Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00237
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/06/2011
Parcel: 25111 CC04300
Jurisdiction: Tigard
Site address: 15925 SW CENTURY OAK CIR
Project: HANSON Subdivision: SUMMERFIELD NO. 1 Lot: 66
Project Description: Panel replacement.
Contractor: URBAN ELECTRIC LLC Owner: HANSON, JEANNE M
4741 SE 36TH PL 15925 SW CENTURY OAK CIR
PORTLAND, OR 97202 TIGARD, OR 97224
PHONE: 503 -295 -4191 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/06/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/06/2011 $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 952-501-0090. You may ob • - - , y; questions to OUNC by calling 503.232.1987 or 1,800.332.2344.
/
Issued By: _ � 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.
May 05 11 05:50p John Schantz 503- 295 -4191 p.1
Electrical Permit Application V FOR OFFICE USE ONLY
City of Tigard ` � ter. J ?." // 677 r« No.: atc9.0I(�(7p3 `-)
III
' 13125 SW Hall Blvd., Tigard, OR 97223' � Plan Review
' Phone: 503.718.2439 Pax: 503.598.1960 \\ Other Permit
T 1(i A R D Imp�on Line: 503.639.4175 -1 Dat Q »may e Reedy/By. lain. la Sun Pupa 2 for
Internet www.tigsrd -argpv w * ray �� c . NotiScd/Mc'thod: ` '4' - sal hdermatloa
TYPE OF WORK fi j ` Print name: r ■
❑ New construction r N Additionlalietation/ � i
\ `
PLAN REVIEW
Demolition ❑ Other: 3�\` Pl ease cheek an Ua appl tmbmit 2 seta of plans swift= checked below):
CATEGORY OF CONSTRUCTION ❑ St:nice or feeder 400 amps or more ❑ Building over three stories.
X 1- and 2- family dwelling ❑ Commezciautndustrial ❑ Accessory building when the available fault arum} ❑ Manua and boatyards.
exceeds 10,000 amps at 150 volts or OF buildings.
❑ Multi family t- n _I Master builder ❑ Other. leas to ground. or exceeds 14,000 ❑Ceemercial -use agricultural
JOB SITE INFORMATION AND LOCATION amps tat all other iestall thus. buildings.
9 � / J ❑ Fire pump. ❑Tnstallatim of 75 KVA or
Job no.: Job site address:
/.S / ); 5-6• „' 4N /r�l adeei;4 C]EructlicncY ate' larga separately derived system.
/State/LIP: ❑Advrtditiion of new moon loud of ❑ "A`, "E", "1 -2”, "1 -3 ",
'7, 9 _,,- , -.4 , C S !� [ 100 or more. o rcy.
no.: I Project name: / N / i Oft or more residential units. E R rraiianal vehicle parks.
Suite/bldg. /apt
1064 6c t✓ / ( . il ti , . ❑ Health -care Tsa re than
lities. ❑ supply oolrage for moan
Cross stttiretldirections to job site: ! ❑ Hazardous locations. 600 volts =our' ad.
❑ Service or feeder 600
amps a more.
FEE SCHEDULE
Subdivision: Lot no.: neoyetem. I Qty. I Fee. I Teed I.
New residential tingle or mall4famity dweling unit.
Tax map/parcel no.: Includes attached garage.
DESCRIPTION OF WORK 1,000 'grit or less 168.54 4
n / Ea. edd'1500sq. S or portion 33.92 1
P / Trice' _ ` " Gl S 14 ry to ti( Pao.e t II' Limited energy. residential 75.00 2
/1/Cel/ /5o ....ii , l
(with above m ld
Limited energy, multi-family
❑ raom TY owNza I E TENANT residential (with above sq. ft.) 75.00 2
Services or feeders loataIatloo alteration, and/or relocation
Name: CC e- , 4 q ii UDq/ 200 amps or less / 100.70 ] ()) . XI
Address: / 201 f� _ 6 ✓ / np 2 f c . f 401 amps to 400 amps 133.56 2
( t ('/ / 401 amps to 600 amps 200.34 2
City/State/ZIP: T ` a rt * 1 4 9 601 amps to 1,000 amps 301.04 2
Phone: (5C3 )3)0.- 8 fro [Fur: ( )
Over 1,000 snips or volts 552 26 . 2
Owner inatallxtiou: This installation is being made on property that I own which is not E services or feeders installation, aNedrrtioq aad/ar
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 200 amps or less 59.36 1
Owner signature: Date: 201 amps to 400 amps 125.08 2
❑ APPLICANT I. ❑ CONTACT PERSON 401 amps to 599 amps 168.54
Branch circuits new, alteration, or extension, per panel
Business name: A. Fee for branch circuits with
above service or feeder fee,
Contact name: each brand[ circuit 7.42 2
B. Pee for trench circuits wis/snstt I
Address: service or feeder fee, first 56.18
branch circuit I
City/StaterEfP: Each add'lbreach circuit 7.42 _ 2
Phone: ( ) I Fax: : ( ) Mss (service or feeder lot included)
Each manufactured or modular 67.84 2
E duelling, service and/or feeder
1
CONTRACTOR Rxmmect only 67.84 2
Pump or irrigation circle 67.84 2
�� Business name: /if/A, - •fi G Sign or outline lighting 67.84 2
Address: y 74'r r� 36- -A. A/ Signal circu it(s) or limier
/ panel, alteration, oreztmsioa. Page 2 2
City /State/ZSP: /C` - Oki 9 ' o .:,>--- Each additional imttection over allowable in arty of the above
Additional ioapection (1 hr grin) 66.25/ hr
Phone: (s )) S / f'- y Q Fluc ( ) Investigation (1 hr min) 66.25/ hr
CCB Lic.: / 7/ .67g 7 Electrical Lie.: C2 / i Snprv. Lie.: j 2 / 4 ( � Indust ial plant p tar mitt) 78.18/ hr pi., //�� / r Inspections for which no fee is 90.00/ signature, Suprv. Electrician signatu, required: ( ` ,�^, -C� apecifu;aup listed (54 1[ min) hr
,c4 43 , -
( ELECTRICAL PERMIT FEES
Print name: ..-7.-- /
s) QA,,^ Jc,Aivi,-,/,_ Date :s S /// Subtotal: ,CO '70
Plan review (25% of permit fee):
Authorized signature: // J 1 / surcharge State schtage (12% of permit foe):
r: tsa0dintlPm�mbtxr .C- p°,mttAyp.dee 07/01/10 a /f S � '- � 440- 4sl57r1 6JRna 10 -, --? D