Permit CITY OF TIGARD ELECTRICAL PERMIT
III a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00441
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/28/2009
Parcel: 1 S134DA01901
Jurisdiction: Tigard
Site address: 11114 SW 108TH AVE
Subdivision: Lot: 0
Project: Grant
Project Description: (2) circuits for lighting and fireplace.
Owner: FEES
GRANT, JAMES R & KAREN DORR Quantity Description Date Amount
11114 SW 108TH AVE
TIGARD, OR 97223 2 crt Branch Circuits 08/28/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/28/2009 $6.42
Electrical
Contractor:
GARNER ELECTRIC
2920 SE BROOKWOOD AVE A
HILLSBORO, OR 97123
PHONE: 503 - 591 -1320
FAX: 503- 642 -7925
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. ATTENT : Ore law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -001 through OAR 94•CltriN0 00. You may obtain a copy of the rules or direct questions to OUNC by callin• ' . 46.6699 or 1.800.332.2344.
Issued . _ .+ --� �L`� Permittee Signatrtre: ' .' i
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.
. •• rt.„
Electrical Permit ADD licatitin ''',. ' 7 ' FOR OFF USE ONLY
City of Tigard
1,11G 2 7 r 09 R.civid o RI
D , ibs , g Percnit Nu.: eke Ade do V....67
IN " 13125 SW Han Blv Tigard, OR 9 . --
Plan Review
I . ' Phone: 503.639.4171 Fax: 503.598,1960 Datefly1 Other Permit t-rtr-Ax,f,e6/11/
TIGARD inspection Line! 503.639.4175 Dale Ittiady/LIT. Judo,: 121 See Page Z for
Internet: www.ligurd-or,gov •
Netifed/lyiethott e'rters Supplemental Information
igitarteraphiliptitt.l1;i4.127tippiritifilifiniplipp,Rp011iMPSIFfirgiTiR011ig ; 6 .1..,*" .. tt ../ litii ,'' 'rein .41X1PRitpag0.e.plIgi'M
:fl,i,, kia.idiAttuusonstao, ' "Ili, '.' 1 . Al lt t111 . --, -1,44,1•1Nit,......:;:titilaittillt:d, ..;,.,., :!..41 it,.ti ' ‘ •,.- ,.., al m., Pv • q • .- -.,• 11. t:I.t.stgal t . ' am ,- .-- A, 4.. 0.4 /. 704 1R4i0A.!. . ,.. ,
Please check all that apply (bud l Z sets or plans w/itetnR checked below):
E:1 New construction bil Addition/alteration/replacement
CI service ur feeder 400 amps or more 0 Building over three stories.
0 Demolition D Other where the available Milt current 0 Marinas and boatyards.
„IripflaiffirlrtINT,j0,MaiiiRCiti' ',' '''' ‘;'` '''Z' ' .,,'-,t 41 VOIT,VIRIMIR $0'.'i. exceeds 10,000 amps at ISO volta or 0 Floating buildinga,
tilifi rciiitfdRialltiaalcIata i it:,:itit1B7AM t.41•6 .si.tr,: lis'Iti,'Idul 'Fs! telqi '. ' 4 7 ; 4 ".v1,•ontltWila:tibitl."." ' less to ground, or exceeds 14,000 0 commercial-use agricultural
1- and 2-family dwelling III Commercial/industrial IZI Accessory building Jams for all other installations, buildings.
El Multi-family 0 Master builder 0 Other; CI Mr e pump. 0 Installation of 75 KVA or
0 Emergency system.
lIC ilit,r,077. • ityik-IfiedgeN . ,; , EM 0 Sep:lately derived system.
0,atilitsar. YtN;, L1, ',;,i1.144 .. $,M.p:Afirg.70[1 14114- . ,iiilksk ,,.:.k; '1,b3.0wickv ,/,,A.„., •'m-gfrai AtIdition Of ILCW ITIDt01 load of 1p "A", "E",
Job no.: Job site address; //// Si ) / e 8 t!-. ,,h7e__, tomb: or ttolre.
0 Six 01 more residential unill, occupancy.
El Recreational vehicle narks.
City/State/ZIP: 77a OV, 97 2 e fa . Z3 OHealth
0 liamardoust locations. 0 Supply voltage tbr more than
600 von: nominal.
Suite/bldg./apt. no8- 1 Project name; CI Service Or feeder 600 tango or to6re.
• ...,. ' k)11,51 1 1t,. ‘. . : 10,1P r ' . 4 1 ` 1: ',1, r .l . '' ' M ' aNAIENEMBEN ."/: )1
Cross street/directions to job Site: , Description "M Fee. ...., ..., Tutu'
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 st4, fl. or less 145.15 4
- -- E. add'] 500 sq. tt. or portion 31.40 1
'fax map/parcel no.:
Limited energy, residential 75.00 2
lir.t7700 crt,i Ilt,„Aliliggi:k;Iftrikerli Vankar" r/121' 41' .:i izt‘j^.."(*. . (with above sq. ft) mardieLtrtitr.19q .,$, : • ,.'" Of. • 4 gpmili j .ti, ;V, 1. !.. ,,,,, ..,,, ',4! ?,,,`)? ' .'' s avm Al •
Limited energy, multi-family
( ri VC t,t i i.:c ir Zigi7 4' /1 • residential (wail above eq. it) __
. .__.. 75.0° 2
r ',//a(e-, , . Services or feeders installatim !iteration, and/or relocation
200 amps or less 80.30 2
f: iiii • ie. .• 7q 7"16 hil rr" . ;NNINELY i amp
llf■CIF . : 13 93/1g2 1 1 201 s to 400 an " ' ' 106.85 2
,iii,,t)S;,.. ..,,,,D l 4:11.4 ., • , -IL,. W... K•••...•- .itek) • • ,. .,-, , -.. , s. .........-
Name: Miete/ilef I ./.j 401 .;" arms to 600 amps
601 arrips to 1,000 amps 160.60
240.60 2
. ,.,
2
_
Address: Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration. and/or
City/Stale/ZIP:
relocation
....,..,...___ ... - ---
Phone: (9)3 ) ion _ I Li Li Fax: ( ) 200 amps or loos . 66.85
,., 1
p 1 2
Owner installation: This installation is being made on property that I own which is not 201 ams to 400 amps - - 00.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701, 401 amps to 599 amps 133.75 2
1
Branch circuits.- new a tera il on extension, per panel
Owner signature: . . A. Fcc for branch circuits witir
litiliKARI , ifIl'i4 - 1lTi'Itittligii.Wl ' !.,01 4EfignirT. tr ubove seivice or feeder fee,
vs-4,;4'4.1,est I . 'itl ',..„.. 4,00,,Istsi . .6 ,, v .' ,..-- . ,, a:A. .. ..l....-,-I%; • , • ■ ov,41,1, liyil,".. e, .Sina 44,61, • / ni ,;.,„y.,, 6.05 2
each branch cirr
Business name: . B. Fee for branch circuits
- - with oui service or feeder tee, i
1 119.85
Contact name: first branch circuit 46.85 2
- '-
Address: Each addl branch circuit / 0,65 t 6 2
_-,... . Miscellaneous (service or feeder not. Included)
City/StataZIP: P.ach manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only , .....
66.85 2
F.. Pump or irrigation circle 53.40 2
, .- .. . ........_
t vorsolisqiiiprostioismtimpotomitexgrifkliptiMiptv,, , , , , !Is 4, . IiiAP limar Sign or outline lighting slap 2
. omit tutt....,,Aakk • Iv v . 4 . ■., . v. , r ,, Uj l'.1 '.1% 1, 1010K.I'; , , 0 .:., .,, 0 ' f ..,t• - ;.--,----- ,
signal circuit(s) or limited-
Business name: GAF? NER u c_
energy mmel, alteration, or
Address: ZrizQ nzv rea r n .
- extension. Describe: Page 2 2
City/State/Z1P: ) 151,- . 1^: / 91 i 23
I- - ,
Each additional inspection over allowable In any of the above
Per inapection 62.50
Phone (03 ) 1 t _455.2... Fax: (5 (o 2-
Investigation per hour (I 1m miu) 62.50
CCB Lie.: 12_1 1 Sei Electrical Lic.: .., ' * - CIS ' _. . Lic.:3, DI-5_ 1 r I P h , °ur,„„„, 73.75
_______......, ISMANitealiAcktittftaiggettage .1,Alk.:gri.:;:.:
Suprv. Electrician signature, required: - • . • •• . Subtotal: 6,...,
Print name: ,
;,.•...,._. „./.- _
:b.:P...4w', •-vir , Plan ivview (25% of pertnit fee):
.01.4.0 ' _
yy 4 .. ' e ' ' - ' : -1 7 - 0 ci . ., , -
State surcharge (12% of permit fee):
. . . . ...,_.....,._. -
Authorized signature: TOTAL PERMIT FEE
• - Thli pernilt upplieution expires If a permit is nut obtoine militia ISO
Print name: I Date: days after It has boon accepted as complete.
* Number of inspections allowed per pertnit.
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