Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00117
- �
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/10/2009
Parcel: 2s102ca00205
Jurisdiction:
Site address: 13285 SW ASH DR
Subdivision: Lot:
Project: BURGESS
Project Description: Groundrods for water service replacement.
Owner: FEES
CARL BURGESS Quantity Description Date Amount
13265 SW ASH DR
TIGARD, OR 97223 1 crt Branch Circuits 03/10/2009 $46.85
wo /Purchase Service or
PHONE: 503 - 643 -5535 Feeder
1 ea 12% State Surcharge - 03/10/2009 $5.62
Electrical
Contractor:
YOUNG ELECTRIC LLC
PO BOX 91364
PORTLAND, OR 97291
PHONE: 503 - 706 -9867
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp: R -3
Total $52.47
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 t • • • • .R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
•
Issued =y: I j' !_ .SL AS .1. , Permittee Signature: : I
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' im+/ o Date: 5 /U u /
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
ar 09 2009 10:52 OFFICE DEPOT CEDAR HILLS 5036266409 p.2
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Electrical P rm A i1C$t P't i I ritlil li I I ,tit 1 1 1 N 1 , 1 .
City of Ti RECEIVE D �Bti .3, q 09 6-y PermitNo.: -ooh x/17 --
• 13125 SW Ball Blvd., Tigard OR 97223 Plan Review
• Phone: 303.639.4171 Fax: 303.598.L960 DareBr. OtlterPermk:
Inspection Line: 503.6394175 MAR 0 9 2009 Dare Ready/By: Juris Set Pale 2 fur
Ili, :,t , =r P
Internet: www.tigatdili,gOV p Notified/Method: �/ ((p Supplemental Information
7 � ! 1 r,� ,. v. s , , � � , r, ` �, as grr r�' y v x � 1 1 w v i + �T r � Yi � l,1 7�' Sir r . , fa y " l ' � I l � uS ' +f�¢, qt r ' - + l 1, .. r'.
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® New construction ® AdditionialteralliU ;.�!it]a:5r„ , 7 i ` Please check all that apply (submit Z Beta of plans wliteats checked be low):
Q 9ervlee or feeder 400 amps or more ❑ Building over three stories.
[� Demolition ❑ Other: where the available fault current ['Marinas and boatyards.
n' (¢ p . ;K . a , ,ir r yrrnwwuraem t�V ^ r, '%ams + w '� ' p y f a ? s eeds 10,1X10 a sat 150 voltt or Floalin build( s
. 1 :.i. vi, x i. li � O era . �w'aM61:* ' F ` ,,,,A� 4 � , 1` fib I A ' .,' loss to green& or ezceeda 14,000 1:1 Commercial- us�eagrloultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family 0 Master builder ► +out t � V El Other: + +l ❑ Fire pump, ❑ InstaABtioa of 75 ICVA or
x + a u+ en ;� rt r M i n ❑ En o5cney system. larger separately derived syst:r
i rr a t g. y +
"!: t � `.r1., l i�� Cl1'1$' 4 ' � m, war �i n+ e �mi�ie � , �, rnmdUttl�ro, u�ra � $ •v �+ .Yea w� A1�i�I11lfIE�Af!�ti 1' .l CI Addition off new motor l oad of ❑ "A „ fi „ „ l.2 „ •'i.3 "
Job no.; Job site address :1230SW Ash dr 13245 4,4 i, 0, amore. occupancy,
psi, or mom res idential un ❑ Recreational vehicle parks,
City/State/ZIP; Tigard Or 97223 0 Health-care facilities, ❑ Supply voltage for more than
❑ Hazardous locadonc 600 voles nominal
Suite/bldg. /apt. no.: 1 Project name; Czed fbt._2.Q,� ❑ Service or feeder 600 em or mote.
. 5 l ne t -. + . It » 7Trir i_ r -, I ' I'
Cross street/directions to job site: aah St n on. io t !• ,w r . liiw____ W
New residential single- or multl- fanrlly dwelling unit.
Includes attached garage.
Subdivision: I Lot no 1,000 sq. ft. or less 145.15 4
-- Ha. add'l 500 sq. ft. or portion 33.40 1
Tart map/parcel no Limited energy. residential
p 1 ; ..n + t � q{�'
+ti�,�mnu+a -r + > �vnrrr 'tti "• t��� 11g fir ' . A � 75,0 2
8 1 ( iii 11pp1 o t _rr! y o �Ilfi`4 121118 1 'r ; fit" !4 C1 (with above s4. fl.) � llnd 'gIMEa e, tea ,i11JlmY„rm rode .v,xwronlwSraisl4xu ra,► +N,MI e�
In electrode due to water line breakage al (with =hi
sq. 75
ly
Grounding , 00 Z
rods) residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation- _
ry � �p {�, �p 200 amps or less 80.30 2
r , t, % k1 Cppl) 4� a . I : %t� f' v I i411∎ R• Z ,. 0 , :, tl ,n � l ' I�' 6 p I II'^ n "If- r ', � Rr
ah :' r ., u, a v r;w y 4 iYt4n ,,�..... ,ti „ 201 amps to 400 amps - . 106.83 2
Name; 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240,60 _ 2
Address: Over 1,000 amps or volts 454.65 • 2_
City/State/ZIP: Temporary services or feeders installation, alteration, an
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation; This installation is being made on property that I own which is not _201 scope °"4°° amps 100,30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits - Dew, alteration, or extension, p r panel
Owner signature: Date: - A pee for branch circuits with
' 4 l i a � � r,wawe« n,y, r�ryxw+�+.eeun�i. il rr+w l f���+
+ �'!l t I , � �p�p +i �g �!+ vn,rv+ r�pv uu+w�aarvn , ` �
� ulnr , R ii i}j�1��lgi {'1I1 iP i�Jl�i. Ill � f'1X l'!1(' f ' Y+ `drnm ,Gar dli(mmrFrIEllar above service to feeder fee, 6.65 2
each branch circuit
Business name: Young Electric LLC B. Fee for branch circuits -
Contact name: Jeremy withers service or feeder fee 1 415 g5 46 2
first branch circuit
Address: POB 91364 Each add'l branch circuit 6.65 2
--- Miscellaneous (service or feeder not included)
City/State/ZIP: Portland Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone; (903 -) 706 -9867 I Fax; : ( ) Reovrmoct only 66.85 2
� , mai } l ?? : youngelec /i , a pp, Mp 'Y;,t, p q7 pry,Yy I sign or In igatlon c ycle - 53.40 2
, filly se ENSI� �' l'� +11Gd I `� RlSwlt {�7 %/IItX:APNIfAtltr�iAn'}mi�T ob min� 9naYi� .Y .n r „., . 4 Q�INtl; si (K outline lighting 53.40 2
Signal circuit(e) or limited -
Business name: Young Electric clergy penal, alteration, or
Address: POB 91364 extension, Describe: Page 2 2
City /State/ZIP: Portland Or 97291 Each additional inspection over allowable In an of the above _
Per inspection 62.50 _
Phone: (503) 7116.9867 Fax: ( ) Investigation per hour (l hr min) 62.50 _
CCB Lk.: 1788$7 10(7.61 Electrical Lie.; C353 7 Su , 9r. Lic,: 37835 �0. (, /Q Industnal •lent hou 73.75
, 1l 074i i ii e -:,p u, -0w:7 rv- 3( „s 1751:;7
Suprv. Electrician signature, required: /�'�. Vy t,.- Subtotal; 46,65 _
Print name: Dennis Young � J , Date -09 Plan review (25% of permit fee):
- State surcharge (12% of permit fee):
Authorized signature: s°' ' - r.t 1 - . TOTAL PERMIT FEE: 52.47
Print name: Date: This p ermit application eiplree if a permit Is not obtained within 151
days after it bas been accepted as complete,
W Number of inspections allowed per permit.
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