -- c - S ,:clildW'...:; -Cr; i I El e,.s. - • - •
v(iiniiiii pink:,
l' 1 0 I kaLil-,41", raellittos 0 !•;t1prl `,,•011,g, ! 11101O1[1,1O
CitY/S1LIte7,11'. 7 , 0,,c; q 7 42, -',. t 0 11 id- ir>caliaini ',in vi noini nal
Suite/told:2 /apt 00.: 1 i I Oji.A-1. 0,1111L. t A il:fx:' a i ,f, C (>44 ei 1 0 SOrV,C,:,01 fOOdr, 60(13111r, t.,0101O
• • r77-77• .. , ' • •• " ' FEE SCHEDULE ... i : :'= • : , ' • •:
1 Class street/directions 10 job. sit,.i { 0r,cription - 7 oi):, 1.,,,.. 1 Tela1__
- I 1 New residential single-. or ottitti-tatudy derelliro mil.
•
. i I Includes attached garage.
......... ....------ i 1 1.1)01) sq. ft. et Icsi: (i 54 4
I
SUbdtviStort: i 1.01 110.: 1 ...........
Fa. add') 5011 ial. 0. 1410111(m 1 I ; 3792 i i 1
i l'aN map/paled 110.: I
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l 1 1.1111i1(n.i i.inergy. reiiielential
75
I . i".•.: .Fi;...: . : , .•:. ' DESCRIPTION • OF :WORK : .:: i : := = . : ::'. : .= :: = : - : ::= • • :' ' I I ( "la' ".''" "I' II.)
• l_iii»tcci citcrgy, multi-amily
75 00
_ _ _ J . ,-,)--iplit 5 lf.. r(sidcniia 1 (wi)h aborc mil. 11.) I .L.
/ 1 Ser., ices or feeders installation, alterar 011, alid/or relocation
( I 1 ,,( 0 ,rip-i, fin. les — 1 - 100.70
._ ...... ;
. • ; • • , 0:•1ROPERII'li OIVNER .:' • • ' • .• : • 'II'. 0 l'ENANT . ,. - .. • I, 1 1 '2(1 ll ll ' 4°{) m
a) 's 133.515 1 J2
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1( :Imo:: to 1100 amp,
i fir I Altli)ii to 1.000 amps
! ' ' i
! 20034 j 2 j
.1)1)14 1 • , 1
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Addre ,.{{ ss: 1 1 0 Loot a'r. or volts i 1 1 5:2.20 1 1 2i
; 1 empritiary gerritioi or i imt nl la ion, olieratiOn, nod/or I
1 City/State,7,,P:
i relocation 1
t l 1
Fax: ( 1 1 200 minim ria- i0o, I
I . I 701 amp in 400 amps j 11'5 08 I j 2
ONs tier installation: . 111is installation is being made 00 10 l0 that 1 ox‘n . {Aticli is not
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i 1 _..-----. ** 1- 1
intended for szole. le ase, rein. or exchange accor
_ din o:o ()R.I 414 '2, 449, 67: i., {al 701 1 4(1 .011 10 099 amp 1 68.54
. { - I
1 1 Branch circuits - OM, alteration. or eitensiota. er unel i
Owni:n signatior 1)ate: { { A. Foe for inane!: 01101010 111)1 i 1 .-1L---
-------- • ' -------7.---- .• ----:--. 1 abmici service or 15.icii]er fire, 1
. : ...••••,•:'. ••:::. .• 51: APPIAC.A,.NT:i :. • . : .. = , = . ' :': •::. '.: 0 :CONTACT :PERSON. :: • • :' .' ' • i 7.42 1 2
1 C2,141 hi:anal 2.11•0011. 1 ■
1 i
1. B. Fce for branch circuit,i nirrlioin 1 1 I , 1
3 n aine: ie,4Ac>,./ 47,7-r S 1 ,
1 I 56 I ri.„ 16 2
ri - 3 1
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braneh einnill . 1 ,2‘
1 Contact mane:
1 i 1-inzli acid li bra:1211 i:ireitii 1 , i 7.42 I 2
,
Address: 4.,, p Ao,t .7 3 / )
' Miscellaneous (service or feeder »ot included) i
I
............_ `-•
- I rag!) manainelureil or :nodular
1 ili7.84 I 1 2
1 C14.y/Strlti?1/1P: S tir/./ .. e , , , w, ,■1.V "..... /2 r e ei 2 , 7 7 9
1 d fyucleil
1 ki.nitinneel 674;11 1 1 2 I
Phone: ( 5 ) ce0 - , -/ - (a. , , 1 :(E0::(..., 1 &-, -7 ri 7,si , .
-1 Puny) or irrigation ci:cic 61st
1 11-10(111: i e4 egtd ec' /40.1/) ,- ' Sign or )utlino lightinit 67.84 1 1 2 I
i 1 •.•'•'; ..-: ••••• " • • - i• i• • i• '. •' (X)iN TRACTOR • • . : • : ' ' . :'• " : •• : -
• .. " • ••• • ' Signal eiteuiii s) Or I intilCd-OnCii gy 1 i ----f-
2
. 1 pant :ilicra Lion. or Li \ lianinni. 1 i Page 2 1
1. •IlllinCi ' & AS' /4/ ____ ...... ._ _... 1 1!•,:ach . iiIii,itionai inspection oveir allowahte ill any of the above
{ .AddresLi: Al-ivd 0 (- p hi- Amy/a e - 1 9. Ars i 1 Ailditinnill inspoetior (1 hr min) - T .1 _ 06 25i hr
1 ; ITIVC:S11,12.1110111 1 iiir min) ' 011.21; hi I
City/State/7. ---
10: i
------VC------71 \ N,le J/4 C t5 lualesicial plant rl lir min) i •
1 78.11 lir
;
1 Phone: ( ) I .iar ( J1 1 % , ' 1 hispcictions 101' which no nit: is
1 90.007 br 1:
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Suprv. Electrician si.9,naturc, required .------, ...--_ ,,,.. i
pl rov i,, , , (2 o r rwrin ii,,y,
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A ..--" (ilri:harre (12 0) novnill roe): 1 if; t 7 Y I
Print name: ; ,_ 1 1)ate: ?._ / 2 _ Slate i
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111) 71.. Pi 1:El1 6 i, 1 z-
Atalanit.ed signatur L e.
Tin', permi1 applkilLion cspircs. or a 11111011 10 001 Obtained 101111111.80
alter it tin. h,-en itcceptcti 00 4
Print 1101110 . 1 1)ate:
'. N :Ill ira'ad per 00011111,
r llniVin9. 1 - ile.oriArp n., O7:01:11) 1.1:i- le, I - l'ril rll'ol. \OVER 4 07,-qx