Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00268
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/24/2011
Parcel: 2S 102 B D02201
Jurisdiction: Tigard
Site address: 9982 SW WALNUT ST 19
Project: Chalet Village Subdivision: NORTH TIGARDVILLE ADDITION Lot: 39
Project Description: Units 19 -26: (1) branch circuit per building for GFCI
Contractor: JARMER ELECTRIC INC Owner: CHALET VILLAGE LLC
5105 SW 45TH AVE #200 BY RANDALL REALTY CORP
PORTLAND, OR 97221 9500 SW BARBUR BLVD, STE 300
PORTLAND, OR 97219
PHONE: 503 - 246 -5381 PHONE:
FAX: 503 - 244 -8037
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/24/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/24/2011 $6.74
Type of Use: MF Electrical
Class of Work: ALT
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 9 - -'' 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _ /
Issued By: Permittee Signature: U/✓ 6 L /CeT'/7C7/V
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 503.639.4176 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.
Electrical Permit Applicatioil>1 c J VE , l'O l: x i l t (� i : (, V l .,
City of
Hall Tigacd, OR 97 MAY 2 3 2 011 a°'1e1e .7 y fr /i PC^nit No : Ec C _ o — i 6 ,'
• Phone: 503.639.4171 Free: 503.598.1960 _•„ OtberPermti: •
Inspection Line 503.639.4175 CITY OF TIC'. ) DntoRmdy/3y; SI See Page 2 for ,
Tnternct: wwW.tigntd- ot.gov • 1 ��+ Noti fied/Method; Supplementallnformadon
r } � y �r - Dt�ln rotuttnieNat
rot '. . , - • .. co _ 1P .
❑ New construction 1 - Addition /alteration/replacement Please cheek nil hat apply (submit 3 acts of plane w/ltettls checked below);
❑ Demolition . ❑ Other. 0 Service or feeder 400 amps or more El Building aver three stories,
w)rcrc t h e available thult current 0 Marinas and boatyards.
. • t v A T E d O R ' 1 l OP 1 E 1 t L � ` ! T O N • ' • exceeds 10,000 amps a t 1 S0 volts or 0 Floating buildings.
El 1 - and 2•family dwelling ❑ CommcrciaVindu.4triai lass to ground. or exceeds 14,000 Q Commercial -use agricultural
❑ Accessory building nice for all other installations. buildings.
I'MMuiti- family • ❑ Master builder ❑ Other: Ol'iro pump. 0 Installation of 75 1fvA or
❑ Er P system, larger separately derived system.
Jbl# SITE pikeltIkbtflOW A14} 1sE)CAtT10N O Addition eke* meter load of 0 "A" "E* "1- a,"1 -3",
Job no.: )? I Job site address Ii or more, occupancy.
}` "' e � 8 0 Six or mom residential units. 0 Recreational vehicle parks,
City/Statc/ZiP: ` 1 2 t' ` O Health care thcilfties. ❑Supply voltage Sir more than
/ (C / 9 th t7 `' °t > Q Hemtdaus locations ID wtts nominai,
Suite/bldg. /apt no.: 1414,10 Project name: -$^ H g g (" C] Service or feeder 600 em
3 ., 6 i f g i s r � f Vr or more,
Cross street/directions E , .. t
tionsro jets site: b
r 9 x e naetaieon (?l f Pm I Total 1"
if New raddential single- or meiti- itimily dwelling unlit.
includes attached garage.
Subdivision: Lot no.: 1, 000 a6. IL or loss 168.54 4
Tax map/parcel no.: Ea. add'l 500 S .1t. or particle 33,92 1
Limited energy, residentla� V
" DESCRIPTIO'Nf'47F' WORK (with above eq. ft.) 67.84 2
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t Limited energy, multi - family
- - t'?1tl . i ,, P "C r.• RS[dcnHal(with abovo sq. a.) 67, 2
• CL.' Services or feeders instillation elteratton, and/or rclocatio
t i )C, t ' • -c t e s4 � F .3..' 15 " J''/ -
71)1 200 amps or less t 100.70 2
' ❑'PRO> t'Y:0WIVER • f' • ❑ TENANT. 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
Address:
601 amps x41,000 amps 301.04 2
Over 1,000 amps or vette 55236 2 •
City/State/ZIP: Temporary nerries% or feeders inshtlladon, alteration, and/o
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I l
Owner installations This installation is being made on property that I own which is not 20t amps to 400 amps 125.08 2
intended for sale, lease. tent, or exchange, according to ORS 447.449.670, and 701. 401 amps to 599 amps 168,54 2
Owner signature: Date: Branch circuits, ne2r, alteration, or extension, der panel
A. Fcc tbrbranch circuits with
❑ APPLICANT•' CI CONTACT PIII SON above service or fe eder fee.
cacti branch circuit 9.42 2
Businegg name 9. For for branch circuits _
Contact tame: • without service or ircdor &c. i 56.18 36 92 2
first branch circuit
Address: Each add9'branch circuit 7.42 2
Miscdlanen aerie pr feeder not included)
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City/State/ZIP: Each manufacture _ or modular 67.84 2
Phone: ( - Fax:: ( ) dwelling, service and/or feeder
Reconnect ant_ 67.84 2
E-mail: Pump or irrigation oirele 67.84 2
COlit? #1 7t OR Sign or outline lighting 67.84 2
Business name: SA(Z,avy a E.L.E.CTEI C I No_ o pri circuit(s) ar limit
for or
Adder 5E O S i) ( h t 21-1 ape ' extension. Describe: Page 2 2
City/State/ZIP: ode L44 NS41 0 c4 _ Each additional inspection over allowable in any of the above .
- & - 53�sl (5 : d P vesti g a lo on 66
,Phane:.��1 Fa g: �"� � Investigation per hoarp hr min) 66.25
CCB Lie.: 5aLf J Electrical Lie.: • TS
S , Lie.:1.40LNG Industrial plant air hour 78,18 -
•
•.1 C licAL '1'>ER142I7' R I.
Suprv. Electrician signature, require �„r,....— ( Subtotal; ' ,L. i X
Print name: ') f ' A( i&)', , 1 Date s / / iit Plan review (25% of permit Be):
Authorized signature: / State surcharge (1296 ofpctmit fee)_ 6) ' i(
TOTAL PERMIT FEE: ( Z- e Cf Z .
Print frame: I 'Date: Tbls permit application expires Ito permit b not obtained within ISO
days after it has been accepted as complete.
t�srs ' Number of inspections allowed per permit.
ftWatmitaiELC•PermitApp.doc 10/01/x9 140 .4015T( 1 1 /ns/(OMW 1!B
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