Permit CITY OF TIGARD ELECTRICAL PERMIT
o • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00454
T f GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 1S134CB05400
Jurisdiction: Tigard
Site address: 11125 SW TONY CT
Subdivision: Lot: 0
Project: Flax
Project Description: (2) branch circuits for NC.
Owner: FEES
FLAX, LAURA Quantity Description Date Amount
11125 SW TONY CT
TIGARD, OR 97223 2 Crt Branch Circuits 08/26/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/26/2010 $7.63
Electrical
Contractor:
TYLER ELECTRIC LLC
PO BOX 807
MULINO, OR 97042
PHONE: 503 - 829 -2498
FAX: 503- 829 -5747
Type of Use: SF
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. At 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 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 50 6699 or 1.800.332.2344.
""
Issued By: _ — — s!' Permittee Signature: ••
/AIIP
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.
Catl 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 -08 -26 11:57 GRF ELECTRIC 5038295747» 5035981960 P 1/2
Electrical Permit Ap E C E N E D rt )u 01,11(4: 1 NI. O`1.1
Re
City of Tigard a 26 'ZAM Reeceiv : ed �
/ v Permit No.: ` ,l0— _
• 13125 SW Hall Blvd„ Tigard, OR 97273 A tI J Plan Review
s Other Permit:
Phone: 503,639.4171 Fax: 503.598.1960 Date/ by: r 14.Cr7,(0 -[tn y01
Inspection Line: 503.
Ins 503.639.4175 CITY TIGARD Date Ready/By: kris: B1 See Page 2 for
Internet: www.tigard -0cgov
1 1 i, A h 1) p O G DIVISION Notified/Method: - I supplemental Information
,
TYPE OF ORK PLAN REVIEW
• ddition/alteration/replacement pi a ll that apply (submit 2 sets of plans w /items checked below):
1:j New construction ❑ Service or feeder 400 amps or mute ❑ Building uvel three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts Of ❑ Floating buildings.
Tess to ground. or exceeds 14,000 ❑ Cun -use agricultural
►: - and 2-family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump 0 humiliation of75 KVAor
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION (] Addition of new motor load of ❑ "A "E", `I.i t - ",
-- r 100HP or more. occupancy
Job RO.. Job Site address: / ❑ Six a mine residential units. C3 Recreational vehicle parks.
L O Hcalth -care facilities. ❑ Supply voltage for more than
Din /State/7.11': / , . / 0 Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: f I _ ❑ Service at feeder 600 amps or more.
�� FEE SCHEDULE
Cross street/directions to job site: . Qescrietioe I Qtr. I see I rout 1 •
- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less - ' 168.54 4
Ea. add'I 500 sq. R or portion 33,92 I
Tax map /parcel no.: Limited energy, residential 67.84 2
47." DESCRIPTION OF WORK (with above 5. ft.) -,
_ ~ Limited energy, multifamily. 67.84 2
41. C... C I t A - residential (with above sq. ft.)
( �,� Services or feeders installation, alteration, and/or relocation
µ
200 amps or less 100.70 2
I • • OPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 a mps 200.34 2
Nance: Li6.4`4_^/1... F a, - 601 amps to 1.000 amp _ 301.04 _ 2
Address: j' ' L ST S (,e.1 h p L•t - Over 1,000 amps or volts 552.26 2 _
Temporary services or feeders installation, alteration, and /or
cicy/scacc/ZIP: Zd- _ _ raocadna ,
Phone: (j 3) ' f � q y/ �"(p Fax: ( ) 200 amps or less 59.36 1
d li 201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not kilt amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449.670, and 701 • Branch circuits — new, alteration, or extension, r panel
Owner signature: - Date' A. Fee for branch circuits with
above service or feeder fee,
0 APPLICANT r ❑CONTACT PERSON + each branch circuit 7,42 2
uit
Business name: B. Fee for branch circuits
without service or feeder fee. 56.18 /' 2
Contact name: _ first br circuit , •I d
Each add'I branch circuit I 7.42 --) . 4 L2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: • Each manufactured or modular 1 67.84 2
dwelling, service and/or feeder
Phone: ( ) _ Fax: : ( ) _ Reconnect only_ 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
r, L �` Signal circuits) or limited -
Business name: • 3 E GC.tYi'l energy panel, alteration, or
Address:
L b l! / 1 extension. Describe: Page 2 2
City/State/ZIP: U 9 - 7 Z- Each additional inspection over allowable in soy of the above
` Per inspection 66.25
Phone: (9 3) Fax: ( ) . • •• Investigation per hour (1 he min) 66.25 _
Elrinffliffn Electrical Lic.: 3 - L# c1 h . Suprv. Lic.: 0 C Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , S ubtotal: 1
r Plan review (25% of permit fee): ,
Print name: G (,. y ' $ r � a !
St a t e s ur ch arge (l2 /o Of permit fee):
Authorized signature: ` � 1. TOTAL NIHAU!' I isc. 1 //
• This permit application (noires if a permit t ob mad n
d ithtc fte
Print name: • , b to
l Date: days after It has been accepted as complete.