Permit CITY OF TIGARD ELECTRICAL PERMIT
0 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00481
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 1S125DD08200
Jurisdiction: Tigard
Site address: 9735 SW VENTURA CT
Subdivision: WASHINGTON SQUARE ESTATES NO. 3 Lot: 90
Project: Hurt
Project Description: (2) branch circuits for bathroom remodel.
Owner: FEES
HURT, JOHN C AND TERESA A Quantity Description Date Amount
9735 SW VENTURA CT
TIGARD, OR 97223 2 crt Branch Circuits 09/08/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/08/2010 $7.63
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971- 563 -8211
FAX: 503- 266 -1349
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952- 001 -0100. You may o • • - - •._L1i u.,: , s or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By:
Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property 1 own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
Electrical Permit A lication
FO It OcncE LISE ONLY
IN
City of Hall Blvd d RECEIVED 7
• 13126 SW Hsu BivrJ , Tigard, o ,.'f P erm$ • xm. �LE� —
e Althea: 503.639.4171 Fax 503.598,1960 Nan Review
TI G :It D Impaction lane 503.639.4175 Date/B . OdtarPermit: * -
a
Internet: www,ti S E P Q 8 ?CIO O Date Ready/By: -L - (J
gard�rgov Notified/Method: Ste Page for
TYPE �1 T N . Supplemental Information
0 New construction SZAdditi - : , .: 1 PLAN REVIEW
❑ Demolition 1 9N Please duck all that apply (submit 3 sets of plans v�tems checked below): ❑ Other:
D Service or feeder 400 amps or more ❑ Building over three stories.
•
CATEGORY OF CONSTRUCTION whore tie available fault t 'i of Q Marinas and boatyards.
l - and 2 - family dwellin exceeds 10,000 arils to ISO 50 volts or lj Floating buildings. g ❑ Commercial/uldusttial ❑ Accessory building less to g m' exceeds 14,000 ['Commercial-use agricultural
Other amps for oilier installations, buildings.
❑ Multi - family ❑Master builder
❑ Fie pump. 13 Installation of 75 KYA or
JOB SITE INFORMATION AND LOCATION ❑Emer gency systan. larger separately derived system.
Job no.: Job site address: Q'' ❑ Addition of new motor load of CI "A °E°, "1 -r" "1 -3"
0 ,� IOOHP or snore. � pymy
❑ Six or mere residential u
tuts. Cr Recreational vehicle parks.
❑ Heaglr t facilities. CI Supply voltage for more than
Suite/bldg. /apt no,: Project name: ❑ 1:3 Hazardous locations. 600 volts nominal.
Servioe or feeder 600 amps or mote.
Cross street/directions to job site: FEE SCHEDULE
tracryrtion I Qtr. 1 Fee. 1 Total 1•
New residential single- or multi-family dwelling unit.
ubdivision: Includes attached garage.
S ax ma Lot no.: 1,000 sq. ft or less 1 68.54 4
p/pareel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
DESCRIPTION OF WORK Limited energy, residcaUal
C i `���� _ with above R. 67.84 2
t . � g f ' .� a � Limited energy, multi- family
residential (with about sq. R) 67.84 2
services or feeders installation, alteration, and/or relocation
Q PROPERTY OWNER ❑ TENANT 200 soaps or less 100.70 2
201 amps to 400 amps 133 2
401 amps to 600 amps 200.34 Address: 601 amps to 1,000 amps 301.04
1 2
Over 1,000 amps or volts 552.26 2
Phone: ( )
Te
ry services or feeders installation, alteration, and/or
Fax: ( ) 2 am or less 5936 I 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps i 1 125 . 08
intended for sale, Lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 5 a mps
2
Owner signature: 16854 2
Date: Branch draft— new, alteration, or extension, , er panel
❑ APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder feet'
Business name: each branch circuit R� j
Contact name: B. Fee for branch circuits
without service or feeder fee, t
Address: first branch circuit 1 56.18 2
Each adds branch circuit 7.42 � It 2
Miscellaneous (service or feeder no included)
Each manufact or odular
Phone: ( ) Fax : : ( ) d wel li rrr ,serv ured ancho m C cede r 67 84 2
Reconnect only 67.84 2
CONTRACTOR imp or irrigation circle
_ 67 .84 2
Sign or outline lighting
Business name: ' lk0 67.84
` C (J �-� 1 Signal circuit(s) or !ironed- 2
Address: a 6. • energy panel, alteration, or
r, extension. Describe:
City /State/ZIP: �m •lee. Page 2 , 2
!7 , 07 0 Each additional inspection over allowable in any of the above
Phone: { () 512 : -Z Fax: (5b3) 7104, r er Per inspection 66.25
� 1 Investigation per hour (I fvmin) 66.25
MIMMIll Lic.: —L a ( , Suprv. Lic.: 51 (57. 5 Industrial plant per hoar
Suprv. Electrician signature, required 1, ELECTRICAL, P ®i�
Print mate: fit! J Subtotal: 1•
�- Awl Date: EO -2Z -0a Plan review ( %ofpennitfiee): —
Authorized signature: State surcharge (I2% of permit fee):
Print name: TOTAL PERMIT FEE:
Date: This permit application expires it a permit is not obtained within 180
rvtaaa awtze,,,,;,wr.r- a days after it has been accepted as compkte
rermdApp,doe taowri Number of inspections allowed per permit
440.4515T(1 l/OS/CoM/ WFB
Z'd 617£699Z£O9 Oupee 1!n a!O Oid d09:80 06 LO doS