Permit CITY OF TIGARD ELECTRICAL PERMIT
II iiii
, `• COMMUNITY DEVELOPMENT Permit #: ELC2011 -00065
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011
Parcel: 2S 102AC00100
Jurisdiction: Tigard
Site address: 9040 SW BURNHAM ST
Project: City of Tigard Subdivision: BURNHAM TRACT Lot: 4
Project Description: Service of irrigation controller, located on the NW corner of Ash St. and Burnham St.
Contractor: NORTHSTAR ELECTRICAL CONTRACTORS Owner: STEVENSON, MICHAEL J & KAY L
19450 SW CIPOLE RD, STE 107 16815 MAPLE CIR
TUALATIN, OR 97062 LAKE OSWEGO, OR 97034
PHONE: 503 - 612 -0840 PHONE:
FAX: 503 - 612 -0891
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/27/2011 $100.70
Specifics:, amps or less
1 ea 12% State Surcharge - 01/27/2011 $12.08
Type of Use: COM 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 do in accordanc- . 'th 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
da . ATTENTION: Oregon ■ e. 'res you to follow the rules adopted by the Oregon Utility Notifi , 'on Center. Those rules are set forth in OAR
9 - 001 -0010 through OAR S. '• . You may obtain a copy of the rules or direct questions to OUNC by c .,nm.. _1 .232.1987 or 1.800.33 .2344!
sued By: c P ermittee Sign. % !_� / �r / l
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:
CONTRACTOF(INSTALLATION ONLY
-■■...
SIGNATURE OF SUPR. ELEC' ��a �f� 7i� Date:
LICENSE NO.
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.
Jan. 25. 2011 4: 31 PM NORTHSTAR No. 1844 P. 1
Electrical lP Perm>I,`'>h App p lica 0
t t �4; 8 W i FOR OFFICE USE ONLY
of Tigard Deceived �a� PrmitNo.: &C. , �blo
13125 SW Hall Blvd., Tigard, OR 9 1 5 201 paw f
Phone: 503.639,4171 Fax: 503.598'.0 " '. ' Y::t llif Daterg
other Permit:
inspection Line: 503.639.4175 I r pp- J . Date Boady/g Juris:
OF T IGARD r -"--- 9J See Page l for
Internet: wwiy.(i- tigattl,or.ua CITY Notified/Method:
i yW . n1A %IN IQl['1i�� thd SuPPlemental[n(ormatlon
G,G T � �E1';q 117e�"u' y �I;.?r. "Qa aL" r .. _
.... §I:�tY7 Y .�:!Lppertlr l°a; o ;a a 1., " , �t"; s ° t ati ° r, i
. x,G �.,;. .,i ,;. f�,.' .. )In�.r "Y- ;l. a a., tie_ t l,: )�
0 New construction ❑ Addition/alteration/replacement Please check all that apply:
❑ Demolition ❑Other: ❑Service over 225 amps, come] ID Hazardous location
f� p' =`�r „?1,4F ? -' , :o- ^ . =} p,'�, ' } . i �: '�1:r8 y 'p�y w� -�;r .;T '�i`+ . . - q i . i ? , ❑Service over 320 amps- rating ❑Buildn over 10000 s , fr.,
.. a: 't ° . x �I'lof , ..r;;:,r( raEti, s° ,: a ; I .;� r gc ., 0 a „ �! ' 1 � : ` r . , of 1 and 2- family dwellings 4 or more new residential
❑..1...and2family.dwelling ❑ Commercial/industrial Cl Accessory building ❑System over 600 volts nominal units in one structure
❑ Niultj family, ❑Master builder t OBuilding over three stories ❑Feeders, 400 amps or more
0 her:
°'i" a ,tr•:- ra ^!xr..?, 9,� ^:F � -r s�'t •L.:_ t n,. i 4 71,.0.,:: G m ; „ -r- v 0ecopa 99 persons ❑Manufacturedstructu
t. r . �' � �� 1 .dA t..Y�� �', �;' �ti , � tyUyl 1 ,71 '•�` �� i ��,. r•;� � nt load over p structures or
ta,l,intg, � ,�.:bt,1574 :r";.,'` ?41r. d" 1 ,...:�._�i*n ?11� Y ;�tDl ri r��htt .��A,ai'._,ac1 i' .'nS?_ t °Egress/lightingplan RV park
Job 110.: Will Job site address: t "Q Q &Wk) 14./ r ❑
- ❑Health -care facility Other
Submit 2 sets of plans with any of the above -
City/StateJZIP: ` A P r . 6 0 - Q A /gg The above are not applicable to temporary construction service,
Suite/bldg./apt, no.: name: r �--� v ` iii rJrt: as t-;,n i 12}`' t r °li zar :::d.
Project A ,r.
] K... I: �: St; �z��t ?,- itl��.•id.;��"�.`la- .�, 1:P, !13 3;?2, .'Y�.,. . ,
Description Qty. Fee. Totoi "
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
llnclades attached garage.
1,000 sq. ft. or less 145.15 4 -
Subdivision: Lot no.: Ea- add'1500 sq. ft. or portion 3140 1
Tax map /parcel no.: /o 2 A G► OO /OD Limited energy, residential 75.00 2
�f; it.: 'F�t,, �� %t;r: . ift''� a �f,�,,�iM{ r'" *^� R{;�,::.� ^;i�.as y :,;:F:�t a Limited energy, non-residential _ _ 2
� 7'. K , .L T.i.,
. i (N i 1 Fi(4I ro pyh fail 11 ) t4 1� i .<'�d3 a , , , r � 4•,� 1 �f '71 18 f ctu 75. 0
r:,, . 'u. +4.. :1- , „t;i;, t � a r• p � a:,,.r ^MO , .r Ir t-t,: ,a. d 4 ^tgott tl; N ` . 12 2 , ,, = "i �? h7itd., t';,;:l Each manufactured or modular
i dwelling;' service and/or feeder' i 90.90 2
J
A/ - Services or feeders install: ion, at ration, and /or '' oration
U of • f ;k9--.' 200 amps or less Karla 80.30 Ci rl
'•;'�"S?;!i) 'i` �S,.I+mfi � F;;`- 1�?L•�.7 #iI;;L :�4. � ie� rl'.g3E� ^:Pyc;yGrt�rLtp�aq ens a n,
i k d;t iz � a U ! nF 1 a� 1 , >.„' i is '' i w1yr`FYf,e,t2J � ir i i,,„4; ,ti r � , ; tT.. ' i 201 amps to 400 amps 106.85 2
Vii, nil i � T 77 f: ° '' ' _e rv..Jf e . 74 '�_.dS...Jk ,f.- . ' n• I•t 9 F.
401 amps to 600 amps 160 -60 2
Name; 601 amps to 1,000 amps 240 -60 2
Address: Over 1,000 amps or volts _ 454.65 2
City/State/ZIP: - - Reconnect only _ 66.85 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) Fax: ( ) relocation
Owner installation: This installation is being made on property that I own which is not 200 amps 66.85 1
intended for sale, ex
lease, rent, or ch angc, according to ORS 447, 449, 670, and 701 201 1 amps t to 4000 0 amps 100.30 2
.
Owner signature: ^ 401 amps to 600 amps _ 133.75 2
ry _ . • _ Date; Branch circuits - new, alteration, O e xt
C;� r;'�G ,Gn �,, r;�r _ , , tension, per panel
£;i�, � ° `,C�.wE;1 ��I ° � � " ^'- '�"id:'�, .i.,Ap�..,N r1S'':' " "i'r "' ::r�: iid[�rs' .�,. s7 }a ", �L al A. C for b
, • p P
!,;ii-'i:Y trx, :Ia3 .4 ;i.>s.�.. ^.; o, �I�,' �, Burr 'Slf',,,.,,':I;'!. ";4;,tii.1Yi - J ,i. > .•: t. f . ''�...a h'i l: Pe
,.,.. �....,_ �cx.. srr6Y5, �::., �, r, :�� ? ?s:x5i ^.m�.�i«i9JihtiiL ^.� J s. i P_ �_ r �- 'v ° �� ,1 �Oai��':T.� 1 �, +..'�• tp�'.,!rl1 _,� Yrutchcirouirs
- service or feeder fee, each
f
Business name: branch circuit 6.65 2
Contact name: B. Pee for branch circuits
without service or feeder fee, aG.85 2
Addre Address: each branch Circuit
tate/ZIP: Each add'! branch circuit F 6 -GS z
Miscellaneous (service or feeder not included)
Phone: ( ) Fax.. ( ) Pump or irrigation circle 53,40 2 •
Sign or outline lighting 53.40 2
E-mail: �� Signal circuit(s) or limited -
r J t a FF + . "'^,, Tie f B ! 1C9,. u '1'� . ,a. R ' n a • . r e s'. o a��a, la • r F d lM1-' energy pane], ahcr Or
Business name: extension. Describe: Page 2 2
NorthStar Electrical Contractors
Address. 19450 SW Cipole Rd #107 Each additional inspection over allowable in any of the above
City/State/ZI Tualatin, OR 97062 Per inspection 62.50
(503) 612.0840 Fax (503) 612 -0$91 investigation per hour (1 hr min) _ 62.50
Phone: ( ) Lic #34 -359C CCB #90454 Metro #1911 Industrial plant per hour 73.75
CCB Lic.: Llectrical Lic.: �."sG , : "J gUEL S g' i M t "''," 'r z1.747.1,r3'ts j�iil;
Sup er w t.: ::z: ..,1,
Su Lie.:
- Subtotal
Suprv. Electrician signature, required: r Plan review (25% of permit fee)
•
Print name `dim ,. Date: f State surcharge (8% of permit fee) c%rm / i
TOTAL PERMIT FEE
Authorized signature: • �
_ This permit application expires if a permit is not obi in d withi 18''
Print name: Date: days atter it has been accepted as complet
F ee methodology set by Tri- County Building Indwtry Service Board
' Number of inspectiens per permit allowed •
iABultaing \Peniaaf..GPcrnatapp.doc 12/03 440a61ST(10/02/COMfWSB