Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00421
Date Issued: 08/14/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S135DB05800
Jurisdiction: Tigard
Site address: 11445 SW 94TH AVE
Subdivision: MILLER Lot: 7
Project: LaBauex
Project Description: (2) branch circuits for NC
Owner: FEES
LABEAUX, DAMIAN Quantity Description Date Amount
11445 SW 94TH AVE 2 crt Branch Circuits 08/14/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 808 - 385 -7694 Feeder
1 ea 12% State Surcharge - 08/14/2009 $6.42
Electrical
Contractor:
TYLER ELECTRIC LLC
PO BOX 807
MULINO, OR 97042
PHONE: 503 - 829 -2498
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 •AR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued Bt.- '��� Permittee Signature: 4�L'l 69 ' d A
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.
. A� 09 08:39a GRFELECTRIC 5038295747 p.1
Electrical Permit City of 'Tigard BUR ?NCaioqft R' til'H h 1 { r! ti1.% Reee;.ed ` `' ' FO
Dntr19 �i Aare; ? /Is p No ♦ /��^j[��
Phone: 503634.4171 Fax: 503 .51 I Q $� I 1 pier':lternew i aZOO ee ' a
E,nspection Line: 5 (Ti,639,sI95 RU 60 1 2009 DardBy Other Permit:
C7i 1: Axle tendyBY
[Memel: waw.tigard or.gov Notified/Marla: Notified/Marla: r % 77 (P.' Sc Fe2fbr
[Memel: .ter rt; ann ' 1 S ppl v rmalien
• 1 r 1 a r ' Vr
❑ New construction 41. '� ,'�� 1 .� °.:,��.` <= .. ;,�:��':1�''r' '1!P'�:.:, :::::..2•.1':::'..`4';,:4.'....;••:. .
Addit �r ilt a ii' d h,r 4 1 1 c ,her i `. , Please chock all that Demolitt0:1 V (cutout b sets of pleas wfitern5 oheoked::crow);
❑ OLh 0 Service o f ee d s 400 amps or more ❑ Building ova three stories.
while the toar:abl a ikelt current D Mannar and boatyard:.
• . CA TEGORY OF CONSTR ils n
t1CT1ON- exceeds 10,000,mt 150 volts or 0 Flooring bulldRs
in.
P and 2- family dwelling 0 Commercial /Industrial leer to ground, or exceeds I4 .000 ❑ Gammerask -we aextrltrual
❑ Accessory building amps forall other mstsf&dont. buildings.
❑ Multi- family Q Masser builder
❑ Other: ❑ Fir: pump, D Installation of 75 K VA ar
'JOB SIZE INFORMATION AND LOCA.7IOW Q Emergency syrtem, •' an A ger ',°E sa " parxt
."1.2-ety • der °1.3". ved eystan
_ ❑Addition ❑
Job no.: Job site address, t.- 5 5 4 100Hp er matt.
occa ry
parr,
City/State/ZIP: 1 ` DSix mare residerdalualm. 0 raeutation al vehicle parks. .
.. i. LZ - D Healttsearr Facilities. ❑Supply voltage for mare hu
Suite/bldg./Apt j ❑Hazardous lncatona. 600 volts nominal.
pt no.: Project name: i� J ❑ S a f eeder 500 a
fr - mPs or mane.
Cross street/directions to job site: FFS .SC IEDULE.
fl°` "1 u" Vt • I xca I Tana [ •
New residential angle - or multi - family dwelling unit.
Lacledee attached garage.
Subdivision:
Lot no.: 1,000 sq. e.. or less I 145.15 ! 4
Tax map /parcel no.: E& add') 500 rq. P orpoaioa 33.40 I
Limited energy, residential -
. OFSC'RIPTTON OF 't4lrt wave ove Era. R.) 75.00. 2
Limited energy. Z - -. �' c- r , ;delta >>� , ) 1 75.00 2
Servieq or feeders installation, alteration, and /or retoein
PROPERTY. OWNER [] TENANT 200 steps or less 80.30 1 2
201 amps to 400 amps 106.35
Name: . a - ri' La.. . - - , 4011. amps tto 6 0 amps 160.60
a ddress: .5 - 601 itmp to l .000 - 240.60 2
A. .1.7 r Over 1.000 amps or volts 454.65 1 2 1 11
City /$tatelZlP: ` - Temporary services or feeders installation alte ti
1- z-3 relocation on, aoor
Phone.(cro 3 kS_ - Fax: ( ) 200 amps orleas
66.85 1
Owner installation: This installation is being made on property that I own which is not 201 maps 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. 2
Owner signature: Dace; Branch circuits - new, alteration, or exteaeloa, ger panel
�� A. Fee for branch circuits with
C(fiTAC1 I"ERSON above saute or feeder fee,
Business name: each branch circuit 6.65 2
I r'.'r E � e eA - ,.i . Li L B. Fee ^or branch circuits
Contact name: p without service or feeder fee,
Address: S
L f �A I't" first branch cram: 46 y( .Q j 2
( j Each &dell branch circuit f! 6.65 ( 4., ft 2
CitylStatrlZIP: YDSeellaneousltervice or feeder not'iaduded)
NI 0 1.1.1 r. ,r � f__ C 1 7 C `c- 2.- Each manufacn:re4 or modulo
Phone: (t ;) r dwelling, service aotl/or feeder 40.90 1
' l r': Fa x: ('L :) 'i
Email: 7 - ' Reeonned only 66.85 2
Pwnp or itrigatior. circle 53.4C 2
COmA & Sign err otaline lighting 53,40 (
7R 2
Business name: Signal circuit(s) or limited-
i 1 r y C. "
-- energy pa alteration or
Address: j� C-' extension. Dcserce: Page 2 2
Cily /Staee/Z>P: f t ( r }" /� �� L Each additional in tion over allowable in a of the above
Phone: ( y' �' t Per inspection 62.50
CCB Lie.; V , � per (1 hrmi+t) { 62.50
� r-k , Electrical Lie.
3 `-LC\ Suprv, L yc�� v giant per hots 1 73.75
Suprv. Electrician signela;rg required: • E RIOLL TEMAIT Subtotal: •
Print name: f J 3 r (,
� � � .�� :` � Date: L '2 Plan review (25% permit fee):
Authorized signatur � State surcharge (12% of permit fee); L.
,. TOTAL PERMIT FEE: f ° -9 , el
t /
`- -'�, " �; ,., Dare: This mica ■pniicstion mire ifs permit it not obtarned i s l it0
darn alter khan been accepted as aim plate.
f: 10 a 11 d 1 nttPetmib ']iLf'RermirAppEoc o!!2r /nfi -
• Nombcr of inspections allowedper permit
1100.461 571(1 :105 /tom' tiL'Wlsi