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Permit • n CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2009 -00127 Date Issued: 03/18/2009 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S102AA03801 Jurisdiction: Tigard Site address: 12415 SW ASH AVE Subdivision: TIGARD HIGHWAY TRACTS Lot: 23 Project: Brian Asher Traditional Homes Project Description: Panel change. Owner: FEES ASHER, BRIAN W AND SUSAN P Quantity Description Date Amount 15795 SW SERENA CT TIGARD, OR 97224 1 ea Services or Feeders - 200 03/18/2009 $80.30 amps or less PHONE: 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 • NTION: Ore..n, requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952 -s ' 1 -0010 through OAR 952 -00 1100. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Is ed By: Permittee Signature: 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 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 OFFICE USE ONL' , of Tigard T areS' 4/ (1 10 Permit No- C pajj .--ae,! D.'7 1 se B l E BOW_ Ti ip uvL OR 97223 >rqt� Knu u I . � > . ?t413_rA 9.4T?i Rue 5:mi,_9 _i (, I IlDitteeeto: Other oninir .':':. A'R.D.I � Line: 5QP3_094t7- Dale Re t8s H See Paget for lnnie¢aeit: irta t '_s5m' 9ilatiifted"L9fisulmar&i: I Samplessiontal infotnataooe TYPE OF WORK � 1 PLAN REVIEW t- � li—!i Ti31:C41.t C.ttUQP IDt2tlllN!� Q, gi�1 r m°+nnw._mr I � mo r-r � • cheek all that apply tsnbnrat 2 sets of plans . checked below is 0 Service or feeder 400 amps or more ❑ Building over three stones. Di 101et11naltliii alll D other' mire the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION ( ( ex 10,000 amps at 150 volts or ❑ Roaring buildings less to pound. or exceeds 14,000 0 Commercial -use agricultural t - and 2- family dwelline ❑ Commercial/industrial Q Accessory building amps for all oilier installations. buildings atl uiti- family D Master Wittier ❑ Other, i 0 Fire pump 0 Installation of 75 1; VA or :FOB SITE INFORMATION AND LOCATION ( © Emergency system larger separately derived systc ❑ Addition of new motor load of ❑ "A' . "E`. "I -'' - "1 -3' . I A � t C s A Bte' HP or more. Recreational a . li _tick Imo.: 1 . ..lob.. site address: ( l �J -g a ❑ occupancy. vehicle parks. S i. or more residential traits. _ 7 ❑ Supply roitase for more than C,nt;,' "ltat - W - ' / 1 . 71 23 /1-/7 1i2 :7 I I ❑H zardouslo � C./ „ �'�� ` Lv7 Hazardous locations. 60 / volts aulaaaal Snuiue. /blaglap:_ u0_: 1 Prole:: name: 0 Snrsice or feeder 600 amps or more_ FEE SCHEDULE .1110`sr.n Sint'::.E'dirortrions to lob site: t Desniution j Qty. I Fee- j Tout! l ? New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: , I 1.000 sq. ft. or less I 14_ _1 Lot no I 5 j i ' a ? Ea add'i 500 sq. ft. or portion 33.4(1 Tai<. u napi l no•_: • p I Limited enerev, residential 1 75 rile; k DESCRIPTION OF WORK 1 twin) above sq R.) Limited energy, multi-family i c I5F A iv,....... �J9 �� - -�. � residential ("dill above sq. fir! I. 7_ -00 Services or feeders installation. alteration, and/or relocation 2044 amps or less 1 / r 80 . ,Foz3 - o PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 106.85 ;�; e_ /� / ��- /l e . 401 amps to 600 amps 160.60 - ��- � ✓ J J fT 601 amps to 1 -000 amps 240.60 ` ss / �7 / 7 rS (iJ /) C7- Over 7,000 amps or volts 454.65 : City7State"ZIP:77G ` ? /e) 1� 9 ? .2 Temporary services or feeders installation. alteration, and /or _ ! ` / relocation Phone: 603) 7 g O - (1 O 6 Fax: 60,5) C2 Q — ' ( 63 200 amps or less 66.85 Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 iiimitellut e,.d for sale, lease_ rent_ or exchange_ according to ORS 447. 449. 670_ and 70L 401 amps to 599 amps 133.75 • Ot signn�Vnauu = Branch circuits — new. alteration. or extension. per panel Date A_ Fee for branch circuits with APPLICANT ❑ CONTACT PERSON above service or feeder fee. I i =eh branch circuit 6.65 Business name: B_ ]Fee for branch circuits f' E.'muutla: t name: I Ntvnhour service or f:cdzr fee_ Y9p I 46_$_ T . fCnust branch circuit � E nSi! add'l branch circuit rn, -&n? : I Miscellaneous (service or feeder not incisededl C.iity /'State4ZlP: { Fatrh manufactured or modular I duelling_ service audio: feedes Phone: ( I I Fax:: ( ) Rectmnect only !i 66-85 I E.- ussaiil: POW or. irrigation circle 5340- - CONTRACFOR Sign or outline fighting 53.30 - • Business name: l - it ' Signal circuit(s) or limited- B :Af ` ' >`t, Ly2_ F- ` r e, energy panel, alteration, or a 1 • extension. Describe: Page 2 • .5 .* S cc r 5 I i..% PUz - Cir' /State /ZIP: ‘Z. 0 f , - cf L j Each additional inspection over allowable in any of the above i Per inspection 1 I 62.50 I I • 'Phone: (.5c3 ) 6:_5 5 5 I Z P Fax: ( 5415 ) 4,3 a' `/d `/ 1 j r mini 5 1 � 1 investigation per hour ii hr mm, I ! e?-5( C: Ci Lie__ ) `-i'2 ' . 1 .Elecitrmca11.Lic..: ' Ssupre . Lic__ gl industrial plant per hour I I 73.75 y, r 3 Y i j� L. �' ELECTRICAL PERMIT FEES Stgu ,, E A.°.: tric.i n signature.. required: I :, 41L \r �l 4 /� f�� t. �` ��K.r /l �� Subtotal: � ( g0.36 , I "tittl name: l,t e: 9 ' 0 Plan review (25% of permit fee): I >,L� 1,,,,-A I `� 1 State surcharge (12% of permit fee): Authorized signature: • TOTAL PERMIT FEE: Print name: Date: 7 This permit application expires if a permit is not obtained within 1811 daps after it has been accepted as complete. ' 'NNtatiber of inspections allowed per permit. I11 ailciagiTenas rd Penviifippadet: ,, tIn.=.;ri., ?4i: -4E,t Sta,t[!Mintalikk -M