Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00692
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/16/2010
Parcel: 2S111DB04500
Jurisdiction: Tigard
Site address: 15266 SW ALDERBROOK PL
Project: Subdivision: SUMMERFIELD NO.7 Lot: 415
Project Description: Replace 200 amp panel.
Contractor: ELECTRIC NORM INC Owner: GARRETSON, JUANITA & RALPH E
1365 SE 10TH ST 15266 SW ALDERBROOK PL
WARRENTON, OR 97146 TIGARD, OR 97224
PHONE: 503 - 643 -3500 PHONE:
FAX: 503 - 861 -2157
FEES
. Quantity Description Date Amount
1 ea Services or Feeders - 200 12/16/2010 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/16/2010 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 accordance • 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. • TTENTION: Oregon =w r =: es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-661-0010 through OAR 952 -06 -0090. may obtain a copy of he rules or direct questions to OUNC by calling 503.2 :7 or 1.800.3/.2344.
Issu By: — �► �_ 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'
: / c ` � J Date:
r
LICENSE NO. �v
Call 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.
•
C t o
i .,,,,,,,, , Electrical Permit Application ACit i ` 1 � Current Planning
3 `�i Washington County,155 N. l AV, Suite 350 Hillsboxo 7124, Approval
o �� Phone: 503- 846 -3470, Fax: 503 -846 -3993, �C 1 1100 Project #
Inspection Requests: 503 -846 -3699, www.co.washin on. .ya ) 0 �
TYPE OF WORK CO G ���IS PLAN REVIEW
❑ New construction M Addition/alteration/replacement ['Other ∎ -∎ \ Please check all that apply:
B v1 ❑ Service or feeder 400 amps ❑ Hazardous locations
CATEGORY OF CONSTRUCTION or more where the available Service or feeder 600 amps or more
fault current exceeds ❑ Building over three stories
13 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building 10,000 amps at 150 volts or ❑ Marinas and boatyards
less to ground or exceeds ❑ Floatin build' s
❑ Multi- family ❑ Master builder ❑ Other: 14,000 amps for all other g '�
JOB SITE INFORMATION AND 'LOCATION installations. ❑ Commercial -use agricultural
buildings
Job no.: Job address: 15266 SW Alderbrook Pl. ❑ Fire r ❑ Installation of 150 KVAorlarger
❑ Emergency system separately derived system
City/State /ZIP: r/ 97224 ❑ Addition of new motor
❑ «A,»«E »«12 »«13 „ occupancy
�
/ - load of 100HP or more
Suite/bldg. /apt. no.: / 7p Project name: (24912.12.,1150 A. ❑ Six or more residential units 0 Recreational vehicle parks
❑ Health -care facilities ❑ Supply voltage for more than
Cross street/directions to job site: 600 volts nomina
FEE SCHEDULE
Description I Qty. I Fee I Total I ”
Subdivision: Lot no.: Residential single- or multi - family dwelling unit.
Includes attached garage.
Tax map /parcel no.: 2S111 DB04500 1,000 sq. ft. or less 153.00 4
DESCRIPTION OF WORK Ea. add'l 500 sq. ft. or portion 43.00
Limited energy, residential 61.00 2
Replace 200 Amp Panel (with above sq. ft.)
Limited energy, multi-family
67.00 2
residential (with above sq. ft.)
❑ PROPERTY OWNER . ' ❑ ,TENANT Services or feeders installation, alteration,°and/or relocation
a a'2.. Q 1 l 5 tU 1-ri 4 1-P 200 amps or less 1 122.00 2
Name:
t
Address: ��i� - ) 201 amps to 400 amps 122.00 70 2
,/� �, .p 401 amps to 600 amps 184.00 2
' � a � � �� L � > = �� o � 601 amps to 1,000 amps 275.00 2
City/State/ZIP.,---776„ eth2'b e2 q 7;,a-Lf Over 1,000 amps or volts 514.00 2
Phone: ( 503 ) Fax: ( 503 ) 7 Temporary services or 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 is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 110.00 2
Owner signature: Date: 401 amps to 599 amps 153.00 2
❑ APPLICANT 1 ❑ CONTACT PERSON Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
Business name: above service or feeder fee, 8.75
each branch circuit 2
Contact name: Phil Tussing B. Fee for branch circuits
without service or feeder 61.00
Address: 1365 SE 1 Oth Street fee, first branch circuit 2
City /State /ZIP: Warrenton, Or 97146
Each add'l branch circuit 8.75
Miscellaneous (service or feeder: not included)
Phone: ( 503 ) 643 -3500 Fax: ( 503 ) 861 -2157 Each manufactured or modular 1 04.00 2
dwelling, service, and/or feeder
E -mail: ntussing @charter.net Reconnect only 79.50 1
. CONTRACTOR Pump or irrigation circle 61.00 2
Business name: Electric Norm, Inc. dba: Mister Sparky . Signor outline lighting 61.00 2
Signal circuit(s) or limited-
Address: 1365 SE 10th Street energy panel, alteration, or 61.00
extension. Describe:
City/State /ZIP: Warrenton, Or 97146 2
Phone: ( 503 ) 643 -3500 Fax: ( 503 ) 861 -2157 Each additional inspection over allowable in any of the above
Per inspection 90.00
E -mail: ntussing @charter.net CCB lic. no.: 30615 ////3 Investigation fee (see compliance)
Electrical lic. no.: 4 -1 C 7/t ! « City or metro lic.: Other:
,--.. /� ELECTRICAL PERMIT FEES
Supervising electrician
signature, required: / 15 �/( 3 Subtotal /e0, 70
Plan review (25% of p ermit fee)
Print name: Robert Turpin Date: 12 -14 -1 0 dr$
Authorized ".-
State surcharge (12% of permit fee) 1.4
signature: TOTA PERMIT FEE cc
This permit application expires if a permit is not obtained
Print name: Philip Tussing Date: 12 -14 -10 within 180 days after it has been accepted as complete
*Number of inspections allowed per permit, vision 6/08 7g