Permit q CITY OF TIGARD ELECTRICAL PERMIT
, COMMUNITY DEVELOPMENT Permit #: ELC2011 -00246
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/11/2011
Parcel: 2S102BB00501
Jurisdiction: Tigard
Site address: 10240 SW KATHERINE ST
Project: Gander Subdivision: GREENBURG HEIGHTS ADDITION Lot: PTS 14-
Project Description: Replace overhead wires to detached garage.
Contractor: CONDUIT ELECTRIC Owner: GANDER, DAVID R & SHANNON R
19461 SW 89TH AVE 22932 SW WASHINGTON ST
TUALATIN, OR 97062 SHERWOOD, OR 97140
PHONE: 503 - 692 -1428
PHONE: 503 - 781 -2957
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 05/11/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 05/11/2011 $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 160 days of issuance, or if work is suspended for more the 180
days. ATTE • 0: • -gon 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 OA' •5 %• 00• •. You may obtain a copy of the rules or direct questions to OUNC by callin• • .. _ 2.1987 or 1.800.332.2 44.
Issued By: __� r !: iLL — d_ Permittee Signatur ', : 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 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.
From:CONDUIT ELECTRIC 5036923652 05/11/2011 11:23 #755 P.002/002
Electrical Permit Application roil orr•lc E USE ONLY
Received � - i
Date
City of Tigard B : 5 / Perm No.: CL �ll� /
IN , r 13125 SW Hall Blvd., Tigard, OR 97223 N DateB Plan Review
Phone: 503.639.4171 Fax: 503.598. �1 Other Permit:
T lei A . R.0 Inspection Line: 503.639.4175 • r ; " Date Ready/By: lulls, B7 See Page 2 for
Internet: www.tigard or.gov r Notified/Method: Supplemental Information
:TYPE' iF,W eV� ', ._ ;: � `,. °-, • : `
....: ., PLA;REVIE
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❑ New construction lddition /alteral7re lS \ O Please check all that apply (submit 2 sets of plans w /items checked below):
v ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition (I] Other: where the available fault current
0 Marinas and boatyards.
exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- less to ground, or exceeds 14,000 0 Commercial -use agricultural
3 and 2- family dwelling ❑ Commercial /in.is rial ❑ Accessory building amps for all other installations. buildings.
El Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
' .. 'JOB SITE :INFORMATION .AND,;LOCATI,ON , .. ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ", •
Job no.: 1I S � 1 Job site address: / 43 Z 4t.. 5, Ai; A 5170 I in or ore res occupancy
Six or more residential units. ❑ Recreational vehicle parks.
r
City /State /ZIP: '"DLO `u` . r 7 2 Z. 3 ❑ Health -care facilities. ❑ Supply voltage for more than
(J ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt.no.: Project name: 0511- 0/7>e/L-, 0 Service or feeder 600 amps Or more.
' " 'FEE_ SCIiEDULE','' • "
Cross street/directions to job site: Description I Qty. I per. I Total J
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
• Ea. add'1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.:
Limited energy, residential 67.84 2
DESCRIPTION : OF'WORK•` :. '' .. (with above sq. ft.)
imited energy, multi- family
C -c e7 L of } � Q e J l ! r ' ✓ L 2
� �i L Y �' �.'j � lit z residential 67.84
(with a hove sq. ft.)
amps or less rsmstaltatto 1 / � ,
G 200 Services is s ore s 100,70 feeders ton
X01 amps to 400 amps 1 33.56 r
installation, a ergt re oc • (� ROPERTY'OwNER . :>:' ' : 0 TENANT: :: ", - p P 2 Name: DA :; -e G ra-1�i i -�� 401 amps to 600 amps 200.34 2
WA-50 601 amps to 1,000 amps 301.04 2
Address: 72. 9 3 'Z 5 IAJ W , A-S0 e (\rT•po(\/ 57: Over 1,000 amps or volts 552.26 2
City/State/ZIP: 5' (. 0 Ca ? :7 /4/L Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( 503 7-- b' r • 2 % • . Fax: ( ) 200 amps or less 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 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. —
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.., :.., feeder fee,
r ; . :.:. . ..... ... . . ..... service r el oe �
CI'APPLICANT;;. ' . .
[]`.CONTACT %PERSON.. ':.;.:.: above se 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56. 2
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
' ` . CONTRACTOR '.'. . ... Signal circuit(s) or limited- energy -
Business name: v b U t r E Z C 'T _panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: /?y6 ( S, t S f f` A V - Additional inspection (1 hr min) 66.25/ hr
E c 7� ( Investigation (1 hr min) 6625/ hr
City /State /ZIP: 71 eft 1-T t IV re.... •7-v q ( � ? Industrial plant (] In ruin) — 78.18/ hr
L
Phone: (S5 ‘F 2 "- (ye. € Fax: (�=> C r z -- 3 Z Inspections for which no fee is 90 - 00/ hr
specifically listed (h hr min)
CCB Lie,: /C f (v 6 c� Electrical Lie.: a? ` f - t1,5 - , u prv. Lic.: Z/ ' . ELECTRICAL `PERMIT FEES - >;,;`-
Suprv. Electrician signature, required: - Subtotal: / k� .
Plan review (25% of permit fee): • --�'�'
Print name: 0/.{ - -�-� ?(�-&.'C'f,. --_ Date: , `' ( ( /6 , State surcharge (12% of permit fee): / 2 , 0
/) TOTAL PERMIT FEE: ir
Authorized signature: /y. y This permit application expires if a permit is not obtained within 180
//_ // / ( ( days after it has been accepted as complete.
Print name: Ott J I Date: S�� f ' Number of inspections allowed per permit.
rltruilding \Permits \ELC- PermnApp doe 10/01/09 440.461 ST( I I /05 /COM/WEB