Permit •
CITY OF TIGARD ELECTRICAL PERMIT
:111 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00521
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1S133DD16500
Jurisdiction: Tigard
Site address: 11994 SW 129TH PL
Subdivision: VILLAGE AT SUMMER LAKE PARK 5 Lot: 201
Project: Chin
Project Description: Covered patio, outside electrical outlet - move existing
Owner: FEES
LARRY CHIN Quantity Description Date Amount
11994 SW 129TH PL 1 CH Branch Circuits 10/07/2009 $56.18
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/07/2009 $6.74
Electrical
Contractor:
DEXHEIMER ELECTRIC INC
9844 SE EMPIRE CT
CLACKAMAS, OR 97015
PHONE: 503 - 786 -0886
FAX: 503 - 786 -2040
Type of Use: SF
Class of Work: DMB Type of Const:
Occupancy Grp:
Total $62.92
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. 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 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332..23444..
Issued By: V 'lr L (cr) A,
Permittee Signature: 0 �� l
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.
r ._
R_0I'06/2009 11:31 5037600387 HOFFARD PAGE 02
Electrical Permit Application 1.012 ,.on OFFICl_ l.'si'.ONUS
City of Tigard 0 C T 0 5 2009 Uaeel)3 Petnrik No. :�(� Uq ooS l
74 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
l . Phone; 503,639.4171 Fax: 503.59 Date/13 : Other Permit:
' 1'1' OF TIGARD
I I t � A 1Z. n Inspection Line: 503.639.4 L75 Date Ready/B Yuri.: y, ®See Page 2 for
Internet: www.tigard or.gov BUILDING DIVISION Notified/Method: Supplemental Information
TYPE OF WORK • ' PLAN R ;
❑ New construction Addition / alteration /replacement Please check all that apply (submit 3 sets of plans writems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Demolition ❑ Other: where the available fault current El Marinas and boatyards.
CATEGORY: OF CONiSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
4V1 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. building..
❑ Multi- family ❑ Master builder ❑ Other: ❑ Ere pump. ❑ installation of 75 KVA or
300 SITE INFORMATION AND LOCATION new m ❑ Emergency . larger separately derives system.
❑ addition of new motor load Of ❑ "A" "E ". "1 -2 ", « 1 - ",
Job no.: Job site address: WI C r ! f �� f �1 D/ 100KP Or more. occupancy. p
/ ❑ Six or more residential unite. Recreational vehicle arks.
Ci /State /ZIP: �p {n� �y �7 LI Health -care facilities. 0 Supply voltage for more than
tY tcd r f (�dJ 1 l! /� F* ❑ Hazardous locations. 600 volts nominal,
Suite/bldg./apt. no. Project name: 1-/ C3 Service or feeder 600 amps or more.
i •FEE SCHEDULE
Cross street/directions to job site: nescrlpilon I Qtr. I Yea I Tow I °
New residential single- or multi - family dwelling unit.
Includes attached gara: e.
Subdivision: [Lot no.: 1,000 aq. ft or less �M 4
.. Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential ■
DESCRIPTION OF WORK • with above s•.ft. 75.00 2
7 � ' Limited energy,, multi- family II
75 2
C O et4 PLZE i) tJs /C.A . residential with above s,. ft.
�^ Services or feeders installation, alteration, and/or relocation
6 4/4 D Lit X / ST //L) Lt6' _ 200 amps or less 80,30 2
'Cif-PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
Name: i„,..-Ag_,rz l C /d ilL! 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: i t 0 111 S L /2_111-1 PC Over 1,000 amps or volts 454.65 2
City/State/ZIP: / . • * d -..- Temporary services or feeders installation, alteration, and /or
w . _ relocation
Phone: (S S 7 i - i ` crl Fax; ( ) 200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that 1 own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits — new, alteration, or extension. per panel
Owner signature: pate. — A, Fee for branch circuits with
ki- APPLICANT I Li CONTACT PERSON above service or feeder fee, 6.65 2
fie, each branch circuit
Business name: Fr /tab pleiM6 - W 0t )r B. Fee for branch circuits r
Wattle: without service or feeder fee, 46 / J ra 2
Contact
� L_ m D , ,x ' � I / / i first branch circuit 7 -u .
Add ress :�'7 g /3 Each add'l branch circuit 6.65 2
_ Miscellaneous (service or feeder not Included)
City /State /ZIP: PO� y Q '.7 3 4 Each manufactured or modular 90.90 2
1°' dwelling, service and /or feeder
Phone: (jO)) /4 /_ 01 77 Fax: : ( gl.5) - 2 b l) --- 0,343, Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Signor outline lighting 53.40 2
Signal circuit(s) or limited -
Business name:
axi- /Iv 7-2 ELEicretc energy panel, alteration, or
Address; /Q ,3c3 56 put,t Z D , extension, Describe: Paget 2
City/State/ZIP: ?d 2j -,' W), 0 Q q 7 . j - Each additional ins , action over allowable in an of the above
Per inspection 62,50
Phone: (0037,) 76 0 — ® 4 g W Fax: ( ) investigation per hour (1 hr min) - 62.50
CCB Lie.: /,./35 35 d Electrical Lic.: Z V ? 1 C Suprv. ELECTRICAL PERMIT TES Lic.: 25 )L1 3 $7, industrial plant .er hour 73.75
Suprv. Electrician signature, required; ,, �� Subtotal; . i
Print name: . r Da : _ P review (25% of permit fee): �, (p , 1 X
I,' State surcharge (12% of permit fee): (e t 1
Authorized signature: TOTAL PERMIT FEE: (p,?-._44. St
'
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as coupler.
Number of inspections allowed per permit.
118uildiag ',Permits \ELC PennitApp. 05/23/06 440- 4615T(l1 /05/CCM/WEB