Permit H CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00431
T [ G b 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2010
Parcel: 2S104AA90311
Jurisdiction: Tigard
Site address: 12646 SW KAREN ST 31
Subdivision: Lot: 0
Project: Bellwood Terrace
Project Description: (2) branch circuits for washer and dryer.
Owner: FEES
BELLWOOD TERRACE LLC Quantity Description Date Amount
PO BOX 189
YAMHILL, OR 97148 2 crt Branch Circuits 08/20/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/20/2010 $7.63
Electrical
Contractor:
FIRST ELECTRIC CO
19093 S BEAVERCREEK RD #305
OREGON CITY, OR 97045
PHONE: 503 - 632 -8373
FAX: 503 - 632 -7989
Type of Use: MF
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 OA: • 52- 001 -0100. You may obta' copy of the .les.or-direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued - 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' 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.
Aug 19 10 01:09p Mark Lengele 5036327989 p.2
51 . r ° ,1 ,,, , .
Electrical permit Application 11 . [ ,,, 1 , - , a ` I' c'1 + 1i ' ? ‘v;:-,',- l vi t� ti { `
City of Tigard �
R° °d / 1 ''e� i�C lv —(X713 I
AUG 19 2010 � � R r at iv ��T
13125 Sllil Nett Blvd., Tigard, OR 97273 P]ao Rwieet Pan*
Phone: So3.639.4171 game: So3.s98,1960 pdalBr. rify)pi c) t X1 � —mil
rnspemyiw+LiriC 503.639.4175 �. I � 1'Y (J �i ii Ri) Darers�W S t ePAIR3 ter os0ornct: werw.tigard•acaavw : ! , r.;• y ��(' ptc.a rpeseJraranaar{or (
NoriRsdilrkrbod: ether P
RI 116 6� e.t9i tit
• • . • . • ` I a you ,F• a • .:. ;tr �• 1�! : " =:i ='sP:== :'aN= ,
• lycw eonabenetiOn Addition !alteratiettt /leplacemrmt PtaQao axe t Feu wvh {embalm tees epic'," .rrrtm,. atcea t>
Q Demolition CI Other. re ono amiable 400 nova r � O Madan end bonyenk
•
: - - :1`011C DRr Olr CO1V *VCE)O* • . - . so ooa comsat 150 obi at 0 FloaRinitbeolcbnp.
Gros to "trend, or mccoods 14.000 a c maei+4c,e Ji{eideoea{
- sad Mustily dwelling ❑ Commercial /industriai 0 Accessory building mope for ail other Natal Wien. betihfiap.
Mufti family -.-- - 0 Master builder 0 Other: I3Fne Rasa• 0 hatadatiev or 7S KvA ar
,jj(( OF +ay spawn. tamer cneb derived system.
- .;: •• AN • • - • ❑ Addi** *rem meow toed of Q "A "E". "1.2'. "1 -3, I 1
troy: J o b s addre ' ! 100APormom. away • Jab
( (i � ,W t0.S� SS� 0mx armory resikondwws. CIRopwisaut wirier, swim
City/StuteIZ1P: `'(^ V�2-t � alleahh- enrefacilities. i7SuFpir,otu.sef
l - ..1'3ltaramowtaeotiona, 6cowloaaminal.
Suite/bldg. /apt, no: � P name: tti s.�},t,L Tc c..fe' �TS DSerriaar focdm . 600 mope a mom.
CrossstrectVd' D teed.% '::: ,:: 1 021 rev. }>• Taal 1 •
New residential sine*. or mull - fanny &venir a unit.
lndades attached yjt*age.
Subdivision: 1 Lot no.: 4000 sq. ft or leas 168.54 4 e
Dec map/parcel ale.: Ea. addl 500 sq. t or portion 33.92 1 '
Limited energy, residential 67.84 2
hJ� pp l
Limited matey. m dtidamssly 67-64 2
NcL1 �-d. -0,..c,\ d�, c— e( G.cGus''c5 G.,..9. e ,+,.., residential S tesidential(no Aiwa se. It)
ScnIcq ur feeders buitallinfort andInr Mantle
_200 amps or lets 10030 2
• .. Q 111RO)P 'Ooi►1915R 'I'fi ' - • •,1: • . ❑ ONT• '• • • .. 201 amps to 400 amps 133.56 2
Nair= 601 manes to 600 amps 20034 2
601 stops 10 1.000 amps 301.04 2
Address: Ora 1.000 amps avail 55226 2
Ciiy/SSffieIZ]P: Temporary services ar feeder/ ii nilladon,jdtent- on,sad/or
rcteealian
Phone: ( ) , Fax: ( ) 200 amps a less , i 59.36 1
Owner installation: This installation is bang mac on property that i own which is not 101 amts to 400 limps 12S.0 2
intended for sale, lease, rent• or exchange, according lb ORS 447. 449, 670. and '701. 401 amps to 599 amps 168.54 2
arnmselr el ' •: — new alteration or cat • , :, • - • not
Owner sit/palm: Date: A Fee far branch circuits with
• • 0•18IRTAEJtilf F' • : • . -. .. f - E]'COPfrAC? lL1t;9ort • above service a feeder fbe- 7.42 Will
each branch circuit
Busmen name: B. Fee for branch circuits
w h i n e r service or fader f¢, r i
Contact rime: lied branch circuit 1 SfttB 56, 2
Address: Each addl branch circuit 1 7.47 '7,99 2
Miacellemeotes ' - - afeedereatincclude•
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone: ( ) 1 Fax:: ( ) Reconnect only 61.14 _ 2
E -mail: Pump or irrigation circle 67.84 2
Sign or outline lighting 67.E4 2
� calm Signal eireuit(a) a limited-
Svshle (=(zsr CLEcret. Cx- v\AP 4p , -)'? enemy wet attention, or
Addre:s-m V X t-...1 6 cateasion, Describe: Page 2 2
CIty/State IP: s e___S Ce ( c' -7UL� -S Each additional inspection mew Airmail* in an of the above
Po inspecon 25
Phone: (Sy3) ( 1 . � T I Fa= (.53_ toga ! t g.9' C tavcsti on Per hour (t br ram) 6 78.18
CCBLic.: I'-f•'fcj EtcebicalLie. :(4- —Si.G1 Suprv,l.ic.:(,.6"q,•l(S y h ransbimiplmmtparhaar r
•° T r : :. f�
Supra. Electrician signature, required: (9 . ( Subtwal: - /„?
Print naate:Z-�l mule Date: (- (4 1 {r„>
S P1aalLVicw(257`afpermitfee): �3
1 urtercharge(12%ofpermitRe): sv
Authorined signature TOTAL PERMIT 'FEE: t " 7 f u
u se,era spelkadm eivpivv if perm:CH +ler obtained a:tIde 150
Print mom s N. c Dade: days seer N leas been meepeutr as complete.
• ..Number of irupeetiaaa 1100saed pr/ perm {t
C1Bmlemal poem utter mallet for tarter o KrwR1ST(i IJ091:014 ►YER
ifrZt Len) Oe f