Permit a
CITY OF TIGARD ELECTRICAL PERMIT
• 11, COMMUNITY DEVELOPMENT Permit #: ELC2009-00170
Date Issued: 04/20/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103BB03700
Jurisdiction: Tigard
Site address: 12153 SW 125TH AVE
Subdivision: BROOKWAY Lot: 37
Project: Lauzon
Project Description: (1) circuit outlet.
Owner: FEES
LAUZON, THOMAS C & CAROL M Quantity Description Date Amount
12153 125TH AVE
PORTLAND, OR 97223 1 crt Branch Circuits 04 /20/2009 $46.85
PHONE: 503- 590 -4641 wo /Purchase Service or
Feeder
1 ea 12% State Surcharge - 04/20/2009 $5.62
Contractor: Electrical
TYLER ELECTRIC LLC
PO BOX 801
MULINO, OR 97042
PHONE: 503 - 829 -4146
FAX: 503- 829 -5747
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
Required Items and Reports (Conditions)
This pe 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 ne 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
18 days. ATTENTION: Grego' aw r >•uires you to follow the rules adopted by the Oregon Utilii 'otification enter. Those rules are set forth in OAR
95 - 001 -0010 th •ugh OAR 9 r r 1 -0 ' 0� ou may obtain a copy of the rules or direct questions to O 699 or 1.800.332. 344.
I ued By: h. , .'i I14 . / J . Permittee S ignature_ ' = �.�
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 QNLY
SIGNATURE OF SUPR. ELEC'N i� �� 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.
1._ Mr 17_ 09 10:54a GRFELECTRIC � •, f ,. 5038295747 p.1
Electrical Permit Application 7 ': ` -
rot; tlrtI/t:
City of Tigard APR 17 2009 R.:v.4
111_-- 13125 SW Hail Blvd., Tigard,OR 97213 t re y, N 7I, q y 35 "" r it No.: ADO �/ 70
Phone: 503,639.4171 Fax: 503.598.1964 Plan Review
I n s eetion Line: SC0.639.4175 C ITY OF TIGARD Dare Other 1: 1 El l:
aE::', r. l> P Dan Rend
Internet www•tiltatd- or.gov r� p�/� D S+ O Y sir 1 @t See}ytFe2for
RUN rnNr I11v1,11`/I� Not ;6edlMolhod: BupplemcvdlLformMon
PE OP wont[ -.: - ;: _ .4I JOI .:
C New construction ddtt:on/altcrationfreplacement apply (ubvtic arts of Tans wntemr aheobod below):
Pleaec check a0 that s a P �
❑f)emollAOn � (]lher: ❑ service or reeder400 ampsormore ❑Baddint over throe glories.
when the available I1<ult current ❑ Marinas and boa yards.
CATEGORY OF CO • exceeds 10,000 moot at 1 $0 role CT in Floating building,.
• rr-�� and 2-family dwelling Commercial/industrial /lase last to prone, or exceed° 14.000 Cl Commercudwrsc
,1 Mu nd 2-fam Accessory building amps for all other bntatation twiklinga. atmailtural
❑ Master builder C Other ❑ Fitt
Taw. ❑ Iaai4llatinn of 71 K vA or
• JOB "51">iE INFOR11QAT1�•I � EOCA I7QN1 ❑ Emergency system, larger separately derived system.
� 0 Addition n a' , :had fnew met ad of "A '' E °t.2 " -
Job no.: f Job site address: _ ? � 5 ) L t ) / 1 � 100,'�p or motr occupancy
!�I e ❑ 3r c err motx rcaidrndal unite ❑ Reerea6p,rrtt vehicle parka.
City/State-ZIP: � ❑He alth -care Facilities. Supply voltage 1 (g � � ZZ 3 ❑Su 1 volt for mere that
CI Hazardous Ineati0sa. 600 vela nominal.
Suite/bldg. /apt no.: Project name: ( a4A. 2�
{„� ❑ savior or fade 600 ampu or morn
Cross Street/directions to job site:
I) u° Ir TVA -
New residential single - or multi - family dwelling un
Inch deo attached garage.
L Subdivision: + Lot no.: 1.000 xi, ft. or less I45.I5 4
Tax map /patcel no,: Ea add'1500 aq, ft. err po t an 33.40
-
Limited ene:g(, residential
DESCRIPTION OF'WO (With above sq,A.) 75.00 2
f Limited ;new. multifamily. 7500 2
CA ^� t -r Ot ,C. e-1 residential (with above sq. R) _ l
Services or feeders installation. alteration. and /er relocation
200 amps or leas 50.30 2 I
OBI ry- owicut - . • • .. • ❑ TENANT 201 amps to 400 amps 10615 2 •
Name: f p 1(3 t___ t___ T.o 401 amps to 600 amps t 60.60 2
Address' I Z .5 S 6O1 amp° to 1,000 amps 240.60 2
"t/ I Z. 5- fri -e,.. Over 1.000 amps or volts 454.65. 2
City/State/Dr: / r j� 4 q Z 3 Z -T Temporary sees or feeders Fnauparioa, alteration, and /or
Phone: ( ) J r relocation
` , '"l Fes: ( ) 203 amp s or leas 6615 1 1
Owner installation: This installation is being made on property that I own which i5 not 203 amps to 400 gulps 100.30 2
intended for safe, lease, rent. or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 033,75 2
Owner signature: Date: 1 Branch circuits - new, alteration, or extension, panel
APYLICAT IV A. Fee for branch circuits wail
1' ❑ CONTACT lrleRSON • ab,c service or feeder fee,
each branch circuit 6.65 2
Business name: r ." al :' %(Y2. (' , t L -
•
D Fee'Tor bra :ch c i rcu i ts
I
Contact name: { without service or feeder fee I
, �/
L N 4 r... first branch c2. curl 1 1 46-85 . 7 2
yG 0 o i Each add'i branch circuit 6.65 2
Address: 15 i
p Mlscellaacoue (service or feeder not Include
City/State/ZIP: Al vt i.ei , _ !� 1�' . g ) c `f - L - Each manufaeturx or [nodular
Phone: L') i - _ dwelling. service and/or feeder 90.90 2
(� ) �2." =J - ` � V r Fax:: (t:1'•+
,, .., 2- -t `) ) - 7 _ Reconnea 1
only _ 66.85
2
E-mail; � Purnp or irrigation circle 53.40 2
CON'CRAC1fDR Sign or outline hgteing 53,40 2
Business name: i r r El �f - n /.... Signal circuits) or limited- '
energy panel, alteration or
Address: i3 t "t i extension. Dcscrioe: L Page 2 2
city/suite/zip: I t_.t i i E ach additional inspection h �. c 1/4'.- 't " 'f it. � ,� spectloo over allowable is any of the above
Phone: (t I S) - '?.,_:,- - i ' _ F�c t Pet inspeaion 1
In 62.50
( ('� Z 4 T ?
Investigation per hour (1 1u min) 62.50
C C • Lie.:1 Electrical Lic,:3 --4C, '\C Suprv. Lic.l - : . tndumial plant per h
73.15 1
Suprv. Electrician signature, required: , ��- • n " ; GL 1?16 (f FEES
Subtotal: +I J e
Print name: Cca.' ��� p, , , Dat e. ` � li 7 1 GtIf1 �� rt+i�+(ZSy of pe rntit fee): ( , State surcharge (12 °/s of petfii t fcc ([–r-
Authorized signature: L� `
TO tAL PERMIT FEE:
Print attar: _ permit earns if • permit ��L.cr„1 This r •
R.,�.�,� _ 1 Date: tb rmitissotoba aedmit ?
leo
liars i i n steer it has been steeped as cnnaptree
S :lgufldlna'InrNU�ELGPamiblpp.da 01,0.3:05 ``— ° Number of impactions allowed ca permit
440.4at 67•(i I'OSICOWWEB