Permit I CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00274
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/25/2011
Parcel: 2S 111 CA00103
Jurisdiction: Tigard
Site address: 9449 SW LAKESIDE DR
Project: Jackson Subdivision: ALDERBROOK FARM Lot: 13
Project Description: (2) branch circuits for A/C and exterior outlet.
Contractor: WEST SIDE ELECTRIC CO INC Owner: JACKSON, DAN & MARLA
1834 SE 8TH AVE 9499 SW LAKESIDE DR
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 -231 -1548 PHONE: 503 - 684 -8901
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo(Purchase 05/25/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/25/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 '01 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
E ~
Issued By: ��..�- _ ' . 'ermittee Signature: �� n
��� 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.
May 23 2011 4:34PM West SiddeElectric 503- 736 -0656 p.2
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Electrical Permit Application
MAY 2 3 2011 Received
City of Tigard Date/B : ./ / a '��, r
13125 SW hall Blvd., Tigard, OR 97 3 'j � ( /�c p,
Plan Review
Phone: 503.639.4171 Fax: 503.598 .19 D l OF t i i t D Date/8 : other Permit: AA' . f'
Inspection Line: 503,639.4175 BUILDING DIVISION Date
Internet: vvww.tigard- or.gov. Notified/ Method: i
1:414 : leg a l'� er a YI s i :=:: .. i, :s,' b J' ^rr k'.RI': f :'i i , � a' ' ' _
r,+?Ut.: h� >- n...�r r Y { ,.. i.. t l^. r � ' .. , �.>. >._.,,._ .•.,.. ,�f, #1 '`# ., +; a;Yl;� Fi;� xy�V ce _it, 1P,�1.w A Y T . ...�� � �, 6' r Ot r yt f itigirVIZ::;x `it r1
❑ New construction 'Addition/alteration/replacement Please cheek all that apply (submit a sets of plans w /items checked below):
❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more In Building over three stories.
, d =i ; ` i €w . ' Nn y ;- N:'Yl s ti?u{^ where the available fault current ❑ Marinas and boatyards.
rMA't ,AIS .•r ":`z _a.• LLW,I. �'• �••'S:;-s,:;:iiifid':.:.:: ! exceeds l0,000 amps at150 volts or ❑ Floating buildings.
f;. ._ ..._:,..;x;,. .. 1=^ ir• r: �...'.,. a"—, I. �?�Y r' Y!,'14R�!!�.x�'(�`.'a`..,. .:..,:,� F.. .... ..
'� � '� less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building > amps for all other installations. buildings
g Multi family ❑ Masher builder 0 Other ❑ F1Te pump. ❑ Installation of 75 KVA or
� '4' \ 1 a � . iIlc n (t'7 - i^ r . ;� - , :�„ ❑ Addition ofne em. larger separately derived stem
4 a i ,a3 ; i . y* i w •: • ; `' , ear system_
, .,t. � .. - r �.' to 3 r.a •'- ;�Si (]i„ v. . . _i�aj. : r
t1 ' "+ - . � • /e 4- -• Add1 tion of new motor load of
Job no.: „7 I Job site address: 9y 9 s•Gt) 4 44e.;ci t00HP or morn occupancy.
/ j� ❑ Six o/• more residential units. ❑ Recreational vehicle parks,
City /State/ZIP: 4 � / /a 722
l ❑ Healthcare facilities. ❑Supply voltage for more than
f c3 Hazardous locations 600 volts nominal.
Suite/bldg./apt...no.: I Project name: ,.7
s C/E J y /(/ yyl4 R ❑ Service or feeder 600 amps r
o more.
9 f
Cross streeddirections to job site: ,' �eeri ...,. , 'i ° I i Q n, s� V !? ");:,•; - ��e�
3<r.,..; iy lb4 i'.ltr „, '.'e�i . 3`F38trl: - -
_ Aacriatien I 116'. I Fee. I row 1 : •
New residential single- or multi - family dwelling unit,
includes attached garage.
Subdivision: 1 Lot no.: 1.000 sq. ft. or less 168.54 4
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Tax map/parcel no. Ea. add'l 500 sq. ft. or portion 33.92 1
;"•fi s'ivt' ..;tk.. 4 4 F �� ii b OE:• 1 H {l ,A c Ed :i. t ry `.f�,`. =, ..` ^:`' •,f ;f;�y' = Limited above 11 75.00 2
• r:< residential
li C exkr/o 6/ `-�- (Uf* f Limited energy, multi-family
above sy
/� �° residential (with shove sq. ft.) 75.00 2
Services or feeders installation alteration, and/or relocation
200 amps or less 100.70 2
'( 'ffliM::1 u;i;t "=IY tg f,,lit 201 amps so 400 amps _ 133.56 2 •
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552. 2
City /State /ZIP:
Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.3 6 1 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.64 f l 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
=x n
, , r . ' ^ ,.. � above service or feeder fee •
x lrr u PE I : t r h,t,t1,?r iittv�_ r, a: a ca • L.. z r , . s
- n _.� .� ,....^ n each branch circuit 7.42 2
Business Warne: B. Fee for branch circuits withal /
service or feeder fee, first
Contact name: branch circuit / 56.18 �` 2
Each add'/ branch circuit / 7.42 7 yam- 2
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Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E-mail:
rn , !,, e z p-C"" 4 ^ t': }.rx _
•. t : Signor outline lighting 67.84 2
; 11`4ai r 4u,r w r:L .z 'E rt,i 4 G N'17 &. 7"4“ 'iC::.S . -µA:<... , .R�J,�t, ...._...i i`e44
Si eire uit(s) or limitedtner
Business name: West Side Electric Co., Inc . panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (Ihrmin) J 66.25/hr
City /State/ZIP: Portland /OR/97214 investigation (1hrmin) 66.25t hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 231 Fax' (5 0 3) 736 inspections for which rto fee is
• ificall hated I/, hr min) 90.00! hr
CCB Lic.: 13306 Electrical Lic.. 26 I Suprv. Lic.. 465 4 - S ” a'.1IIG#L t , - ,r °
/ e �, Subtotal: �b
Suprv. Electrician signature, required: iKG i , ,
!7 — �J Plan review (25%ofpermit fee):
Print name: Randall F Roberts I Date: State surcharge (12% of permit fee): 7 45
TOTAL PERMIT FEE: 7 J e3
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has beau accepted as complete.
Print name: I Date: ,
Number of inspections allowed per permit.
1: 1Building \Pnrnits\ELC- PaxmlApp.doc 07'01/10 440-46157(11105/COM/WEB