Permit v CITY OF TIGARD ELECTRICAL PERMIT
1111 a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00624
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/04/2010
Parcel: 2S 111 DC 12700
Jurisdiction: Tigard
Site address: 15960 SW OAK MEADOW LN
Subdivision: Lot: 0
Project: Stoneking
Project Description: (1) 200 amp temporary service
Owner: FEES
STONEKING, RAYMOND D AND GERALDINE J Quantity Description Date Amount
1040 CEDAR ST
LAKE OSWEGO, OR 97034 1 ea Temp Services or Feeders - 11/04/2010 $59.36
200 amps or less
PHONE: 1 ea 12% State Surcharge - 11/04/2010 $7.12
Electrical
Contractor:
VAST ELECTRIC
1525 SEATTLE SLEW DR. SE
SALEM, OR 97301
PHONE: 503 - 566 -7274
FAX: 503 - 585 -8828
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $66.48
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 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: O't) rl/" / G / U �V
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 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 protect
Approved plans are required on the job site at the time of each inspection.
Electrical Permit ApplicatikRECEI V ED 1:012 t)Fr1( 1: 1 0 ..1.1
City Tigard Received %/ y /0 , permit xn(�rap /61 131 Hall Blvd., Tigard, OR 97223 , °V 3 2010 Plan Reif -406
' Iiii M ' Phone: 503.718.2439 Fax: 503.598.1960 Date/11 : Other Permit:
T, G n P. O Inspection Line: 503.639.4175 CITY OF TIGARD hate Ready/By: Ju l RI See Paget for
Internet: www.tigard- or.gov
81111 DING DIVISION Notified/Method: eel: SupplemeotalInformation
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit sets of plans wlitems checked below):
CI New construction ® Addition /alteration/replacement
❑ I)etnOlition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other. where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
® 1 - and 2 family dwelling ❑ Commercial/industrial 12 Accessory building am to ground,
other or exceeds 14,000 ❑ Commercial -use agricultural
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" "E" "1 -2" "1 -3"
Job no.: Job site address: 15960 SW Oak Meadow Lane IooliP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: Tigard Oregon 97224 O Health-care facilities_ 0 Supply voltage for more than
❑ Hazardous Locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: S ,e,"/6---- ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I otr. I Fee. I raw 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 1
Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited
Temp power residential (with R)
75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
(ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Sr'
N/ � 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: /0 1(0 CEO_ S7— Over 1,000 amps or volts 552.26 2
�r QS j� €C-� �� Temporary services or feeders installation, alteration, and/or
City/State/ZIP :
I 9 74e 3 y relocation
Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 _ 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 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, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without '
service or feeder fee, first 56.18 2
Contact name: branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
- Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Vast Electric Inc panel, alteration, or edtetuion. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1525 Seattle Slew Dr SE Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Salem OR 97317 investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
.0
0/ ✓
P}IElne: (503) 780 -8597 r Fax: (1503) 585 - 8828 Inspections for which no fee is 90.00/ hr
specifically Iistcd (%r hr min)
CCB Lic.: 175531 Electrical Lic.: C28 Suprv. Lic.: 5186S /0°l i/ P ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required " - Subtotal: 59.36
I 17 , r' ,', T Plan review (25% of permit fee):
Print name: Tim Vander Stoep D: te: 11/3/10 State surcharge (1 of permit fee): 7.12
Authorized signature:
TOTAL PERMIT FEE: 66.48
This permit application empires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
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