Permit CITY OF TIGARD ELECTRICAL PERMIT
11 11 COMMUNITY DEVELOPMENT Permit #: ELC2011 00105
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/22/2011
Parcel: 1 S134ACO2643
Jurisdiction: Tigard
Site address: 11010 SW COTTONWOOD LN
Project: HOLDER Subdivision: ENGLEWOOD NO. 3 Lot: 209
Project Description: Panel replacement.
Contractor: GARNER ELECTRIC Owner: HOLDER, W JUNE
2920 SE BROOKWOOD AVE A 11010 SW COTTONWOOD LN
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503 - 648 -4552 PHONE: 503 521 -8230
FAX: 503 - 642 -7925
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/22/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/22/2011 $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 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 -0090. You may ohtain a co; direct questions to OUNC by calling 50 2.1987 or 1.800.332.2344.
Issued Bye �� ��:� 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' 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.
FROM :GARNER ELECTRIC FAX K. :5036427925 Feb. 22 2011 10: 59AM P2
___
Appl
EigtitiPPSIBIL
9
City of Tigard , Reaeived , / __
7
.- Date/By J 1 n i , ..-7---- PfmThit Wa ''
li 13125 SW 1 Blvd., Tigard, OR 9/223, ( 4 1.t Plan Review i -
I,r Phone: 503.639.4171 Fax: 503.598.1W - ....,c,..3 Date/By: Otter Permit:
Inspection Line: 503.639.4175 ,k \ , ' ,,,q Date Ready/By:
h
LH. •s i In
■t, l.) ' \ ' rti_l___ j_ ----".- 1 Su
NottlecVMathod; ■' pplemental IMformation
Internet: www,tigard-or.go 'C't - ., -----
ininall tp7:77'...•:::. • ! -47''!! ;:, .' i''. :':;;;'':t 1:',1 .1:•..:;!..1' .,,. 1.14141..tavrE . . .. , . „.... .
fl New construction M Addition/alteration/replswement Please cheek III that apply *brim g sets of plane w nem chc b'.1t y
LI Service of ibedar 400 amps or more D Building over three stori.g.
0 De. . lion 0 Other: where the available fault cumin 0 Marines and boatyards.
7; tkiittj7; t's ' ,'":, `;.9",i i
.,. .., :. .?Jkb . . '.:::,;t4.1's exceeds 10 m noo ampg ISO visite or El Floating buildinps.
' ''''' ' *:' I ' • •• • • • ' . • -,-." N. ',, . - ".- -'....:A.......'' i''' ' to grourei, ur rumor 14,000 0 ecutanerciel-use egricult ural
L 1- and 2-family dwelling El Conunercial/indostrial Ei Accessory building 1111,11 lbr *II other installations. buildings.
I:1 Mtdd-family 0 Master builder 11 Other! 0 Fire ram. 0 Installation or - P. , KVA tts
• ,. ...-t 0Esnargency sysimn. wipe Ropgratall derivcci Nystote,
-1, rV;;Vi "V . . TiOrRitp. 07 iii'il ... (r; 1 ' 1.: . :!' r....+:7;1
Addition of new motor hind of 0 "A", "E", "1-2"
100HP or more. oer.upsney.
Job no.: Joh site address: i i ,S/A) (444440d Zane 0 Six or more residential wins. 0 Recreational veelc parks,
7. .
0 Heidth-earo facilities. 0 Supply voltage for more noel
City/State/ZIP: / I , ,,, • ,, • i ‘ 3
.........., oHilitatioua Meatiness eon wilts nominal.
Suite/bldg/apt. no. Project name: 4 l LI Service or feeder 600 amps or morn,
-„-.
11110Kill
Cross street/directions to jolt site: t__:..__....._1== IN.
- " . . New residential single- or Ililultl-family dwelling unit.
Includes attached garar. _
, -- - , —„
Subdivision; — 1 - LOt no.; 1,000 eq. ft. or lees
— , 145.15 4
Ea. addl 500 sq. ft. or portion
Tax map/parcel no.. , Limited energy, rosidential 7500 2
Piiii. 4;'",f,Vt'iri.W...;1'.:..nt'',c',./4-11Yigkiftel.f5itWitifiiii0;',.,.;"'..?.?1:1:.:':-%'...,z;.*!.g.;2,,,,-;':.. t r.;.•?; __IL,kal abavc El It) -- — _ - ....
t „ ,.., V... '. - -... -, - -' '' ...$....... • -- - • •• ... , '-:1' ' - ' ' ' . . -.'-'...-- • ' - ------' Limited energy, multi-family I
75.00 2
ef ti,.1 .. _, patil.f l C. vv6C, rosideritteil (with above aq. ft.) 1
S '" — Services or feeders installation, alteration and/or relocation
200 amps or less - - / L
so 30 kr. 5
, ..1,NT , •': . .. ,; i kart' ,, . '.'; jt... AI." .1*;.:4 ' p'',i ''' 201 amps to 400 2
. .__. 60
1
---1- 401 amps to amps 160 . 2 . ,
Name: 1/.) i . :40 kn. 4 : 6 1 ti .. _ _
240.60 I 7
... _.. ..._
Address: Over 1,000 amps or . -
volts 454,65 1_ 2
_.....i .
Temporary services or feeders installadon, alteration, endior
City " /State/ZIP; relocation__
,.— .. .. —
Phone: (05) 52.1 - g t 2.3 0 c ._,....,_ 200 amps or less • .. ,
.. . -..
_
) . . , 2
Owner Initellation: This installation is being made on property that I own wiiih not 20 ato 400 amps 10030
401 amps I
intended for sale, lease, rent, or exchange, according to ORS 447, 440, 670, and 701. to 599 amps 133,75 L -
Branch circuits - new alteration or extenelan er panel _1
Owner signature: Date: A. Fee for branch circuits with
., ....7! ? .,.77.1747E.4.1111t,iiktitc■..:'. ' ' :.'., , 14 , ..'tio.i, 1 ,..k..... NI. . :5 , . 1.;„.• .'.... ,1.,;•, ., .:,.:0 .. .. ,
— above service or feeder fee, 665 2
each branch circuit
Business name:
544::tiIc ot . ...
B. Pee fo a r bran circuits ... - - ........ — -- •
... without service or feeder foe, 46.85
Contact namic; first branch circuit ... ,.,_ ,. ._.„ . __1.
Address Esc), add"I branch circuit 6,65 7
: ___.
Miscellaneous (service or feeder aotinclud
City/State/ZIP: Each manufactured or modular 90,90 ,
____ ,... . , dwelling, seivice and/pr feeder
—. .
Phone: ( ) Fax: : ( ) __-- Reconnect only 66,85
.. ._ _
E-mail: ' • A , ' frffeil • 0, i — ' • . . a pump or irrigation circle
53.4() ,
' 1); .4... , 1 ';■■....'iri,..s Sign or outline lighting
. ',.:,74T4',7, AIM , F.,'.., ,......, Ai, ..k.,,, ..,, ,.... • ., ...;....,...... ---, ...._. ....._ .. _..
Signal eireuit(s)
Business name; nallte: GAR (N1 ER g Lc C..- energy panel, alteration, nr
.__.
.. ..
44"A-
Acic j,w;s: e s I ,. ..._ extension. Describe: Page 2
.....
City/State/ZIP; . a • ae, 4* e ll 1 2 - I . Each additro nal inspectiall over allowable hi any
of the 'boot. _
-, , 0 --- Per inspection I 62.50 _ T _
Phone: 13) I Fax ( c P k, Li a.:)125- -
investigation per hour (1 la min) 62.50
' 73,75
CCB Lie.: 12_ i ..T Electrical Lie. ,.-Ig o pM'
' . ,
S 1 , Lic,..3 , 0 - 7 -5 , Industrial ohm! per hour
' WM' . :Vit.1E___L
-- .. ." -
Suprv. Electrician signature, required: Alfr/07 / - : -, , & E0,70
Print name: -
. -
' 0 1,601111/ ' ..../ -_- • - - . ..- - ,. ,. . . .
Plan review25% of permit
Y A
64i . , ...I/
. .., i I .
' - 1-- -
..10
iALert, 1:1 State surcharge (12% of permit fee): . /AIL ...
Authorized signature: TOTAL PERMIT FEE: r,,,n,„,, .-- 1/A . 1?
.. i
TIM permit appneittine expires if * pertiit is not ; 'Med wlihie 1
Print name: _1 Date:
---- days after It MI beta accepted 1.4 camplel..
-- - — ' Number of inspeetions allowed per permit.
• . • .•-, . ,r1 e ti.r.A I AIM Fi