Permit CITY OF TIGARD ELECTRICAL PERMIT
.11
a • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00461
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/31/2010
Parcel: 2S102AD01800
Jurisdiction: Tigard
Site address: 8965 SW BURNHAM ST
Subdivision: Lot: 0
Project: Armature Coil
Project Description: Conversion - overhead to underground.
Owner: FEES
CARL H JOHNSON FAMILY L P II Quantity Description Date Amount
BY JOHNSON, CARL H, 8965 SW BURNHAM
TIGARD, OR 97223 1 ea Services or Feeders - 200 08/31/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 08/31/2010 $12.08
Electrical
Contractor:
NORTHSTAR ELECTRICAL CONTRACTORS
19450 SW CIPOLE RD, STE 107
TUALATIN, OR 97062
PHONE: 503 - 612 -0840
FAX: 503- 612 -0891
Type of Use: COM
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 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. ATTE n law re uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 95 -0 - 1 /You may obtain a copy of the rules or direct questions to OUNC by calling 50 .6699 or 1.800.332.23 4.
Issued Permittee Signature: l �c-"L__1'
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' - _ • ±V Date:
LICENSE NO.
Call 603.639.4176 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. 31. 2010 1No.0586 P, 4
city of Tigard
ac,.eivw
i " 13125 SW 1-1:111 Blvd., Tigard, Ott 97 Z�`l. 'r V b:udB : 0 3 / /� _ 1 � Permit No �a0 /D• � O�
Phone: 50:.039,4171 Fax: 503 598. )-� " Plan Review
t .,„4,t Other Permit:
TI GA RD Inspection line 503.63' . 4175 _ r „ Una Ready/1.1y. mns
Internet: www.tigard-or. ov /VI C? ' , tiee lle 2 for
a R , , i [ , ,- Nmihed. MclhaJ. Supplemental Inf°rmal[nn
TYPE or W �T ,� - - PLAN REVIEW - --
31 'ew' construction ❑Addition /all'e / p W1 pvtCif t`7 Please check all Owlnuply( sub n tit2 sets urplans wiileuts checked behov .r
` 1 � �
i i i Demolition ❑Other: T. .:, ❑ so, ice or fcedc, lito ;sops of more ❑Building over three:eyries
where die a Iaull'current ❑ Mnnn and hoalcards
.. CAT 'G e ' ' OF CONSTRUCTION exceeds 10,000 am
• ps at 150 subs or d Floating buildings.
• •
- less , o - ground: dre)Tae11s G{ a - - ' - use agric,d[' -
ural
. •••••-• 1zargr2= fdtttity ilUN :II ommerc[fl17['n�ustlal Accessory building ❑Zm
� amps For all other install;tlioni. buildings. dings. l•
❑ Multi-family r Master builder ❑ Other: ❑ Fire wimp. Q Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ limcrge,rcy sysrcnr larger separately derived sysrcm
❑ Addition of urw motor load of ❑ q" 0 , I_r -•1_=
•
Job no.: I Joh site address: 4 j/v / .dg17. 100HP or more. occupancy.
❑ Si. tr more residential units. 0 Recreational vehicle parks.
City /State/ZIP: �J, ❑ I Iv,iIIh -care facilities. ❑ suppl vohage for more than
Suite/bldg./apt. 110.: Pro ec[ nattte: ❑ I laz &Sons locations. 600 volts nominal.
J Service or f eeder 6n0 amps or more.
Cross streeddireetions to job site: FEE SCHEDULE
pe;e6puen =M11.1 Tong-
New residential single - or multi-family dwelling snit,.
• -,- _ Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. n• less -
145.15 4
'fax map /parcel 00.; - Ea. add] 500 sq. R. or portion 33.40 1
IIESCRIPTI N OF WORK Limited energy, residenlbal '
(wrlh above sq. R�
75,00 2
/ / Limited energy. multi- family
d (J restdantial (with above sq. a.) 75.00 2
/ r / Services or feeders install atio ' n, alteration. and /o location
V 200 amps or less • :: a P OPER. .. 06.80
R TY' OWNER' TENANT 201 .2 00
70
�
� ` ❑ U I amps to 4(10 amps • 106.65 • 2
Name: • _ '•4ill _ am ps to 600 amps 160.60 ` �
Address: - 60I amps to 1.000 amps - 24(.60 2
A Over 1,000 amps or voIrs _ 454.65 2
Gil /StaltJZIP: Temporary services or feeders installation, alteration. and/or '
- - _relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 )
Owner installation: This installation is being made on property that I own tvhich is not 201 nntps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670- and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: _ Rrttnch circuits- new, attention, or extension. per panel
A. Fee for branch circuits with
❑ APPLICANT ❑CONTACT PERSON above service or feeder fee.
Business name;
e ach branch circuit 6.65 2
- D. Fcc for branch circuits •
Cunt:, name; - without service of feeder fee, nF RS 2
• -�� rust branch circuit
Address: - r ;ch add'I branch circuit y 6.65 2
yliccelt:tnea (service nr feeder not i ncluded)
City/State/ZIP: Gash manufactured or modular
- dwel Ii I . service and /or feeder 90.90 2
Phony Fay::
( ► ) 8
_Rcconnccl unit 66.85 ,
E-mail: -
Pump or irrigation c 3.
trcic S I U l
-
CONTRAC,TOR Sign or outline ligIuine 53.40 2_1
Business name: Signal circuit(s) or limited NorthStar Electrical Contractors energy panel, alteration. or
Address: 19450 SW Cipole Rd, #107 cx(easten, Describe: Page 2 2
Tualatin, OR 97062
•
City/State/ZIP: (503) 612 -0840 Fax (503) 612 -0891 - Each additional_inspcction over allowable in an of the abov •
Lic #34 -359C CCB #90454 Metro #1911 - - �P,r nspection i 6 50
Phone; ( 1
Investigation per hour (I hr mu,i 62. i0
CCI3 Lic,: Electrical Lic.:
1
pry. Lic.: L � Industrial plant per hour
73.75 ----+ ----+ Suprv. Electrician signature, required: L__.... _ ELIsCTRICAI. PERMIT FEES t Su it fccbtota): l: fr�
r.�s/ x/0
Print name : . .
� ,/,2 ' a
Audtori2ed signature:
State Plan review (25%of perm sttrchargc (!2 %ofpermilfcc): (/
__ TOTAL PERMIT FCI : i
Print ntttne: ,Date: ' This permit application expires if a permit i not abla I 'd Rhin 1' fro
days after it has been accepted as complete.
I lDuildiny1Pp'minVELC- P°r i i r App der, 05/0/6°
• vtimbei ol' utspcclumi allowed per pennil.
4.6-ie 'rtrIm5 /COM,WEa