Permit 11111 ►t
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 00650
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/17/2010
Parcel: 1S134CA00503
Jurisdiction: Tigard
Site address: 11205 SW 119TH AVE
Project: Stricker Subdivision: PANORAMA NO. 2 Lot: 14
Project Description: (2) branch circuits to reconnect NC and furnace.
Contractor: DOUBLE E ELECTRIC INC Owner: STRICKER, PAUL
2626 SE SPRUCE ST 11205 SW 119TH
HILLSBORO, OR 97123 TIGARD, OR 97223
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PHONE: 503 - 807 -5156
PHONE: 503 - 516 -1000
FAX: 503 - 430 -5966
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 11/17/2010 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/17/2010 $7.63
Type of Use: SF Electrical
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 - • • •ted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR •52- 001 - 0090. You mayob = , - • of e rules or • rect questions to OUNC by calling 503. 987 or 1.800.332.2344.
Issued By: _ r�� Permittee Signature: II*. �! L ' /c_,
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.
Nov 16 10 02:31p Fred Ekstrom 503 - 430 -5966 p,2
Electrical Permit Applicatiion FOR OFFICE USE ON .a
$1
City of Tigard � Received
13125 SW Hall Blvd., Tigard, OR 97223 �6etI Permit Ne.:
i '.' -r a
t ' ` C Phone: 503.718.2439 Fax: 503.598.196 \ P IeReview
Da
Ti GAR t7
Inspection Line: 503.639.4175 y a�Date/By: Other Permit: t�fll� r S L
e li, pate Ready/By kris' H See Page 2 for o S �
- Internet: www.tigard- or.gov ?'t G _ ', rtitied/Method:
,,��.,�� !1 ���� � 72 ' Supplemental Information
TYPE OF WORT{ 0I,`,.g�l 1 PLAN REVIEW New construction AdditionlalteTt7tiorl ement Please check all that apply (submit 2 secs of plans %!items checked below):
El Demolition �TJl ❑ Service or feeder' 400 amps or more ❑ Building over three stories.
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w here the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial industrial
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder
❑ Other: ❑ Fire PAP ❑ Installation of75 K VA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E', `! -2 ", "1 -3 ",
Job no.: Job site address: 1 v--
e— �J 100HP or more occupancy,
� i U - 4 ` £ ❑ Six or more residential units. ❑ Recreational vehicle parks,
�-
City /State /ZIP: 1 1 ixA PO, G R. . 7 ZZ3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Description 1 Qty. J. Fe- i - recd I • '
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'I 500 sq. ft. OX portion 33.92 t
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft) 75.00 2
MC-- �� 1 Limited energy, rnulti- family
t � I i Fli aA NC-e. 'J � residential (with above sq. ft) 75.90 ! 2
/� '� Services or feeders installation, alteration, and /or relocation
b's Mutts
200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
T -
Name: 401 amps to 600 amps 20034 2
Address:
60I amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 I 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits — new, alteration. or extension, r panel
-_ Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit f j 56.18 i5r ( /8 2
Address: Each add'I branch circuit / 7 42 ' ^'l c Q -G 2 -
Miscellaneous (service or feeder not included) [ t '�
City/State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) f Fax: : ( ) Reconnect only C
E -mail: I or irrigation 67.84 2
Pump gation circle � 67.84 2
CONTRACTOR Sign or outline lighting 6784 2
� Signal citeuit(s) or Iimiled
Business name: boo g c, coL / _ - C , panel, alteration, or extension. Page 2 2
_ Each additional inspection over allowable in any of the above
Address: �,(o SE P L C E Sl e Additional ins P
inspection {] hr min) 66.25! hr
City/State/ZIP: 1,--j (LI- -S C0I G c i z � Investigation (1 hr min) 66.25/ hr
�,-` ax: ®� . Industrial plant (1 hr min) 78,18 / hr
Phonc: (Z)3) ( l_ S'I F
- � (�� 4:3L, - `.a� (s:c... Inspections for which no fee is
CCB Lic.: < Electrical Li( specifically listed ('h hr min) 90.001 hr
C: u p . Li c.: ELECTRICAL, PERMIT FEES
Suprv. Electr ' L, e, required: \ ,fir 0 i 1 ,3 Subtotal: 6;3 Plan review (25% of permit fee):
Print name: r e) Li( f -k 5 V Date: Stale surcharge (12% of permit fee): 'Z t
Authorized signature: TOTAL PERMIT FEE: 1 r '73
This permit application expires if a permit is not obtained within 80
Print name: 1 Date: days after it has been accepted as complete.
1 ` `lumber of inspections allowed per permit.
I: Building\PermirclELC- Penuitapp, doe 07/01,10 440.4415T([1/651COMVF$