Loading...
Permit • CITY OF TIGARD ELECTRICAL PERMIT ,, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00221 Date Issued: 05/14/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 25101 DB00400 Jurisdiction: Tigard Site address: 13085 SW 76TH AVE Subdivision: Lot: 0 Project: Fields Project Description: Reconnect. Owner: FEES FIELDS, FRED W Quantity Description Date Amount 1149 SW DAVENPORT 1 ea Reconnect Only 05/14/2009 $66.85 PORTLAND, OR 97201 1 ea 12% State Surcharge - 05/14/2009 $8.02 PHONE: Electrical Contractor: LAKE OSWEGO INSULLATION 503 - 245 -6460 PHONE: 503 - 245 -6460 FAX: 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 t roug OAR 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246. 9 or 1.800.33 344. Issued By: ('f t.O .f lX \ 1. V ' Permthee 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'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. Electrical Permit Application FOR OFFICE .USE ONLY City of Tigard Received DateB 1 �� O n ( l K L) L2 Permit No.: C _0 (ALL ^ - ° 13125 SW I Blvd., Tigard, OR 97223 Plan Review 3 4 Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit: TIGARD Inspection Line: 503.639.4175 Date Ready/By: uris: ® See Page 2 for Internet: www.tigard - or.gov Notified/Method: ( ' Supplemental Information TYPE OF WORK PLAN , REVIEW ❑ New construction ❑ Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 400 amps or more ❑ Building over three stories. ❑ Demolition ® Other: where the available fault current ❑ Marinas and boatyards. - 3 CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ 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 pump. ❑ Installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "I -3 ", Job no.: 099 7 / Job site address: / 3 Q 100HP or [Wore. occu pancy. V (N / ( tJ ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State /ZIP: f A c7 / O� 9'7 2 `� 5 ❑ Health -care facilities. ❑ Supply voltage for more than "y ^ ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no.: Project name: " " ' el `4' _ ❑ Service or feeder 600 amps or more. _ _._. ,/ FEE SCHEDULE Cross street/directions to job site: S zo i /I2 , r s $' j f Description 1 Qty. 1 Fee. 1 Total �K 'g iV L New residential single- or multi - family dwelling unit. Includes attached garage. — .___._ Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 - -- Tax map /parcel no.: , , `_ DESCRIPTION OF WORK Ea. add 500 sq. ft. or portion 33.40 1 • 2e ed,tiie C C �F'w et -_ . t Limited energy, residential 75.00 ,:uv;,:d:. 2 (with above sq. ft.) . L PROPERTY OWNER ❑ TENANT sc mrrianiea d I Limited energy, multi - family Name: x ' e <• /`" i e L- 0/s residential (with above sq. ft.) 75.00 2 Address: /e''9 j L A 1/e4Do21 41,e. Services or feeders installation, alteration, and /or'rclocationstow : City /State /ZIP: <20 %/404./e/ OF ' 97/ O/ 200 amps or less 80.30 2 • Phone: ( 503 ) ,2,,Z 8� ?08 9 Fax: ( ) Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 106.85 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. ; .e. Owner signature: Date: 401 amps to 600 amps 160.60 �•:r l APPLICANT ❑ CONTACT PERSON ._ Business name: , 4 /fe Q�W e o ✓w ,sv t,A ly6N 601 amps to 1,000 amps 240.60 i 2 Contact name: G o � !es u __ Address: J Over 1,000 amps or volts 454.65 . __.__ _;._ / 9 7 .2 9 Temporary services or feeders installation, alteratio . F : City/State /ZIP: /24 � ( Q relocation :.: ..i:r�:_�.� • Phone: (6°03 ) Fax 4© '�,3 )v 15 -9a?O/ • •,:.:,�;3, 2 Fax: ( J 200 amps or less 66.85._ °� _-___�. -- E - mail: j0�;J/1'67./ ©.l d1 !747 &/l7e it/� x .. i ; CONTRACTOR 2 l 201 amps to 400 amps 100.30 -_2_1 Business name: i'o' li,t . I Address: 401 amps to 599 amps 133.75 .2 l City /State /ZIP: Branch circuits - new, alteration, or extension, per panel .. Phone: ( ) Fax; ( ) A. Fee for branch circuits with 2 above service or feeder fee, 6.65 2-;` CCB Lic.: J .� ;_; s•- B. Fee for branch circuits - : ?Z Suprv. Electrician signature, required: without service or feeder fee, 46.85 _ 2 first branch circuit ... ,, •_ - . Print name: Date: 2 ' Each add'I branch circuit 6.65 . _2 Authorized signature -� i l .' - -- Miscellaneous (service or feeder not included) - , - - -' Print name: ,i /��d,6)e4 ' Date: I:\ Building PermitsELC -PermitApp.doc 05/23/06 440- 4615T(1 I /05 /COM/WEB I2�� S( A_ i t air\ CQ�l- ..._a_4_,. ( \ \