Permit CITY OF TIGARD ELECTRICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00169
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04!01!TIGARD
Parcel: 2S115AD00600
Jurisdiction: Tigard
Site address: 16740 SW 108TH AVE
Project: Hackett Subdivision: WILLOW BROOK FARM Lot: 30
Project Description: (1) feeder and (3) branch circuits.
Contractor: DAVIS ELECTRIC LLC Owner: HACKETT, JULIE A & BRUCE E
239 SILVER LOOP 16740 SW 108TH AVE
SILVERTON, OR 97381 TIGARD, OR 97224
PHONE: 503 - 508 -9855
PHONE: 503 - 995 -9392
FAX: 503 - 874 -9714
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/01/2011 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 04/01/2011 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/01/2011 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 • • m- • • - in a copy •P • direct questions to OUNC by calling 503.232,1987 or 1.800.332.2344.
Issued By: /' - _APT, Signature: rim - ••••
IJ 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.
03/31/2011 18:30 5038749714 DAVIS ELECTRIC PAGE 01/02
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'CAS) I OR 0111(•. I 'sl". ()NI 1
City of Tigard
Date/F3 :
..A) Received ill Pon , —
Ira )* No„ i_ L . • —_ i ; q
1111 ..,'" - " 13125 $W 1-1311 Blvd, Tigard, OR 97223
Man Review
' a Phone; 503,718.2439 Fax: 503.598.1960 ,-, satc/13 : Oder Peorrit:
1,, ( , , . ; I) I nspection Line: 503.639.41 75 .4 .,,,,\ . " .,', RdY/BY! Jump. fli Sec Page 2 fear
internot: www.tionnl-or.gov ,. „ c., , • ed/Method: Supplemental Information
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Please check all that apply (submit 1 seta of plans a/Jima checked below):
0 Now construction Iii Addition/alteration/replace , 2: - '
ID Service or Feeder 400 amps or more 0 Building over ihrice stories.
1:1 Demolition 0 Other: - ,' where the available fault current 0 Marinas and boatyards.
Ati0 exceeds 10,000 amps at 150 v011.1 Of 0 Mooting buildinpe,
. .r ' ' " , ' • '' - ' "" ' ' ' " ' ' ' '' ' ' ' '' ' less to Atoned, or exceeds 14,000 0 Commercial-use agricultion1
LI - and 2 dwelling 0 Commercial/industrial 0 Accessory building amps AA all other fitictallations. buildings,
0 Multi-fink 0 Master builder 0 Other: (3 Fire pump, 0 Installation of 75 KVA or
.iiii.:::i:diti0:414"00100.( H rlo.dof cv
I 00HP er mote, occupancy.
Job no.: I I , Job site address: 1 ( 5 t.• i ot 4
0 Six or more residential anga, CI Recreational velli ;le parks,
City/Slate/ZIP: 1 CI Fliz_b O 14... ci . 7 2:1 4 0 ffealth-carc timittrios, 0 Soppiy vrtikge kr more Arm
0 1 locatims. 600 volts nominal,
Suite/bldg./apt. no.: Project name: S , er i c 1 Cl Service or fccdcr 600 amps or more.
2N t
, - Cross street/directions to job site: t , r _pompom, WI.. 1111111t11111 tone mai
_., .. ''s si
New residential single or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq, It or lass 1E1 168.54 in
Ea. add'? 500 sq. R. or portion 33,92
Tax map/parcel no.:
residential
75,00
riFi..tlg'.'..i'OOKO#0k,OR7*7,7i7.7775,77,7Te'.i.NOZ 06thI Limited energy, r"1.114
II
n in timitea energy, multi-family
75,00
esAg-r- aer S B re 1A 41". C r 4....:14 0 +e10 midentia1 with above s.. ft.'
Services or feeders installation alteration and/or relocation
200 amps or less Irj 100.70 /d6.7 8
Pl.010111,4tV.::i. , ,''.4iN:N.4 , :'...n..NRi§"!;? ,, OAR:::';' , Utitti'ti0:: , N , I.:0,ci,P,::',4'„'.•; 201 neaps to 400 amps RIO 13156 El
Name: 401 amps to 600 snips II 200,34 2
601 amps to 1,000 amps 301,04 2
Address:
Over 1,000 amps or volts 552,20 2
Ci /S tate/ZIP: Temporary services or feeders installation, alteration, and/or
ty
relocation
Phone: ( ) Fax; ( ,) 200 amps or less 11111 59,36
s W — I
Owner ins(allation: This ;wont/eon is being nmde on property that I overt Which is not 201 amp to 400 amps INE=
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps IIIIINESEI El
Boma cir 1
• f ' i ., uaM1111
Owner signature: - D ata A, Fee kr branch circuits with
■: iiii , ',..***MIPV'',i'''''';:.,:;:;6':'.'''?i'", ,:'`):1;M::.',.:'''.:,.0At01.1*.t-tt10001V'A.:',0 a e b B:il s t: n r : c e r ee r it ed" ice 21 • 74 0
Business name: ti. I d i . -FrLic,_ B. Fee for branch circuits without
service or thader fee, first
Contact name: 1 ;. z . '''' ID elm) branch circuit ill
- Each add'I branch circuit 7,42 El
Address: 2.3 St Lv . a.a.. L.45 0 e Miscellaneous service or feeder not Included -
City/State/ZIP: S r- 0 (2 0 (738 k Each manuthctured om
r odular 111 67.84
dvvellin ,t, service and/ot feeder II
Phone: ( 5p) ) 5 0 g , ei gs Fax: : (c ) g-7,./ _ • / Reconnect only 1111 67.84 1E1
pup or irrigation circle MI 67,84 '
m 13
- C.: , i - • C-0
. .!' Sign or outline lighting El
Mill .
, :cre$4: ! Signal &mitts) or limited-energy il 111111
Business name: l'3/S , M,C,CIT2-le,___ and alteration or extension. • III
Each additional Ins on over allowable in an of the above
Address: - z c‘ ¶ t Liva2 Lo o p
Additional inspection (1 hr min) II 6625/ hr
II
investigation (1 hr min) 66,25/ hr
City/State/ZIP: 1 L titiPro p.) (21. g__ R7 - S, 1
Industrial plant (I hr min) 78.18/ hr
Phone: (5z• ) 5o -' : Fax: (%3 ) 87y _ i Insnections for which no fee is
90.00/ fir
R. eifieldi listed Vs hr min I
Suprv. Lk,: 5: 0 s ,:. Ime „, ciek ypt ... , I ;."'irReltSW',')i14:'/::•c,f",;:N^'..
CCB Lie,: (q0 (99 Electrical Lie.: C ,- 03
•• ....
Suprv. Electrician signature, requirer Subtotal: 2.. .
an fCVCW (25% of permit fee):
Print naillet *- g 4 2 4 jor,4 1) i-t I Date: 3 iglir 1 1 State am (12"/. of permit fecy,
TOTAL PERMIT FEE: '3 L
Authorized signature: .->.___,.___.
This omit application expires if a permit Is not obtained Within 180
der; after It lilts been accepted so
Print name: 'B Date: 3 1 k / 1 k
• Number of iaspections allowed p permit, complete.
imeadise1Pennitatc.permaaped 07/110/ 0 440-4615TO t/i/S/COM/WRII