Permit •
CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2009 -00398
a COMMUNITY DEVELOPMENT Date Issued: 08/04/2009
13125 S W Hall Blvd., Tigard OR 97223 503.639.4171
TIGAKD: 9 Parcel: 2S111CD01800
Jurisdiction: Tigard
Site address: 15625 SW SUMMERFIELD LN
Subdivision: Lot: 0
Project: Hamilton
Project Description: Replace service panel.
Owner: FEES
HAMILTON, DEWEY Quantity Description Date Amount
HAMILTON, MARGARET C, 15625 SW
SUMMERFIELD LN 1 ea Services or Feeders - 200 08/04/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 08/04/2009 $9.64
Electrical
Contractor:
COHO ELECTRIC INC
PO BOX 40
WILSONVILLE, OR 97070
PHONE: 503 - 582 -9774
FAX: 503 - 582 -9840
Type of Use: SF
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. 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 through OAR 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 By: , Permittee Signature: Pie) j� �/ e 77o
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' Date:
LICENSE NO.
Call 603.639.4175 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 Applicatio �;�o ti '`''
�� FOR OFr1C r +11Sr N l , R ..
,IFS : v'. h' . x .t...... r. .,... "K.}: a l
hew °4ti City Tigard ty w � , R¢ceived (/ �, s�
; ' 7
, r
t •J DateB : d / /��� Permit No / / jo,.7 % a�
, 13125 SW Ha11 Blvd,, Tigard, OR 97223 �p
t ^ ; a. Phone, 503,639.4171 Fax: 503.598.196 U L 3 O 2009 Plan Review
Other Permit.
4w,-,,° Inspection line: 503.639.41.75 Datc Ready/By: hairB See rage 2 for
tl:le�n_lira' C ITY OF Nodtiev Nleu supplemental 7
s�i+m- llama: www.tigard�r.gov lnformatioa
; � r r..7 -'7 ,J'2 1"tf ::" l r .. i T g , }-r err , J, y t e . rrv w� i�"x z-x .? I c .. r ^^ x; 45 . .
z y ti r r J t7 C4, v , , . t. 1 r i r \ fir -t' r u/ s a J x .. .— 5 / r :. ` ,,.. if , , Z ... .� r:
.f...x . .1¢,r:•.,;,. ,� :- ,. ..,M .�,.. < .r_ ,,•�.rr^r,,.r_.. , - F, ..lCri,,:5, l.J.. v:,,r�'., ,- ,.,. .� .., ,ti., =. �.. .... � -,_.,. _. r.i.. err„ _z� - ..cY : ..,. ,.,c ».3.�,.. ✓ � .,..
�� P lease c heek a ll that apply (submit 1: sets of plans w /items checked below):
'
❑ New construction r, Addition /alteration/replacctnent )
[] Service or fbeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other; where the available limit current ❑ Mennen and boatyards
Y'"'.""' V i'ft•,4 V / N M� !. �,.J ✓. / t -� ��1 -'f' ( -�.� K 4 J L .. / .^ A 4" 2rz,., "2"Arr
4 ` ' � ? ': f =Pg t a ere u r r , ? , t b j. exceeds 1 0,000 amps at 150 volts or ❑ Mating buildings.
,
xi c -rr,'r, r,. .. .,..Ma. «�,t,,,n:.,>. ,,a •z,8,&: r -r. A t. a :« , :',,,: less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I. 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi family ❑ Master builder ❑ Other ❑ Firc pump. ❑ Installation of 75 KVA or
zt- t , y � . �F b, r= t r J , i t 1 r ,1 r , . ,x, ,«� -� ❑Emergency system. larger separately derived system.
t 4, r ` i + a r , t} g e r 1, t �r n'� ❑ A ddition of n ew motor load of
� ...,c. S..v., ..h.�ac {%v. �,:1r,,. ,.r r _ .,, a...r:.n:. xM .._�: .._ _. _. _._.. a __, _ _.._ . :f^.^. ❑ , <A» "E","1-2", ,.1.3„
b >rs t Six or or more. occupancy.
Job no.: \4 ‘ 1ct Job site address: i 5
� T't 4 . ❑Six or more residential units. ❑ Recreational vehicle perks.
CityfState/ZIP: '1--1 ' ❑ Health-care facilities.
CI Supply voltage for more than
❑Hazar azardous locations. 600 volts nominal
[] Service 4r reeder 600 am mom Suite/bldg. /apt. no.: Project name: its or m om
5<r,..:�6zdi,�,:.; r _._ .,. . . x.
. :. �3.�tr':�`n� ,rc.r� s..
Cross street/directions to job site: netcriptiOO
Qty Fee Total -
New residential single- or multi- family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.:. 1,000 sq. ft. or less 145.15 4
Ea. add', 500 sq. ft or portion 33.40 i
Tax map /parcel no -
, + r, x rr`- .,^c. .. �:. f - J n . _ ,� /•' xeq � limited energy, residential 75.00
r f. i� Y• , - f r i ti� r V ,K .4 Wi
.. . hr � h.�.: . ° k: ,7,-
Limited energy, multi
, (Wit above 9Q tt .)
� 11 r
tattnily 75.00 II
" ""14k4� ... .�,..,„.1 e... o-t1 . P214‘.4,,' residents Jwith above so. ft.)
Services or feeders instailatlon,alteratton, and/or relocation
200 stops or less . \ 80.30 C i,p, a y 2
. Fever ' /. .✓ F r^ ^rte - --* . v t'w , u`7 ? F : :F. a. r�. ✓- -.., r <r r + e us
:i :r e ....... � � _:. , zc 2 :n " 3 6 a:. cA .,....,e - r ..t.u ^` G-.^ 147 ,7, r st 201 amps to 400 amps 106.85 2
_ 401 amps to 600 amps 160.60 2
a! 601 amp to 1,000 amps 240.60 2
Address: 1 1c - , ny v ' - Over 1,000 amps or volts 454.65 2
City/State/ZIP:"'� i Q,Q (t—1 �1 Temporary services or feeders Installation, alteration, and/or
e 1 relocation
Phone: ( ) 6 _ ( B Q ( Fax: ( ) 200 amps or less 66.85 1 _
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 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
Owner signature: Date Branch circuits- new, alteration, or extension, per panel -'
rru7 ^ r"'^ a . l Y'r . a� rrr. ..
_ A, Fee for branch circuits with
3` { ' ` r l a : i 7 � r r r y a L y - + t� / above service or freder fee,
.,,R; .iva: .,,.x x.✓,_..., n:.'.`.. �'. '.�xS.:�.� {_, -,..1. ,. ,..- r. :u .. cr.. ..s:._...Y,,.,aCSi... �..,..,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: _ witho service or feeder fee,
first branch circuit 46.85 2
Address: Each add'I branch circuit ! 6.65 2
Kiscellaneous
City /State/ZIP: Each manufactured o cmo not included)
dwellinj, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( )
Reconnect only 66.$5 2
E-mail: • Pump or irrigation circle 53.40 2
. 1 ::',..,..., r._._<...R., r . .:,...�..r r ,• f ?a✓ .. Sign or outline lighting 53.40 2
Signal circult(s) or limited-
c-� + energy panel, alteration, or
Address: Pc b ctl _ lf. 4, cl extension. Describe: Page 2 2
City/State/ZXP: t A 4 'J v>J , ` C.. (:) r1 C . I C)•, Each additional inspection over allowable in any of the above
1 Per inspection 62.50
Phone: (5o ) 5 a _ 5,-1-' Fax: ( ) %a _ c‘% c) investigation per hour (1 ttr min) 62.50
ktdustrral plant cr hour 73.75
CCB Lic.: 1 51Ib�C. Electrical )ric.: Suprv. Lic.: 5a55c..s P P
.era ,r�,Z, - i;:5 ytv,3. , a a ^ * ` - Ya y 74'
i!J ^r�i,. ,. r_7 n .`I ,�� x. !acii �>y S + urfwl�rbJ _�j�,^] u r �Ou : Y �
Suprv. Electrician signature, required: �•' '` Subtotal: b _ y�
/! �.�r..:� -I �I :�-: �. s
Print name: i , . ' Date: Plan review (25% of permit fee):
e,. 1 m�nS t -31 - L
State surc (12% of permit fee): � ,
Authorized signature: r 1 , . TOTAL PERMIT FEE: e ,Ql - 9 4 ,�
Print name: , 1 k t Date: This permit application expires if a permit is not obtained within 180
1 r "- I Q� • + days after it has been accepted as complete.
Number of inspections allowed per permit.
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