Permit CITY OF TIGARD ELECTRICAL PERMIT
.- ,'`- COMMUNITY DEVELOPMENT Permit #: ELC2009-00224
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05!19/2009
Parcel: 2S112DC01500
Jurisdiction: Tigard
Site address: 15695 S.W.24TH -AVE -300— 1
Subdivision: FANNO CREEK ACRE TRACTS Lot: 6
Project: Squire
Project Description: (4) branch circuits
Owner: FEES
REHAM 1 LLC & Quantity Description Date Amount
DEC INVESTMENTS LLC ETAL, BY C &R REAL 4 crt Branch Circuits 05/19/2009 $66.80
ESTATE SERVICES CO, 1440 SW TAYLOR wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/19/2009 $8.02
Contractor: Electrical
S &A ELECTRIC, INC
PO BOX 218
BORING, OR 97009
PHONE: 503- 658 -5368
FAX:
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.82
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: Oil ,' k. � Perm ittee Signature: -� � �� R '
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'N 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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City of Tigard Permit No.: � ' L
, -r1 . D2.2. .D2.2. 13125 SW Hall Blvd., Tigard, oRC9W2 , Dale/B : OF 7IGARD Plan Review
' l I ( \ Phone: 503.639.4171 Fax: 503i595031598. 0 DateB : Other Permit.
a } fi Inspection Line: 503.639.4175 t�t �� �1V�+70v� Date Reedy/By: Juri, HI See Page 2 for
1 I t'
..,I,: - Internet: www.tignrd or.gov Notified/Method' Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit? sets of plans w /items checked below);
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: when the available fault current 0 Marinas and boatyards.
. CATE OF CONSTRI.SCTION • exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
❑ 1 - and 2- family dwelling commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑Multi- family ❑ Master builder 0 Other: 0 Fire pump. ❑ Installation of75KVAor
( ❑ Emergency o system, larger
E","1 separately
"1 -3 system.
. JOB SITE INFORMATION AND LOCATION
❑ Addition of new motor lead of ❑ "A ", "E ", "1 -2 ", "I -3 ",
Job no.:) 1 Job site address:) 5� ' 1 �'�`� 0 Six or o a more. occupancy. parks.
or mao re residential units. ❑ Recreational vehicle arks.
City/State /ZIP: \ V ❑ Health -care facilities. ❑ Supply voltage for more than
1 J ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: \).\ ,2�- R-,,.,_._ 0 Service or feeder 000 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: ncmription i Qty. i Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK ( with above sq. ft ) 75.00 2
•
Limited energy, multi - family
ZIC-
VI\ k Q_ \ �*-\ residential (with above sy. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
_ , PC F= _ S , mil^ L-te"'\ - 200 amps or less 80.30 2
0 PROPERTY': OWNER • • 0 TENANT 201 amps to 400 amps 106.85 2
\(� 401 amps to 600 amps 160.60 2
Name:
f- �v \ �. I` i �—� 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State / "LIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1 00.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, ur extension, per panel
Owner signature: Date: A. Fee for branch circuits with
0 APPLICANT . Q CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
Contact name: without service or feeder fee, I 46.85 t
first branch circuit `
Address: Each add'! branch circuit J 6.65 9 4,�
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 I 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
•
Business name: Signal circuit(s) or limited -
4 . \ C�� -- C' V �1 C i ' L ' energy panel, alteration, or
Address: Po ` �-' / ("�(� 24 8 \ extension. Describe: Page 2 2
CD '� ( / ` /�� �
City /State /ZIP: Each additional inspection over allowable in any of the above
�
Cy .52./4., ` � C- � ) Per inspection 62.50
Phone: (563) ! 17 , Fax:(SU_3) r T t U Investigation per hour (I hr min) 62.50
CCB Lic.: 19 ,61(4 Electrical Lic.: ' -5 .. c4 Suprv. Lic.: 11-E)335 Industrial plant per hour 73.75
f��, ///�JJ ELECTRICAL PERMIT FEES
Suprv. El si ature, required: . 1 1� Subtotal: 4,6 ,60
Print name: 5C � - A t-V ` l � Date: Gs -12 �J Plan review (25% of permit fee): ,�
� ti t 1 I� I N p- / State surcharge (12% of permit fee): g, OZ -
Authorized signatu C J. J " j �`� - 1 TOTAL PERMIT FEE: 7y. g 2i
L c This permit application expires If a permit is not obtalnedwitbtri 180
Print name: 1.��.7 �,.) �� 1\ ( Dat r 12"V 9 days after It has been accepted as complete.
• Number of inspections allowed per permit,
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