Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00514
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/16/2011
Parcel: 2S 111 AA03400
Jurisdiction: Tigard
Site address: 8625 SW GREENSWARD LN
Project: MCCONNELL Subdivision: GREENSWARD PARK Lot: 4
Project Description: Reconnect only
Contractor: VAST ELECTRIC Owner: MCCONNELL, BRIAN A &
1525 SEATTLE SLEW DR. SE MCCONNELL, MARGARET M
SALEM, OR 97301 8625 SW GREENSWARD LN
TIGARD, OR 97224
PHONE: 503 - 566 -7274 PHONE:
FAX: 503 - 585 -8828
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/16/2011 $67 84
Specifics: 1 ea 12% State Surcharge - 09/16/2011 $8 14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 • 13.9.52- 001 -0090 You may obi,- a copy of the rules or direct questions to OUNC by calking 503 232 1987 or 1 800 332 23444
Issued By: Permittee Signature:
401/21110 7 /
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 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
a q ‘ �
Electrical Permit Alp>Eslicatioa SEP FOR OFFI(E 1'SE ONLY
CI{�" ofT 1"C� SE 1 6 Z 1 Received ,
IN ''J g D : �`� A
1 S W H all Blvd , Tigard, OR 97223 F 9 /` y Plan Review
Phone: 503.718.2439 Fax: 503.59 &. ] 960 i n ..: + � ® 17areIB : Other Permit:
Inspection Line: 503.639.4175 ) ' Date Ready/By PI See Page 2 for
T1c i n Internet: ttiww.tigard- or.gov R� I ��� " NotifiedlMetlwd• Supplemental information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /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 agricuit oral
®1 - and 2-family dwelling ❑Commercial /industrial 0 Accessory building amps for all other Installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency w system. larger separately derived "1 3 , system
ID n Addition of new /00/07 load of
10011P or more. occupancy.
Job no.: lob site address: 8625 Greensward Lane
❑ Six or more residential units. ❑ Recreational vehicle parks
City /State/ZIP: Tigard OR 97224 ❑ health -care Emil hies. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt" no.: Project name: McConnell ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 fir. I Fin 1 Total f '
New residential single- or multi - family dwelling unit.
Includes attached garage_
Subdivision: Lot no : 1,000 sq ft or less 16854 4
Ea. add' f 500 sq. ft. or portion 3192 1
Tax map /parcel no.: Limited energy, residential
7500 2
DESCRIPTION OF WORK (with above sq ft.)
Limited energy, multi - family 75,00 2
Service Reconnect j residential (with above sq R.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER I 0 TENANT 201 amps to 400 amps 133 56 2
401 amps to 600 amps 200 34 2
Name: 601 amps to 1,000 amps 301 04 2
J
Address: Over 1,000 amps or volts 552 26 2
Temporary services or feeders installation, alteration, and /or
City /StateiZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59 36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
1
intended for sale, ]ease, 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, per panel
Owner signature: Date: A Fee for branch circuits with
® APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: Vast Electric, Inc B Fee for branch circuits wuhout
service or feeder fee. first 56 18 2
Contact name: Tim Vander Stoep branch circuit
Each add'l branch circuit 7 42 2
Address: 1525 Seattle Slew Dr SE Miscellaneous (service or feeder not included)
Each
City /State /ZIP: Salem OR 97317 dwelling, service manufactured or modular
67 84 2
and/or feeder
Phone: (503) 780 - 8597 Fax: : (503) 585 - 8828 RiXonneet only 1 67 84 67.84 2
Pump or irrigation circle 67 84 2
E -mail: vastelectric @comcastnet Sign or outline lighting , 67 84 2
CONTRACTOR — Signal circuit(s) or Inn ited
Business name: Vast Electric,inc panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1525 Seattle Slew Dr Se Additional inspection (1 hr min) 66.25/ hr
investigation (1 hr min) 66.25/ hr
City /State /ZIP: Salem OR 97317
Industrial plant (1 hr min) 78.18/ hr
Phone: 503 780 - 8597 Fax: (503) 585 - 8828 Inspections for which no fee is
Phone: ( 503) ( ) specifcalfy Listed (%r hr mm) 90.00/ hr
CCB Lic.: 175531 i'i i)ii ElectricalLic.: C -2:0 71 11 Suprv. Lic.: 5186S id`t/r ELECTRICAL PERMIT FEES
Subtotal: 67.84
Suprv. Electrician signature, required: ,. 3 y � , Plan review (ZS% of permit fee):
Print name: Tim Vander Stoep D; te: 09/16/2011 State surcharge (12% of permit fee): , ..,14:15 . a'. 1
. TOTAL PERMIT FEE` 7 5 7 Q Y
Authorized signature: This permit application expires if a permit is net obtained within 080
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per peryait
1 'Rniidins1eanutS1u- Permi: 07/01110 440- 4615Tt11/oveorvwe9
Z 8288 - £09 'out oilpel3 IseA BL17 :60 1.6 96 doS
_ I~ q uest to Energize an Electrical Installation . ./, r o 11 ` 00,5 `1
,4'4' .
e 4.4 '.. 7.. i /I 6 I
/
— - REQUESTING SUPERVISING ELECTRICIAN INFORMATION
Name of supervising electrician: - .. , .. • ". t• .,, Date of request: 3 Min i 7011
Supervising elcctTiciart's license g num number: _51 S_ Date installation was completed: I ,I . 11
Electrical permit no,: S f C tk-ckc 1 Mq[d' If a remporary permit it poled at the Job site, please in lade a copy of if with this form.
EMPLOYING ELECTRICAL CONTRACTOR INFORMATION
Name of electrical contractor: t . . • License no.: , 31 -,,i; •
Business address: " c • 5 �' i tM - - J l
City: _ ' k State:
Phone : S3 110: ' t Ci7 Far: _() -5 I -mail: k 1! '. i c( Or eo •,
CUSTOMER INFORMATION
Customer's name: C • v
Customer's address: '-7 Q ._„► • ti L-Q kit (- p
City: • • State: C ZIP:
•
Address of ins r ation if different than customer's address:
City: State: ZIP:
INSPEC N INFORMATION
�:�/,
Authority having jurisdiction to inspect: -� �� , g Phone: SO3 - 7)t' ' ' 4
Address: . Jr . - L Vl�
1 . f'i.
City: s • t i t State: ) (Z... ZIP_ 7 ea-A-3
RECEIVING ELECTRIC UTIUTY INFORMATION
Name of electric utility receiving request: p _ Phone: - L / -
Address: -
City: - State:, _Z.IP:
R EASON FOR REQUEST
A. Restoring electrical service that was interrupted or disconnected because of either a:
❑ Service change or p4 Uncontrollable event, such . 4 or severe weather,
or
B, Electrical service at a remote location needs to be:
❑ Initialized 0 Restored
COMPLETION _INSTRUCTIONS AND SIGNATURE
Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you mast (1) notify the authority having jurisdiction
(3) the inspecting authority, that the installation has been energized, and (2) request that the
authority inspect the completed installation.
Supervising electrician's signature Date Electric utility
Note: Please consider notifying the inspecting authority
identified in this request when an installation is energized
�,�,�� 11D before inspection.
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' '� 8288 99 '£09 out o1a1�el3 ;sun $i;9 60 14 91. doS
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