Permit I I I CITY OF TIGARD ELECTRICAL PERMIT
• 12 . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00323
13 125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/26/2009
T1GA . , Parcel: 1S125DB03702
Jurisdiction: Tigard
Site address: 9520 SW 74TH AVE
Subdivision: BOULEVARD HEIGHTS Lot: 23
Project: Cole
Project Description: Alter (3) branch circuits for a /c, service outlet, and existing furnace.
Owner: FEES
COLE, JAMES S Quantity Description Date Amount
9520 SW 74TH AVE
TIGARD, OR 97223 3 crt Branch Circuits 06/26/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/26/2009 $7.22
Electrical
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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 o .800.3322344.
Issued By: (1 Q to UJ A Permittee Signature:
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.
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,,L ION co � �
2� Electrical Permit Application Current Pla
\ ni • 3� , —^� 4 • , st . . • • i, ■ - 2 Hillsboro, OR 97124, Approval
` R P - - Fax. 503- 846 -3993, Project #
In pectiw - Requests- 503 -846 -3699, www.co.washington.or.us
- . TYPE OF WORK ti - ' . - - PLAN REVIEW
❑ New construction 14 Addition /alteration /replacement ❑ Other: Please check all that apply:
❑ Service or feeder 400 amps ❑ Hazardous locations
. , or more where the available ❑ Service or feeder600 amps or more
CATEGORY OF CONSTRUCTION fault current exceeds ❑ Building over three stories
10,000 a mps at 150 volts or
pi
-and 2- family dwelling ❑ Commercial /industrial ❑Accessory building ❑ Multi -famil Master builder Other: less to ground, or exceeds Marinas and boatyards
Y ❑ ❑ 14,000 amps for all other 1:1 Floating buildings
ins tallations. ❑ Commercial -use agricultural
JOB SITE 'INFORMATION AND LOCATION buildings
Job no.: Job address: 951 5� ❑ Fire pump
❑ Installation of 150 KVA or larger
�� � ti � � � ❑ Emergency system separately derived system
❑ A ddition of new motor
❑ "A" "E" "I- 2, "'9 -3" occupancy
Ci /State /ZIP: *mi 9 ? ,,
tY l C, d( O r\ 7 03 load of 100HP or more p y
J t ❑ Recreational vehicle parks
Suite/bldg. /apt. no.: Project name: El Six or more residential units
❑ Health - care facilities ❑ Supply voltage for more than
Cross street/directions to job site: 600 volts nominal
� � m ivaoj , 'EE "SCHEDULE .
Description Qty. Fee Total *
Subdivision: Lot no.: Residential single - ors multi- family dwelling'unit.
Ineludes attached - garage.': ,
Tax map /parcel no.: 1,000 sq. ft. or less 153.00 4
DESCRIPTION' OF WORK " '. .. e. : " 0 sq. ft. or port
Ea. a 500 portion 43.00
w i y Limited energy, residential 61.00 2
1�l ew A tr Crft C CM i 5 ( , %uice othVet cc rid (with abovesq.ft.)
Limited energy, multi - family
f11GG' residential (with above sq. ft.) 67.00 2
- . '' 1 PROPERTY_. O WNER - - ` • , . .. ❑, TENANT. ° .- service s °or feeders`installat
° . _ ion, alteration, a /or relocation
200 amps or less 92.00 2
Name: J J. h'1 G5 ,...„,„ it 61
201 amps to 400 amps 122.00 2
Address: Cl S z 0 6 t.z.i 7/4 41 A ✓ 401 amps to 600 amps 184.00 2
City/State/ZIP: �-� 7 601 amps to 1,000 amps 275.00 2
Cit
Y 1 L a ✓ ( 0 9 ZI1 Over 1.000 amps or volts 514.00 2
Phone: ( ) J Fax: ( ) 'Temporary services feeders installation, alteration, and /or
relocation , -
Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 79.50 2
my immediate family. This property-ipnot intended f o , ale, exc ang r-at. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 1 10.00 2
Owner signature: i/ / ..- .3',,„r/ _,� Date: (j IZd7G"� 401 amps to 599 amps 153.00 2
• ° •
- LICANT m ew, alte �tion,'or exten' panel
`" APP Branch °circ is —n sron;:per ane
❑ CONTACT PERSON°
A. Fee for branch circuits with
Business name: above service or feeder fee, 8.75
each branch circuit 2
Contact name: B. Fee for branch circuits L��, J
Address: without service or feeder i o
fee, first branch circuit 2
City /State /ZIP: Each add'l branch circuit -
'Miscellaneous ( service or feeder n_ of included): -
Phone: ( ) Fax: ( ) Each manufactured or modular
104.00 2
E - mail: dwelling, service, and /or feeder
Reconnect only 79.50 1
°. r ,C - .. x ` a Pump or irrigation circle 61.00 2
Business name: Sign or outline lighting 61.00 2
Address: n(bner Signal panel, or limited -
energy panel, alteration, or
extension. Describe: 61.00
City /State /ZIP: 2
Phone: ( ) Fax: ( ) Each additional° inspection 'over - allowable in any of the above
Per inspection 90.00
E - mail: CCB lic. no.:
Investigation fee (See compliance)
Electrical lic. no.: City or metro lic.: Other:
Supervising electrician ELECTRICAL .PERMIT` -FEES . ,
signature, required: Subtotal
Print name: Date: Plan review ( 25% of permit fee)
Authorized State surcharge (12% of permit fee)
TOTAL PERMIT FEE 1 ' 4 1*
signature: �•
This permit application expires if a permit is not obtained
Print name: Date: within 180 days after it has been accepted as complete
* Number of inspections allowed per permit. Revision 6/08