Permit Is
s CITY OF TIGARD ELECTRICAL PERMIT
':-- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00482
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/11/2009
Parcel: 2S114DB00100
Jurisdiction:
Site address: 17005 SW 92ND AVE
Subdivision: Lot:
Project: Cook Park Shelter & Bathroom
Project Description: (1) 200 amp service and (2) branch circuits for BBQ, shelter, plugs and lights.
Owner: FEES
TIGARD, CITY OF Quantity Description Date Amount
13125 SW HALL BLVD
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/11/2009 $80.30
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 09/11/2009 $13.30
Service or Feeder
1 ea 12% State Surcharge - 09/11/2009 $11.23
Contractor: Electrical
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503 - 252 -1609
FAX: 503 - 253 -5831
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.83
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 1.800.332.2344.
Issued By: o r�u -- Permittee Signature: e , V (/ ie /V---C
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.
h
,-I Electrical Permit Applicatid?ECEIVED FOR OFFICE USE :ONLY i
1
City of Tigard ' -0' // t .: �i -P °emit No.: 6'" 'fa, -- �� r
13125 SW hall Blvd Tigard, OR 972 P 1:1 2009
'I Phone: 503.639.4171 Fax: 503. 598.1960 Cr PCrmi �i. / , —di 014'
i T I GARD inspection Line: 503.639.4175 CITY OF TIGARD . Date Ready/ Dr IM 0 Sec Page 2 for !
Internet; www.tigard -or.gov BUILDING DIVISION Notified/Method: Supptementananfurmtstittn
e^ai;� k Rjv, v , Fix ,.,! ;ny �' ita�f, r 1tµ44 tp, aC n ro-�llK 91 rtr l�' ? � �' �, ".. N V 11 w�
o , ,' �'. r .c ai Y 6 �IyIyit , 3 . `' trt WD�r tl ,'�,p9pN 1, Y;Q r ��g 73 r p ,' .. ... i� ,
• u1r; �T r r�* �u �': �`Ilit�4,.. °lJ ���.. ^'71�.i SN,Ta�,,��- i�ihM14'1���' f ry 'k '� l', �� s � �'� ' ,. ±. „1e' :?� k�..'1F'� "'p,
►1 New construction ❑ Addition/alteration /replacement Please check all that appb' (submit? cote of plans whicros checked below):
❑ Servacc or feeder 400 amps or more ❑ l'uiiding over three stones
• ❑ Demolition ❑ Other: where the a,ailable fault current ❑ Marinas e nd bo'atyards.
' li'"`
"e ;; ,.k �..J'� s Part i W , d � " t "' i r: S ��w�7�0,�� � ty „ it • I! „.. exc.. � ? exc 10,000 47774 at 150 volts or ❑ Floating bmldln&s,
•
• 4 r
� + n ¢tr HJ4 1aS� p . "�` 1 1., uiv Cd eels ra ground, or excnecte 1x.000 ❑Commercial - are �ricnitursl
❑ I- and 2- family dwelling ❑ Commercial/industrial n Accessory building amps for all other installations. buildings.
0 Multi - family ❑ Master builder r Other: ❑ Ftrc pump. IZI installation of 75 KVAor
., a, p �.q ��., , tt. _ r: ❑ Emergency system. larger separately derived system.
• MI i ti Iro n+ i. "w�s a T 1 f14Q A_k ii' } I,A- t 1 ,' ,. P ; ` - ”
_ ❑ Addition of new motor load of ❑ A, F. ", " "
Job no.: Job sitc address; /1t, D_ y �� loo„rn (V 111610. occapt ncy.
Q e1 Six or mi, re3idential umtR. ❑ Recreat,oital Vehicle polk
City /State/ZII 1 lj (pia / C k 9 ❑ Hcatth -care facilities. ❑Supply voltage 6 r more t3ian
.._/ ❑ 1la.anious looat,ons 600 volts noel nal.
Suite/bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or more.
/// /(� / / /� / \lj // / � / /��s - vp. 4 w'tih 6it7 "k } i ° f 1>,a� " , iYi ry a ?t a* �; r� ;ate
Cross street/directions to job site:
Vr V/'' ` / " �( . «' p �,...i .'Itr IN
ue•FeeiQden l y. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1 ,000 sq. ft. or less 145.15 1 4
- Ea. adds 500 sq. fl. or portion 33.40 1
Tax map /parcel no -: 1,imited energy, residential 75.00 2
;. l, , i. 'q$ hy,,,M��. :,n :,: 'ii a �Iw4 o,,. ;, �Tilea��Js :p ;.:�'' .,'Ii!fSp (with above 5 . $.
• :`i '�.'^ ,'.I C ,5; ,ha' •,6i 0KW t i gr.i iif � ow'� .« . ��Irl -ih..;' : fll4!;.ftl ( q ) _
A �� -- . Limited ener multi-family 75.00 • ; 2
' T co 64, C� # .• 7 + 11 c d t residential (with above sq. ft.)
�� Services or feeders installation, alteration, and/or ;relocation
200 amps or less / 80.30 2
: ,• i ����13 ��1 ,,.. .a i • Y' '^nc a 'I r d ^a ra ,.
? "fir $ . ;� °p �,,1 r, l , : af' ; ; " > " tti' ? 11 Y 4 t'1 " 201 amps to 400 amps 106.g5 . 2
401 amps to 600 amps 160.60 ' 2
Name: -
_ - --- 601 amps to 1.000 amps . 240.60 2 •
Address: Over 1,000 amps or volts 454.65 . 2
•
•
City/State/ZIP: Temporary services (Sr feeders installation, alteration, and/or
relocation
•
Phone: ( ) Fax: ( ) 200 amps or less 66.85 : j l
Owner installation: This installation is being made on property that I own which is trot 201 amps to 400 amps 10030 2
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: _�_ _ _, Dale:
.. , a,:Ca.w a,,, eve,. �i Nir .. .a,.Z^_v ; hh
NW' .':, Ke e ,' � O tar l� :410#01#0.1 i0' w yx A. Fee for branch circuits with b. • ` p above service or feeder fee, c G.65 / 2
" - each branch circuit
' Business name: B. Pee for branch circuits
Contact name: without service or feeder fee,
aG.85 2
first branch circuit 71-- Address: Each add'l branch circuit 6.65 — i
Miscellaneous (service or feeder not included) :
• City /State/ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 , 2
• •'sa li a ;t aw 4 Ili crN a (j r f _ . , " r t f I t N I Sign or outline lighting 53.40 I 2
a WU P I, ......... ,u,
Business ram . �� Signal C1rCl11t(S) UI limited- .
�U (rq , / Y e. 1� r i[-�� energy panel alteration, or
. Address 1Z x //09,6 f extension. Describe: Page 2 2
• ' City /Statc/ZIP- I"[?4 1 b 9 � Each additional inspection over allowable p y of the above
_ Per inspection 62.50 :
. Phone: ) � ,2 - /ed9 Fax: ( i � J '', -/ .� Investigation per h our (I hr mi n) 62.50 ;
/VCCl3 1,1c.: A r Electrical Lic2 /Z / Suprv. Lie.: -2.-/.870::16 Industrial plant per hour 73.75 I
�`( tt�� m #`..l".k:C'l`R'ICAf P IF3' .Mktg. ors it;''
Suprv. Elcctrid ars ure, reclui , Subtotal: 1 . ', /
Print name it " re _.4 Date: 9 // Plan review (25% of permit fee):
State surcharge (12% ofpermit fee): , i o
Authorized signature: TOTAL PERMIT FEE: /6 �, Q
Print name: - Dale: This permit application expires if a permit is not obtained withinjlSO
days after it has been accepted as compleee.
'"' ' Number of inspections allowed per permit. •
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