Permit �! CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2010 00684
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/10/2010
Parcel: 2S103CC15200
Jurisdiction: Tigard
Site address: 12322 SW PLANTATION TER
Project: BARLOW Subdivision: STEPPING STONE ESTATES Lot: 2
Project Description: Reconnecting (4) street lights of Stepping Stone Estates subdivision.
Contractor: Owner: BARLOW, LEWIS R & NANCY J
12322 SW PLANTATION TER
TIGARD, OR 97223
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 12/10/2010 $67.84
Specifics: 1 ea 12% State Surcharge - 12/10/2010 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 - ,, . -dopted by the Oregon Utility Notification Center. Thos-��y -s are set forth i OAR
952- 001 -0010 through OA '. You ma ob - a copy o direct questions to OUNC by calling 503. .,2.1987 or 1.800. "3"' 4.
Issued By:
0 _4' _ _ _ '�f Permittee Signature: `(NU +�� i wl
/° ,
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.
CaII 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.
Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard � ��
Date/By: ((�'] Permit No.: (�, sl�
v 13125 SW Hall Blvd., Tigard, OR 9 • S Plan Review W v `�
° .: Phone: 503.639.4171 Fax: 50 kV" i ' Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 V3\ Date Ready /By: Juris ® See Page 2 for
® Notified/Method: Supplemental lnformation
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�� � � ��° ;,�� � � � r- rJ � '� � �g PLAN �REViEW�" �'" ; ,., � �!
,..�_,>��a , ., �Hn . 5.. N TYPE OF WORK � � �U .,, ° . � ° .. .. �� l �,,
❑ New construction ❑ A ddit ion /a l t er $x l�r � l On Please check all that apply (submit 2 sets of plans w /items checked below):
-' �p ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El 5[� • Other: ? n eC where the available fault current ❑ Marinas and boatyards.
' "" amps at 150 volts or Floating buildings.
. � � �. � , . , � N � � � . . . � exceeds 10,000 am P ❑ g s.
g
_,' .., CATEGORY OF CO , _ ,,
' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
A- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
"Multi -family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
Emergency system. larger separately derived system.
-' gJ9B A ND :LOCATIO_N ,5, ' i . _ ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
/� //�� i t `"gy 100HP or more. occupancy.
Job no.: Job site address:
'/ , 7 , 7 , 'L (GM 1 ah 6 1, 4 id( ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: — ad b 2--. Z 6 ❑ Health -care facilities. ❑ Supply voltage for more than
[r ❑ Hazardous locations 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
_. ' , FEE SCHEDULEt ' a ,, ;, x
Cross street/directions to job site: ,'1,I , , - f - - ` Ca(&ArC� Description 1 Qty. 1 Fee. 1 Total 1
` mot New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: J 0 t V ! �"" mil ,5-ir S - Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
i. ' DESCRIPTION OF WORK ' ° (with above sq. ft.)
,/ {n 1 / I � Limited energy, multi - family 75.00 2
1 (� Y &tc,0 u l Ile Cf h _eiCp � 1 i/ Y l `- • residential (with above sq. ft.)
°�� J Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 12
' PROPERTY` OWNER ai �.: '0 TENANT ' r ,r„ amps to amps
201 400 133.56 2
\(k � � 401 amps to 600 amps 200.34 2
Name: uw _ u 601 amps to 1,000 amps 301.04 2
Address: I � 27. , 5 VV (t/Ui t l a� ( 1 1 I ' ( Over 1,000 amps or volts 552.26 2
v ` Temporary services or feeders installation, alteration, and /or
City/State/ZIP: 6 and I 0 1 2'L /� relocation
Phone: (10:5) h e f Q • 3 Co ID I Fax: ( ) 200 amps or less 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 c above service or feeder fee
' PERSO ' 7 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
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 12
Y and/or feeder
Phone: ( ) I Fax: : ( )
Reconnect only ( 67.84 61 ,ctrl 2
Yump or irrigation circle 67.84 2
Email
t e`� : g ��: CONTRACTOR ,� .'r:t , .4 ';_I „ Signor outline lighting 67.84 2
,- �, . -;,' � ,�. , _ . _, . _ . „ - _ - ... Signal circuit(s) or limited-energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: 1 Electrical Lic.: 1 Suprv. Lic.: ELECTRiCAL"PERMJT;-FEES ::`a`, ,'L
Suprv. Electrician signature, required: o Subtotal 7 r rl
Plan review (25% of permit fee):
Print name: s_.te: State surcharge (12% of permit fee): I , I III
TOTAL PERMIT FEE: 7 , 9 "y
Authorized signature: L , , / y � j This permit application expires if a permit is not obtained within 180
Print name: +' � /v l .
IF Date: days after has been permit. e a as compl
11 . Number of inspections allowed d per permit.
C\ Building \ Permits \ELC- PermitApp.doc 07/01/1, 440- 4615T(11/05 /COM/WEB