Permit CITY OF TIGARD ELECTRICAL PERMIT
:. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00125
Date Issued: 03/18/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AA03801
Jurisdiction: Tigard
Site address: 12405 SW ASH AVE
Subdivision: TIGARD HIGHWAY TRACTS Lot: 23
Project: Asher Traditional Homes
Project Description: Panel change.
Owner: FEES
ASHER, BRIAN W AND SUSAN P Quantity Description Date Amount
15795 SW SERENA CT 1 ea Services or Feeders - 200 03/18/2009 $80.30
TIGARD, OR 97224
PHONE: amps or less
1 ea 12% State Surcharge - 03/18/2009 $9.64
Electrical
Contractor:
WINNER ELECTRIC INC
5950 SW PROSPERITY PK
TUALATIN, OR 97062
PHONE:
FAX: 503- 638 -4242
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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. ATT T • • . •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -00 throu.h OAR 9 -'.1 -010' You may obtain a copy of the rules or direct questions to OUNC by callin. e'. 46.6699 or 1.800.332.234 `
Issued U /� J � J Permittee Signa !'1' �2 � C �1��
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'N
,�� /�� �!i 'e -C---)-------) 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.
Electrical Permit Application FOR ( OFFI C E 1 SE ONLY
, ,
City of Tigard lac_ / / C Of . ' I Permit 'No.: e el �rN 1
. , . 11.312 SW HAD Elffvt.. Tai r& OR 91721; t'lan keauew
. )wane:. 501.639.4171 Far_ 5(013_59S_i9at"In ; mmtequu° I Ogler Peuuut_,
"::r: } r: 11InsTecairann P inne: 503_K�4e_4 l75 tam Ready/By; ' See Paac 2 bar
fl eattelt: arww...nn minal-er _sav Nanifittigbatlenn ad.: l 1 Sappetbat ltfttar at ua+
TOTE OF WORK PLAN .REZ'LLW
- ;' co g pc pjj
✓s\ i� e um ,,, � • check all that apply iattarat 2 sets of plans sxriteres checked. below):
Y �
Service or feeder 400 amps or more 0 Building over three stones
Il II DIstmuntilitlinn 9 Cabin-
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONS)- it1CTIoN exnseds 10,000 amps at 150 volts or 0 Roaring buildings.
( less to ound. or exceeds 14,000
� 0 Commercial -use agricultural
li- and 2- family dwelling 0 Commercialtindustrial 9 Accessory building amps for all other installations. buildings.
Iii Multi-family 9 Master builder 9 Other: ( j 0 Fire pump 0 Installation of 75 KVA or
`
0 Emergency system. larger separately derived syste
JOB SITE INFORMATION AND LOCATION 4
D Addition of new motor load of ❑ "A" "F" •'I '" "1
lrok, Sao.: I i 1 .-,� -- addfess: irt ltBiMHP or morn. occupancy. l /� OS S1,/) As ❑ Sr. or more residential units.
0 Recreational vehicle parks.
C'i ➢ti':, 'Sate: ZIP: �p /� _ i it- D /S 72-2-3 ! I D Health-care facilities. D Supply: voltage for more than
• L CTT' `7 ! 0 Hazardous locations. OM] Yobs motional.
l Saniteibld4* -lap?_ no.: � Proiect tame: i D Spice or feeder 600 amps or store
FEE SCHEDULE
Des
t site: ', .RiCT.i�' StfL.ti.�'- ¢�Brd'.."U:ISSL'ec So job S'3te � �1' 3 a imtiou O
I Qty. Fec. j Tout
, i
i f New residential single- or multi -famil dwelling unit.
Includes attached garage.
Stta fiivision: I Lot no.: 1 1.000 sq. ft. or less I 145.15 I i •
Ea_ add'! 500 sq. ft. or portion I 33.40 1
Tan, tntaaptigxxl no `' Limited energy, residential
( 75.00
DESCRIPTION OF WORK I itwith above sq. ft.)
/, A Limited energy, multi- family I - I
'A A
- C OA e . i r idential (with above sq. f 1 I { 7 o.00
Services or feeders installation. alteration. and /or relocation
200 amps or less I / 80.30 1 x10. .
0 PROPERTY OWNER. 1 0 TENANT 201 amps to 400 amps r 106.85 b
i1 aunnr:: / / , 4 1L '1 S / /, 40I amps to 600 amps f 160.60 : •
.�deimess: / 79 5 5 , , /`vl 6Ui amps to amps or volts L000 amps 454.65 J sj tY /} C r Over 1,000 amps 454.61
City/State /ZIP: 7 /`�` -.. 0 �'0 9 7 ✓ , y A / I Temporary' services or feeders installation, alteration, and/or
V 7 J relocation
Phone: ( 5 G Y 75 -G/06- Fax: (S 6)-o . (G'3 200 amps or less 66.85
O'w'ner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 1.00.30
untended for sale, lease_ rent, or exchange, according to ORS 447. 449. 670. and 701_ 401 amps to 599 amps 133.75 :
Owner xitoatlnnau : - Branch circuits - new. alteration. or extension. per panel
Date: A F B for branch circuits with I l
0 APPLICANT
£ 1 9 CONTACT PERSON above service or feeder fee. ' I I
e
r:
ach branch circuit 6"65
Barstinn�' name B_ nee for branch circuits
mr whour service or feeder fee_
Contact tnanane: East branch circuit `
stllsl a ss: wit add'l branch circuit l 6 Miscellaneous (service or feeder not included)
C ina " tate7ZI6': F u im manufactured or modular r
dwelling _ service and /o feeder
•
Mont: tx 1 Fax :: ( 1 1 Reconnect only b 66.85 b :
i I E.- nauail: Pump or irrigation circle 53 4()
CON CTd ACTOR Siett or outline fighting I 55.40 I :
Bwesiianess name: P r y Simal circuit(s) or limited -
energy panel, alteration, or
wdl t —'- : , extension. Describe: Page 2 •
�"t .7 S 1-. ' 1 5 f ' ' ` /,' .
Ci'r,' /State /ZIP: c 764 j Each additional inspection over allowable in any of the above
Per inspection I I 62.50 I
Phone: (.5c, ) 6.55J & z �' Fax :( 52`S) E3 b' 'id. '/) • � investigation per hour f 1 h_ min) I i 62S0 I I
iq g
C'eD.Lie_: ) ` b) I.E1ectricul Lie..:' /_/5/' L II Supre'. Lie.: a 0as industrial plant per hour 1 I 73 I
ELECTRICAL PERMIT FEES
Sup.... E.i: cw'veaax rig -gja]T; r u egelicee ` tJy ,bk. 1
t_,��i1.0 .t 0
J i
i r �� Subtotal: 1 ��.3 , Plan review (25% of permit fee): I --69- 3'mnnn name: Sc? L�,11,( I D ate: J ,' -- 0 ci /
State surcharge (12% of permit fee): , e.t!
Authorized signature: TOTAL PERMIT FEE:
I y `1 -i
Print name: Date: This permit application expires if a permit is not obtained within 80
days after it has been accepted as complete.
Nrtmber or inctions allowed per petit
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