Permit III CITY OF TIGARD ELECTRICAL PERMIT
,,
COMMUNITY DEVELOPMENT Permit #: ELC2009-00283
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
TIGARD Parcel: 25101 DB00400
Jurisdiction: Tigard
Site address: r 3085_SW 76_T.H.AVE_
Subdivision: Lot: 0
Project: Fields
Project Description: Install 200 amp or less temp service panel.
Owner: FEES
FIELDS, FRED W Quantity Description Date Amount
1149 SW DAVENPORT
PORTLAND, OR 97201 1 ea Temp Services or Feeders - 06/11/2009 $66.85
200 amps or less
PHONE: 1 ea 12% State Surcharge - 06/11/2009 $8.02
Electrical
Contractor:
BOONES FERRY ELECTRIC INC
PO BOX 628
WILSONVILLE, OR 97070
PHONE: 503 - 682 -4936
FAX: 503- 682 -7946
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.87
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
J may obtain a copy of the l�V/ /l ru ul les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: q--( `�� Y l\ �1 a Permittee Signature: at 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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r All . , City of Tigard JUN ®g 2009 R!n!:w SvTigard OR 9 )� Permt Nc: !
d : P 5 03.639.4171 Fax: 503.598 :
t DatcBy: Other Permit
I n s pect i on Li 5 03.639.4175 vll �t:, 1?il1
.T l t A R ), Date Ready/By: Iwia El sac Pa
,Ir % 'f:', Internet: www.tigard or.gov BLHLD1 P•)illIF''(),•.` Notified /tvlclhod: get for
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Supplemental Information
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p Plea c heck all apply? ( check
El New construction ddition/alteratiort / re lace ment that a 1 (submit sots of Plans w /itoara checked below):
0 or feeder 400 amps or more ❑ Building over throe stories.
❑ Demolition ❑ Other:
r.,. • .:a" u'�r�:a= .,•,,. , : „rsn -�.; _ T- ,..�.. _ where the available fault current
,»,...,M.- o::a�r✓ r,F,� .n: ?H: , ';� ;'": - c ,;�%rl"t?". ^" _ ❑Marinas andhoa ends.
} Ohli;x ttS?„r ivdt` ,.u •N x• e1 ;4 ;'r)1 r' ,+5' , c , v : <_.• 1 ., .. 5:, ,y,, , i' < " =.. ..,..�r^� n h
t -:- �5 w u�». » .*criaa: ',u`z' ,s7Zrs i •s f _ am.. `✓::;z.k ?:;s.� : ' aaA__ c> `c *r " s exceeds 10.000 amps at 150 volts or ❑ Floating buildings
�T- and 2- family dwelling ❑ Commercialindustrial ❑ Accessory building less to ground or exceeds la,000 ❑ Commercial agricultural
-� ` ❑ amps for all other ias(sllatioas. buildings.
Multi- family Master builder
❑Other: d Fire pump, ❑ Installation of 75 KVA or
k., ✓.: 1 .w, m; « • . sn4 . ' 171 gat :-; %•
p :" . '- `.r.��§ ' , �`,'zp . 5` 1 ; :u%r,:� sf:.;c ^- �� - ` r c • F1'3i� m a r ` 13 "'" at r.: R-r E e y y
3 '.3;., 7tia �• t-R `�x y.i•:, ^.. , �N� ?' ❑ m rgmc s Atem. t
2?'2 .1 . 1 ai : i - gdz y.�" .' "}` .: . larger separately aratel derived sy
..rla3:�+fc,.alr�.. � , • � ._.. K - �R = {' �h; > t :�e:� t „�..�; ,., . F P Y n ed stetri.
T' P.,. ..< , _.^» � T:: �^' z._:., :_i7"icarii.- .f��3< % : '= ?_3'~ ❑Additi
: _,r on of new motor load of ❑ "A" "g" °1.2^ "1 -3"
Job no.: l 8 0 I 5 Job site address: 1 0 8 S S t / 100F1p or more. occupancy.
b ❑ Six or more residential units, ❑ Recreational vehicle parks.
•
City /State/ZIP.: '-i i 6r , ,.J 0 2 ❑ Health -care facilities. ❑ Supply voltage for more than
v ❑ Hazardous locations. 600 vella nominal,
Suitc/bidg. /apt. no: I Project name: ❑ Service or feeder 600 amps or more, _
I coons to job - r 7b�r :_M. J• r(�:w ;:ti , r'SC »�6
Cross strceUdi e 4" 5. :. x� � . ; .? .Flt44zA:;^i ,,,:;,_':: s: -s
Qty. Pee. Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea_ add'1 500 sq. 11. or portion 33.40 ' 1
rr •• „ »« ri r •
fr:�/z:*r;�G.> =7"ZoFflF; S y.; IFti'rr"a - .r'.• . r,; s 7,rif : r =f ;, .; � Limited energy, residential
l i li t ,�e...•.� r.: , v F u'a'1:4 'ate i',' - r-l.+ -' 4 ,(C t ' N 4�^ • " ' ''I' & } ;"r.,_...
care .»,.z,..3..:,.0 ;G":�:. «�•.rxG4,v�.. ,• ar.,- ,.,..,,.,ra,�` 'r•::fi . ,✓ ...�; .��;�?.c ;� ; t' 75.00 2
„....__. �.. .»,r: , ; >.ka;ira ,. ::�.' . (with above sq. R.)
Limited energy, multi- family
e ' v. 'p s `t.. R ' ` residential (with above sq. ft.) 75.00 2
Services or feeders Installation, alteration, and/or relocation
3. —r''�F c,: amps or less
i, ; t.9 r-,. 5: V --` ;;,1 ;- . t-, �.z,72 A „ =a - -:,Y:. ,:f ; _ ; :-; 200 amp. ao,ao 2
f:+C -='` .tit;: t . .... r.�1,7. 1 .tiit
.i:,e tr 14aT, .0:0.g �v:J, t. ::: M r'”` .AP,I,., :? ✓ :0'1,4 `. " 201 am
,�.::.,rs,,, , -r . ✓ � ; . •v , .� ;: ,....... p S to 400 amps 106.85
Name: 401 amps to 600 amps _ 160.60 2
601 amps to 1,000 amps 240.60 2
idress:
• Over 1,000 amps or volts 454.65 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
_ relocation
Phone: ( ) Fax: ( ) 200 amps or less f 66.85 ' I
Owner Installation: This installation is being Made on property that I own which is not _201 amps to 400 amps 100,30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 133.75 • 2
Owner signature: _ Date: Branch circuits new alteration or extension , er tonal
FW .,n - „- s— _. A, Fee for branch circuits with
,. w• xx^1�-, : c "^i'* h43,1 i iR . rY:= '�^�iP.p's 3 ;�^ � l..e : r 4 .a; e x , ;,:v. » - 5*; «"» , ng: -+: -5'17 •"^'&Arm",un3 '.,.`,+
t t��;: 1 . gf .. -. .. .:..,.: 1: :•^ .a .. , K ,M�, : c - />,�r, ;fi, 6 i I
r -a 3, . r It ""~,.::_ ,: fir✓. above service
if vv�� t ,.,, X54 �, s i or feeder f
wiS/d %" .ar. wJG4 �:� ii:• ^..:1: �/1t:. vdK'• »+'� L r��� t'Y`,
6.65
each branch circuit 2
Business name:
B. Pee for branch circuits
Contact name: without service or feeder fee, 46.85 2
_ first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only
l .. 66.85
E mat : 2
n` .''v=?:%'^ KS,.;mm' �„ v '"; �i�i : ��F'.:.,:. , F.rr.;.... ^^.MCr � x , . �.,..,.;c >n :::,rte �:'?7..,. -M �;::� m : s; ,, ; ...., m _ — e 53.40 2
• ru'_ {...,. ty � , ��,✓ r,..r ........:. � �, .. , �'•,. :, a acs ,' ti::�;.. y +•..^• ; �.,. —
j5" Pump or irrigation clrc 53
C�w�wf�i:i�w:s,?e!� %�:rL_ =7_as: ..e...:' +� •"� `"' ,�:::,FI "•w -- . _ri;'�%� :.:(, '1�:�1„ �,ry:t ;:. >r; ^� $i or outline l'
1:.�x2»�u ,. _. �-:.. �..,. �`•._ k�• i. �tw / . , ..�,.t.;��.ri,,.�,»«+,rar,3f ��..: arw�:.:r.., ;�'a ;;: <.c��.;v -I_t � tghting _ 53.40 2
Business name: Boones Ferry Electric Signal circuit(s) or limited -
energy panel, alteration, or •
Address: ?.O. Box 628 extension. Describe: Page 2 2
City/StatcJZIP: Wilsonville OR 97070 Each additional ins, ection over allowable in an ' of the above
Per inspection 62.50
Phone: (503) 6821936 Fax; (503) 682 -7946 Investigation per hour (1 hr min) 62.50
CCB Lic.: 88482 Electrical Lic.: 3- 3C Suprv. Lic.: L t, 1 $ ' Industrial plant per hour 73.75
. .:ri7.: 7 IFFiil er
s,.4:,:,ti' ... � .., ram. , . ". - ..�" y • `.
Suprv. Electrician signature, required: £ � - �. ' .S- 0:,.,':t ter '•. .. �a' ,1 ' q g ',, ,e_ =' t r4 3 iz ' :• i
: 4; : - l l,✓
si ature, re uired: - -- k
Subtotal: 66 t
intname: J G Plan review 25%of permit -- .
■
s�o n {e,�. Date. 6 / ( D ( ( P ): '
State surcharge (12% of permit fro): e , z
Authoti2cd signature: TOTAL PERMIT FEE: - 7 Lt . 9 '7
I Print Warne: This permit application expires it a permit is not obtained within 180
Date: days after it has beau accepted as cornplei.
• Number of inspections allowed per permit,
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