Permit CITY OF TIGARD ELECTRICAL PERMIT
'' " COMMUNITY DEVELOPMENT Permit #: ELC2011 -00426
Date Issued: 07/28/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S104AA01300
Jurisdiction: Tigard
Site address: 12300 SW BELL CT
Project: Cook Subdivision: Lot:
Project Description: Panel change
Contractor: CREATIVE ELECTRIC INC Owner: COOK, DALE J /JENNIFER N B
PO BOX 659 12300 SW BELL CT
WOODBURN, OR 97071 TIGARD, OR 97223
PHONE: 503 - 634 -2454 PHONE:
FAX: 503 - 634 -2454
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/28/2011 $100.70
Specifics: amps or less
14 crt Branch Circuits w /Purchase 07/28/2011 $103.88
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/28/2011 $24.55
Electrical
Type of Const:
Occupancy Grp:
Total $229.13
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 rdance wi 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. AT NTION: Oregon I- , - qui es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 010 through OAR 95 181-009 J ou may obtain a c.py of the rules or direct questions to OUNC by calling 232.1987 or 1.800.332.2344.
Issu d By: � Permittee Signature: r � —
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'
- Np , /��1� / / 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.
07/27/2011 15:33 50359601 >Fr p CITY OF TIGARD PAGE 01/93
glectrical Permit ApplicatO[F `e'" Li l 4)/2 OM( rr It 1: o MI. WO r
City of Tigard JUL 2 8 2011 , . // K PermitHe.: ei.Eo�o! /-00
13125 SW llall 13196., Ticard,OR 97223
Phone: 503 - 716.2439 Fox; 503,598 PlanRevirw 44,
„ Inspection mc: 503.639.4175 i A ( TILT D manse,. Other Pura:
r i ' rhos Roadw73y: Mac W Cce rage Z rer
Internet: www.tigerd -"r gov BUILDING DIVrIS, ION hwidedrtvrethod: J s.,,,,,,,,.....,„,,,,,„,...,
TYPE OF WORK FLAN VIEW
❑ New construction Addition/alteration/replacement Plena cheek all that apply (ev6mil1 sots oJplan+wtitctna cheehod below):
D Service or (ceder 400 3111p1 yt or more Building three stories.
❑ J7emolition ❑ Other:
wharr the avnilableranit current ❑Marine, and bomyerd,
CATEGORY OF CONSTRUCTION caceMr 10.400 nnras el i50 volt, or O Plosing buildings.
w. 1 - end 2- family dwelling ❑L'turtmtJCial /industrial teas togrottad,ormccods14,000 0 Commercial-ow .rintrvn1
❑ Acecsoory building amps for all MieriasralUtinns, hnilden e.
Multi - family ❑ Master builder ❑ Other: 13 Eire pump. 13 lnstallntios of 75 % VA or
•
JOB SITE INFORMATION AND LOCATION t7Fmcrgencrtyettan. lutorseparately dtnvedeystcm.
0Addhiom of now motor load of U "A ", "L" "1.2 ", "1.3",
Job no.: i Joh site nttdress; /2 3Qp r , (,c.) , , L / ( tom. t0081P or mole, oecepoecy.
A 0 Si%or more residential noire, 0flecrentieenl vehicle peel'.
City/Stattc/ZIP: 7 ! Q K. 9 `727,3 [Meth-cart fadlittcs. OSopplywlragefermorelhan
Cl Hamadan loc stiont 600 volts menthol.
Soite/btdg. /apt LProicet ❑Sorricoor mime or mere,
Cross street/directions to job site: FEE SC.HCAULk
.0ucdralen 1 Q. i roc 1 Sour I •
New residential silt( k• or multi .family dwelling unit,
tnelades AIlached garage.
Subdivision: Lot no.; 1,000 sq I) orlon 16!.34 4.
Tax map/parcel no.: Bs. add l SO4 sq. ft Or portion 30.92 1
DESCRIPTION OF WORK Limuodenergy, rtestthatinl
( with °bon sq, ft) TS,40
t e i C Li mited energy, multifamily
✓� F raddenstsl two above 1„g. R.) 75.40 2
Services or feeders in 3tallatioe,attbratioet, and/mr relncatian
❑ PROPERTY OWNER 200 amps or less 1 _ 100.70 /0 12
1 ❑ TENANT 201 imp* to 400 amps 131.56 J 2
Name: r ( re (,e ♦ i / 401 amps to 600 amps 2(10,]4 2
L1 Cf 601 amps to J ,000 amps 301,04 - 2
Address: / 2 300 J, DJ. 15g( Cl- °vcr 1,000 mops gr1101is 352.20 2
Ciryl$tatd2 iP! l (o�ro� n l. 72-2-7 Temporary cer vices or feeder, installation, alter
[ rehsentian
Phone: ( ) I Fsix; ( ) 200 emote or lets 59.36' -- 1
Owner inatnllatloa: This installation i9 being made on property that I own which is not 201 amps to 400 amps 125.013 i
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 163.56 2
Owner Signnl:ute, Breach circuits new, al went ion, or catension, per rod
Date! A. Fox for branch circuits telth
❑ AP,P11 tC7l7VT ❑ CONTACT taF.Rcp1v each branch circuit feeder (e , �y 7,42 ! 2 /O ' D
Business name. en- t' Th iC a • Li. fo benh eo rs arithant
se rv r nr f c
eeder fan Grit
Contact name: /4.;111 branch circuit 1 5618 2
Address: f o, g Cs-1 Bach add'! branch circuit 7.42 2
p Misrepaneous (terviet or feeder sat igclaoted)
City/State/MP: (,v 6 wee' tr1- 9 761 Each manurecturcd or mouton- 67.84 2
/ dare11 service and/or (coder
Phone: ( ) !v? 101 Fax:: (50$ ) 4.1 V-$.0/1 Reconnect only 67,84 2
,. E- retail: GA�yS O. ft(pM� } �m rt or irti8svon circle 07.34 2
CONTRACTOR
Sign outline lighting 67,84 2
Signet circuit(.) .... iimited.energy "
Business flame: i r et poneLitlecsusion, 0 rmttcnsion. _ Pose 2 , 2
jr Poch additional Inep echoli over allowable in a� el the above
Address: ,• �7 r �
Additional inspopion (1 hr min)
615,231 br
City/State/ZIP: t b ° eibu 2h t d {e 9-7091 Invest @alien (l min) 66.21 In
� ` indurtrtal pinar(I hrnein) TA,IP/hr
Phone: ( G ? LFax: To G 3 c 3
3 � �' ��.r V � ) 5Q f inspections poi which nu fcc N
e ciricanylined(14htmi ?� ,r�
— { a
/27 l; ta cvical Lic. �^ gltprv, Lic.: ) 27 LLEC7RlCAL PERMIT PEES
Suprv. Electrieitt J
fr(i iata)e, required: 71 //V ' / '
Hof, /, Suetolal ; '' a
CCB Lie.: s
- .4, • Plan review (25%ofpermit (co). .. 6
Prins name: ttS , 1*Ct 44,r - surcharge 3 Date: State (I 2"/e at permit fee} - •
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Authorized signature: - TOTAL PERMIT PRE:: 8�
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