Permit 7 � _ �� ' CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2009 -00514
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/01/2009
T ° I'C,f►RI? g Parcel: 1S134CA04900
Jurisdiction: TIG
Site address: 11685 SW BURLCREST DR
Subdivision: Lot:
Project: ANDERSON
Project Description: Reground for water service replacement.
Owner: FEES
ANDERSON, LARRY R AND Quantity Description Date Amount
CYNTHIA M, 11355 SW TIGARD STREET
TIGARD, OR 97223 1 crt Branch Circuits 10/01/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/01/2009 $6.74
Electrical
Contractor:
PATTERSON ELECTRIC LLC
1834 NE ESTATE DR
HILLSBORO, OR 97124
PHONE: 503 - 640 -4088
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
This permit is .e. su.' -- to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance with a. •roved r -ns. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. • ENTION: Oregon law - •uire .. to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -00 -0010 through OAR 952 -06 0100 Y' may obtain / a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.. \ 2 .3 34 J 4.
Iss ed By: 'i! .1/ . LI : /�. Permittee Signature: 1� w „P - r 1 Ak - , .g.,&_,2N,. .
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:
CONTRAC SR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' C .� • • • ��t • _ •■ Date: /0 /jC,'
LICENSE NO. a// (.Q
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 ONLY
City of Tigard
q Date /B % Permit No.: g , A / ...,60 .
13125 SW Hall Blvd., Tigard, OR 97223 Received Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit: 4 , /ry 7
T I G A R D Inspection Line: 503.639.4175 Date Ready/By: kris: ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction krAddition /alteration /replacement
� Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
O f 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of
Job site address: ((� J ❑ "A ", "E ", "l -2 ", "l -3 ",
/ / / 3 C � ' y (� j3l t r I n S ix or or more. occupancy.
Job no.:
v G \S F ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: \\ ❑ Health-care facilities.
❑ Ha zardous locations.
El voltage for more than
/ �/ / �J 600 volts nominal.
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Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
�r r Limited energy, multi - family 67.84 2
�' n \ iNt 20.. e - .�w� i h Z f i� residential (with above sq. ft.)
/_ Services or feeders installation, alteration, and/or relocation
A-) I ` r vt / V t� OCe i C 7 OC.I J l S . 200 amps or less 100.70 2
I=1 PROPERTY ER S ❑ TENANT 201 amps to 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 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
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 168.54 2
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ' I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits ,
Contact name: without service or feeder fee, I 56.18 6, to 2
first branch circuit
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
1^ Signal circuit(s) or limited -
Business name: 6 e f sot" 4- I- energy panel, alteration, or
Address: C ) 3 IN ; - : I .s -- c. t e 0 r extension. Describe: Page 2 2
City /State /ZIP: 1 - 1 , as 6 of O R Q 7/:2q Each additional inspection over allowable in any of the above
Phone: ( 3) —7 _ / rFax: (' 1 1O /D Per insgectio P ( ) 66.25
t / o Investigation per hour 1 hr min 66.25
0 CCB Lie.: U U I Electrical Lic.3�I -, f / CI Suprv. Lie.: 3114,5 Industrial plant per hour 78.18
/�� / � - ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: \ ' � .cN'CUa ?, Subtotal: , 5? /
)0 Print name: �'D e r ?,, _ / -
Plan review (25% of permit fee): -�—
� � CSC Date: 1V State surcharge (12% of permit fee): (0
Authorized signature: TOTAL PERMIT FEE: ep .9 2._
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
1:\ Building \ Permits \ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all residential systems combined $67.84
Check Type of Work Involved:
n Audio and Stereo Systems*
❑ Burglar Alarm
n Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
n Vacuum Systems*
n Other:
COMMERCIAL WORK ONLY:
Fee for each commercial $67.84
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
n Data Telecommunication Installation
n Fire Alarm Installation
n HVAC
❑ Instrumentation
n Intercom and Paging Systems
❑ Landscape Irrigation Control*
n Medical
n Nurse Calls
n Outdoor Landscape Lighting*
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❑ Protective Signaling
n Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
I:\ Building \Permits\ELC- PermitApp.doc 10/01/09
CITY OF TIGARD
BUILDING DIVISION
PERMIT #: PLM2008-00099
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 3/10/2008
Phone: (503) 639-4171 . 441/100:0
Inspection Requests (24 Hrs.): (503) 639-4175 „_„
INSPECTION WORKSHEET FOR DATE: 3/18/2008 TIME: 7:00AM PAGE: 13
SITE ADDRESS: 116135 SW BURLCREST DR CLASS OF WORK:
SUBDIVISION: BURLWOOD NO.2 LOT #: 022 TYPE OF USE:
PROJECT NAME: ANDERSON
DESCRIPTION: Replace galv. water line to house and inside water line, approximately XV.
OWNER: ANDERSON, LARRY R AND, PHONE #:
CONTRACTOR: CENTRAL OREGON PLUMBING SERVICE PHONE #: 641-390-4797
Inspection Request Scheduled For: Date: 3/1812008 Pour Time:
Code # Inspection'Description Confirm # Contact # Message
395 . inspection 066887-01 503-7M-8497
(Ac Ek-fcA,
Corrections/Comments/Instructions:
1.4-et 9
K . PASS 0 PARTIAL APPROVAL 0 CANCEL 0 NO ACCESS
pi FAIL 0 CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector: 04 1 ji%„..- Date: 3) Phone #: (503) 718-