Permit 1
„ CITY OF TIGARD ELECTRICAL PERMIT
`'� ° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00319
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Da te Issued: 06/25/2009
Parcel: 2S 101 BA00401
Jurisdiction: Tigard
Site address: 12265 SW 72ND AVE
Subdivision: Lot: 0
Project: Martin
Project Description: 2 branch circuits for A/C connection
Owner: FEES
TRI- COUNTY CENTER TRUST Quantity Description Date Amount
BY ADAMS & STEWART, 8565 SW BARBUR
BLVD 2 crt Branch Circuits 06/25/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/25/2009 $6.42
Electrical
Contractor:
BOB'S ELECTRIC
2700 NE BURTON ROAD #A
VANCOUVER, WA 98662
PHONE: 360 - 254 -7200
FAX: 360 - 254 -8219
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 952 -00 r r 1 . 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: -a
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.
Electrical Permit Application RECEIVE r FOR OFFICE USE ONLY
City of Tigard JUN 2 4 2009 Rve 3 JO Permit No � u. 2
111111 •
Tigard, OR 97223 Plaecei ... 13125 SW Hall Blvd., Ti
C g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF TIGARD Date'Bv: Other Permit:
TIGARD Inspection Line: 503.639.4175 Date Ready I3y: Juris El See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISIO Notified /Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w. items checked below):
['Service or feeder 400 amps or more ❑ Building oser three stories
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 ❑ Commercial -use agricultural
E 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "F. - ', "I -2' . "I - ? ".
J ob site address: SW 10011P or more. occupancy.
Job no
09 -578 12265 SW 72nd ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health - care facilities. ❑ Supply voltage For morethan
❑ llazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. add] 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy. multi - family 75.00 2
A/C connection residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name: Shiela Martin 601 amps to L000 amps 240.60 2
Add SW 72nd Over 1.000 amps or volts 454.65 2
City /State /ZIP: Tigard, OR 97223 Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or Icss 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee. 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 1 46.8546 2
first branch circuit
Address:
Each add'! branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E - mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
B ignal circuit(s) or limited -
Business name:
Bob's B ob r s Electric energy panel, alteration, or
Address: 2700 NE Burton Rd. , Ste. A extension. Describe: Paget 2
City/State /ZIP: Vancouver, WA 98662 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 6 0) 254-7200 Fax: ( 360) 254-8219 Investigation per hour (1 hr min) 62.50
CCB Lic.: 53136 Electrical Lic.: 37 4 31 C Suprv. Lic.: 4 3 2 2 S Industrial plant per hour 73.75
Wit // ���� ,4 /i /moo ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required / ��� Subtotal: 53.50
Print name: Date: Plan review (25% of permit fee):
Kevin Broselle 6/22/09 State surcharge (12% of pennit fee): 6.42
Authorized signature: TOTAL PERMIT FEE: 59.92
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per pennit.
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