Permit plp CITY OF TIGARD ELECTRICAL PERMIT
.! COMMUNITY DEVELOPMENT Permit #: ELC2011 -00271
Date Issued: 05/24/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S102BD02201
Jurisdiction: Tigard
Site address: 9988 SW WALNUT ST 2
Project: Chalet Village Subdivision: NORTH TIGARDVILLE ADDITION Lot: 39
Project Description: Unit 2: (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 OA' . 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
411!
Issued By: " / Permittee Signature: , /5P/ 9 6/( 7 ,9 - 7"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.
Electrical Permit ApPlicatiall P/ r r r) FUR tii•I Ill
of Tigard I I, L, V 4 r..7.1 V Ls `11.7,-) Received .,.. ^
b steA3 ; .„( r (/ 4 1 1 PermL- — i p i
- _
. .• 13125 Citit SW Hall Blvd.. Tigard, OR 9722a -
A 2 3 2011
' Phone: 503.639.4171 Pas; 503.598.1960\ y Eggi11111111111.1 4 1.11 it No.:t Other Permit;
Inspection Line; 503.639.4175 Doto Ready/By; la See Pap I for
Tniximet: www.tigurd-Of.griv ' CITY OF TIGARD Notified/Method: Supplemental Information
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Twit oCiVitaiiiNU thyisioN . . .
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0 N e w constuctiotimilMteration/lac .. rep ement Flom cheek all that apply (submit a sets of plans wiltems checked below): •
.7 , 0 Smvice Or feeder 400 amp or more 0 Building over dim stories.
0 Demolition 1.,1 Other: where the available Omit current 0 Marinas and boatyarde.
. : • :: ' ; -- ; ..:' • . • cavrtabox 0 •ColistlitretiON • . exceeds 10,000 unps at 150 yobs or C1Floating buildinp.
' • -.-- km to ground. or exceeds 14,000 CI Commercial-use agricultural .
0 1- and 2-family dwelling 0 CommerciaVindustrial 0 A.cecssory building amps for all other installations. Inrildinp.
>151ri Multi-family 0 Master builder 0 Other: 1:IPiro pump. 0 Installation of 75 KVA or
r. • . ';`-'..''.• • : . • ...RIB: arra oiroagatalk A1 L . . OCATION .
.. 1:1En:rite:Icy symant. larger separately derived system.
0 Addition anew motor loud of 0"A", "E.", "I-2", " I-3".
Job no.: ,,,e,?> 5 Job site address: co 93 sto l , 1631•41 Tn°T°' occupancy.
LI Six or mom residential units. 0 Recreational vehicle parks.
City/State/ZIP: 1 1 c .... - 9 • 2 0 Heelth-care Facilities. 0 Supply voltage ihr more than
..
- --..... 0 Hazardous locations MO volts nominal.
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Suite/bldg./apt no.: - 4fia, Project name: ( to\ ,kt,„5 u I - 4, 13 service erkeder 600 !mpg or mere.
...-,-
...--)
e n „ , • • • •
Cross street/directions to job si , te: 1-'4 ? i-9 7 I Duman 1 he. I Total
New reeddential single- or multi-family dwelling unit.
i includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 _ 4
Em add'l 500 sq. ft. or portinn 33.92 1
Tax map/parccl no.: _..
Limited energy, residential
2
" . - DESCRIPELON'OP 1 „, • • wit bow R. . 67.14
. • .. . . •
.• : i ,,,,•- , AA M aim, multi-family 87.84 • 2
1 p ACC a tAi C.'e-A IA) i ‘-•"%,..,• t I-- ,.,,1_, residential (with above eq. n.)
...'".• . it' Service' or feeders installation and/or reloatdon
C,
, 01 -,e 4- -.6.767)44,:S. 200 anips or less. 100.70 2
. trisaoyeirrveiman • " * ..... - 0 TENANT • • 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 20034 2
601 amp to 1,000 amps 301.04 2
Address:
Over 1,000 amps or volts 55226 2
City/StateRIP: Temporary aervices or feeders Installation, alteration, and/or .
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 l
Owner installations This installation Is being made on property that I own which is not 201 amps to 4 00 amps 125.08 2
intended for sale, lease. rent, or exchange, according to ORS 447. 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch cimnits- new alteration, or extension, per panel
Owner signature: Date: A. Pee foriranch circuits with
.•
• ' . : • Cl I APPLItAlfi ' .• a .CONTAO PERSON above service or feeder fins
' I • .
... . 7.42 2
each branch circuit
Business name
%Fee for branch circuits
Con tact name: - ft branch ci C7 1
without service or feeder fee. I 56,1g ,.jo, 2
rst rcuit
Address: Each addl branch circuit 7.42 2
Mistellanctme (service pr feeder not included)
City/Statc/ZIP: Each manufacemid or modular
.
, dwelling, service and/or feeder 67.84 2
Phone: ( , ) 1 Fax: : ( )
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2 -
•
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• • • COITIltACTOR . • • Sign or outline lighting 67.84 2
. Business name: .." E.I.X.C.T41 & I N(!-. Signal aim* or limited-
mar/ pimel, alteration. or
---1
Address: 61 ac u,) LIV" 2ki ODD extension. Describe: Page 2 2
/ ..-- •
Citt/State/ZIP: t Ottri.A 140 0 12 94pa 1 Each *daffiest inspection over allowable hi any of the above
Par Inspection 1 66.25 I
rono:603) 94167 • 53SI I Fa 603 ) P.itili Investigation pa hour (i hr min) 66.25 I.—
CCB Lie.: • Electrical tic.: . . ' S ) . Lic.:40446 !aunt inliant our 78.1$
.wmawaireswwur * ' . .
• : ..., .. ELECIPICAL 11.11147r Fat.
Suprv. Electrician signature, required: ....,...,....- io.....----, - Subtotal; -5 1 $
Print name: .r.v Nei s 'Nal 12_ • 7 I Date: op) / if Plan review 9.5% of permit fee):
Stein surcharge (12% of peanut fee): b -7 L i I /
Authorized signature:
TOTAL PERMIT FEE: 3 Z,.
Print name: ---- TD - ai c : Thin Permit aPPliontion expires Ito permit is net obtained within 180
days after it hue been accepted as complete.
' Number of inspections allowed per permit.
10aultincalPernetthELc•PerwItAppecc wow 440.451 ST(11 /115/COMN/En