Permit 1114 ,,,, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Per COMMUNITY ELC2011 -00211
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/22/2011
Parcel: 2S 114BD02600
Jurisdiction: Tigard
Site address: 16590 SW WOODCREST AVE
Project: Pete Anderson Realty Subdivision: COPPER CREEK NO. 2 Lot: 32
Project Description: Electrical reconnect only.
Contractor: Owner: PETE ANDERSON REALTY
10610 SE WASHINGTON ST
PORTLAND, OR 97216
PHONE:
PHONE: 503 - 256 -9723
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/22/2011 $67.84
Specifics:,
1 ea 12% State Surcharge - 04/22/2011 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
Required Items and Reports (Conditions)
This permit is is - • •• - o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in - cordance with app •ve• • - •s. permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT NTION: Oregon law -quires •u t• follow the rules adopted by the Oregon ion Center. Those rules are set forth in OAR
952-001-6010 throu' h OAR 952 -0 90. / may ' btain a copy of th rules or direct questions to • UNC by .: •• • 6 987 or 1.800.332.2 4. _
Issued r : _ Permittee Si. . -
. .0' /t l .' /0-
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 ins ection date.
This permit card shall be ept in a conspicuous place on the job site until comp etion of the project.
Approved plans are required on the job site at the time of each inspection.
Electrical Permit Application
to': 0 1 - 1 . 1 ( 1-' 1 1 1 ON.1 \
City of Tigard . D Received Affiri )
I 25 SW Hall Blvd., Tigard, OR 972gSJCVAI. Plan Review
. I Phone: 503.718.2439 Fax: 503.598 . n ( Not \ Daii3 : Other Permit
I
Inspection Line: 503.639.417 5 ; gt 1, I\ ) % ' Date Ready/By: Twit: 0 See Page 2 for
i (' '
Internet viww. fig= -orgov r bed/MNoti ethod:
Supplemental Infornsation
a? s
fiK11%; 4:%::.4.,i'i.;‘,4, 4 " .-, VAIATZIMIZIgtrtgiNit7SISESPil Igalfil
E1 New construction 0 AdditiOn/afteratio ,,. i lacetpent ' ' ' Please check all that apply (submit 2 sets of plans w/itans checked below):
121 Service or feeder 400 amps or mom 0 Building over three stories.
0 Demolition Other: Vacant 6+11tattlts
where the available fault currant 0 Marinas and boatyards.
g :g ' -,.4 '''' •4 ' 7VINtl.:MtaitflYtT2MRM,MIZITT:CINICAW Or' IstriMatit exceeds I 0,000 ainp3 it 150 volts or Ei Floating buildig,.
- .,
n'..2.."0-.e..''e- ''....' ,--...w.timg.lsi.war.4z4v4,,,,&-mestmin;44iiiwmadiliii6esisk :41,, itaii,mwsiadc. io to grund, or eneeds 14,000 0 C ommarciai _ use asria
Z 1 - and 2-ftunily dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. building,s.
0 Multi-family D Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
rl 4 , ,r,".' '• kAltrrlfrilt., '07-7).7f4),;17:MMVF,it;‘57-f1M7°,4.W.RMKtrartiMr4 Ci 8inell./encY system larger separately derived system
' rr' f' .4. ''''''..i,...i,' , , O':',..dinria.A.4whi. 6".kihrikidka 0 Addition of new motor load of 0 "A", "E", "1 - 1 - 3 ,
more.
Job no.: Job site address: 16590 SW Woodcrest Ave 10011P or occupancy.
0 Six or more residential units. 0 Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97224 0 Health-oare facilitimi. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Pete Anderson Realty Relo 0 Service or feeder 600 amps or more
';- lattifill,ffigrlartlreggnit
Cross street/directions to job site:
oftcrtstan Qt Fee, Total •
New residential single- or multi-family dwelling unit.
Includes attached gsuage.
Subdivision:
Lot no.: 1,000 sq. ft. or kw 168.54 4
Ea. addl 500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited miergy, residential
kla;:i4a6, .''i lf.. : Ntial' ,, ,727,721:71727,1", ill%ARIM.171 with above se, fl.) 75.00 2
" • - Limited energy, multi-family
75.00
residential (with above sq ft)
Services or feeders installadon, akeratioa, and/or relocation
., 200 amps err less 100.70 12
._..._
1, I:: .1 -'. .I.V.rire •.'"AstgF,JM,',,, -..,,,,,,--111MitittnOWIWWWIM4 201 amps to 400 amps 133.56 2
. ., , ,,,'A ..y,i ir, x. *.augataiteattett,•.. -.. t61.41kliftVig.tene ', i:c Wittaeio,ete
401 amps to 600 amps 200.34 2
Name: FilLNIC
601 amps to 1,000 amps 301.04 2
Address:
Over 1,000 amps or volts : 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) --T Fax: ( ) 200 amps orison 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps 168.54 2
Brands circuits — new, alteration, or extension, iter panel
Owner signature: Date: A. Fee for branch circuits with
, i 1c la r t , ± 1 , 1 7T'f:N 1 2:.:TIMTIgiri&MIE above hmneservice circuit or feeder fee,
7.42 2
i.ii.,Ci,;:k7dlaitagiM each h
Business name: Pete Anderson Realty Relo 13. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: Jason A. Lee
branch circuit
Each addl branch circuit 7.42 2
Address: 10610 SE Washington St
Miscellaneous (service or feeder not included) T
--.
Each tnanufadured or modular
City/State/ZIP: Portland, OR 97216 -
dwelling, setvice and/or feeder 67.84 2
Phone: (503) 256 ir : (503) 253 Reconnect only
I 666777.8484 6714 2
Pump or irrigation circle 2
E jason@peteandersonrealty.corn
Sign or outline lighting 84 '
2
Business name WAITA.,141itrannina.4, Signal circuit( s) or limiled-enerliY ,
panel, alteration, or ex-tension. Page 2 2
: 14C1. .
•
' Each additional ilitt1011 over aBowable in any of the above
Address: //
Add sal inspection (1 lit min)
Investigation (1 hr min) 66.25/ hr 66.25/ In
City/State/ZIP:
.
Industrial plaid (1 hr min) 78.18/hr
Phone: ( ) Fax: ( ) Inspections for which no fee is
90.00/ hr
... ifIcall listed % lir min
CCB Lic.: Electrical Lic.: Suprv. Lie: - JAMMKTOMEZEZEMEALUMANNMER
R
Suprv. Electrician signature, required: Subtotal:
Plan review (25% of pennit fee):
Print name:
' I Date: State surcharge (12% of permit fee): i.11
TOTAL PERMIT FEE: 7-..... 9 g
Authorized signature:
Thb permit application expires N a permit le not obtained within 180
days after it has been accepted as coulaleta
Print name:
I_ Date:
• Number of inspections allewed per permit.
1.: \1101kling12Chniti \ELC-PatnitApp-dot 07/01/10
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