Permit CITY OF TIGARD ELECTRICAL PERMIT
° . COMMUNITY DEVELOPMENT Permit #: ELC2010 00634
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/09/2010
Parcel: 2S103BB13200
Jurisdiction: Tigard
Site address: 12270 SW ANN CT
Project: Chandler Subdivision: LAKE TERRACE NO. 2 Lot: 25
Project Description: Altering (4) existing kitchen circuits.
Contractor: FITZPATRICK ELECTRIC INC Owner: CHANDLER, STEPHEN L AND
10129 N SMITH ST CHERRYL A
PORTLAND, OR 97203 12270 SW ANN CT
TIGARD, OR 97223
PHONE: 503 - 289 -4196 PHONE:
FAX: 503 - 289 -0912
FEES
Quantity Description Date Amount
crt Branch Circuits wo /Purchase 11/09/2010 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/09/2010 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 -0090. You may obtain a rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
_ Permittee Signature: �
Issued By: � ���i _ _
J
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 the next available inspection date.
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.
RECEIVED
Electrical Permit Application NOV 5 2010 1=oR OFFICE LSI'_ ONLY
City of Tigard Received
t//
� Dale/13 : ®�Q G Permit No.: • id— - L
13125 SW Hall Blvd., Tigard, OR 972113 1 a a OF TIGARD P Review
II Phone: 503.7182439 Fax: 503.5' i I DING DIVISION Date/Fiy: Other Penult:
T 1 GA ?; D Inspection Line: 503.639.4175 Date Ready/By: Juris: RI Sec Page 2 for
Internet: www.tigard -orgov Notified/Method: 'l"'7 I Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans writems checked below):
❑ Service or feeder 400 amps or more ❑ Building over 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
10 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory buitding amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑"A ", "E ", "1 - 2 ", "1 - 3 ",
Job no.: Job site address: 1 221 Q A N ht C.,--r. 100HP or mare. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: — V Ae . r , cs t ❑ Health - care facilities. ❑ Supply voltage for more Hazardous
I ❑ Hardous locations. G00 vohs nominal.
Suite/bldg. /apt. no.: Project name: Lh. ❑ Service or feeder 600 amps or more
FEE SCHEDULE
' Cross street/directions to job site:
Description 1 Q 1 nn. 1 rot.[ l •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: . 1 . 0 0 0 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
�y T�.N residential (with above ft. Limited enemy. multi-family
ea ^ 75.00 2
7X� r T� �-le TG C Ie�UJTf Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps I 133.56 2
Name:
401 amps to 600 amps ; 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/Slate/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 arnps 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,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits without ,p
service or feeder fee, first 56.18 SC* 2
Contact name: branch circuit
Each add'I branch circuit 3 7.42 22 ,1G 2
Address: Miscellaneous (service or feeder not included)
City /State/Z1P' Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
E -mail:
Pump or inigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited- energy
Business name: t TZPA TIZ I CLc & Le-c panel. alteration, or extension. Page 2 2
�� < « Each additional inspection over allowable in any of the above
Address: 1 o•e > 7 /V f ine - Additional inspection (I hr min) 66.25/ hr
ty Pojr a D4 7 ads
Industrial 6625/ City/State/ZIP: plant (1 hr min) 78.18/ hr
Phone: (0.) ) f 0/ . _ Y! 9 6 I Fax: 4.03 ) n2.09 - 01' r a Inspections for which no fee is 90.001 hr
specifically listed (V2 hr mm)
CCB Lic.: 17 ys3 • Electrical Lic.: Sal u Irv. Lic.: C 23 ELECTRICAL PERMIT FEES
r 7 - w,,. i ,� A / / � p
Suprv. Electrician _ required —�� 40r, � Z � i f 11 a Subtotal: '7 8 E(--.
r
Print name: Plan review (25 /o of permit fee):
�� w!O �` �l�A ?�rC� Date: / f (0 State surcharge 02% of permit fee):
TOTAL PERMIT FEE: S 7,
Authorized signature
1d S
�Cfe This permit application expires if a permit is not obtained within 180
— 2"""~ C.; - rzir, 4 weft' fie• ('.
days after it has- been e tin rmit. as complete.
Print name: �
/_ r f� //✓ /Q ' Number of inspections elbwcd per permit.
Z 2160 692 i{ou ;edzlid ppol dLZ:ZO Ol 90 AON