Permit N v CITY OF TIGARD ELECTRICAL PERMIT
I ' COMMUNITY DEVELOPMENT Permit #: ELC2009-00227
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/21/2009
Parcel: 2S102DB02400
Jurisdiction: Tigard
Site address: 13588 SW CHELSEA LP
Subdivision: - ' Lot: 0
Project: Brumbaugh
Project Description: Install /alter (2) branch circuits for heat pump within approved setbacks, and GFI.
Owner: FEES
BRUMBAUGH, KAREN J Quantity Description Date Amount
285 N LOTUS BEACH DR 1 ea 12% State Surcharge - 05/21/2009 $6.42
PORTLAND, OR 97217 Electrical
PHONE: 2 crt Branch Circuits 05/21/2009 $53.50
wo /Purchase Service or
Contractor: Feeder
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503- 435 -0157
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $59.92
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 obt in a copy of the rules or direct questions to OUNC by calling 503.2 ; ' 699 or 1.800.332.2344. / caD
,e
C �� �
Issued By: 0 t�'.A Y A \. / �.! J Permittee Signature: , � 4.
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.
• EIectretaa Permit Apphcatio 1 RECE it FO OFFICE USE 9NLl . ° .
City Of Tigard Received n
MAY
g 21..2009 Date /By: c ? ' a 1 ' ( Permit N o . : , IQ v`1 � � , 06 4
lig • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T PGA A R D ' Inspection Line: 503.639.4175 CITY OF TIGA Date Ready /By: Junk: ® See Page 2 for
_. _: Internet: www.tigard- or.gov BUILDING DIVISIO Notified/Method: Supplemental Information
T YPE OF. YORK
'i 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 - .t OF CONSTRUCTION:
excee 10,000 a m p s at 150 volts o r Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
VI 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
❑ Emergency system. larger separately derived system.
`JOB INFORMATION AND LOCATION; ❑ Addition of new motor load of ❑ "A ", "E ", "l -2 ", `I -3 ",
Job no.: Job site address: 100HP or more. occupancy.
3 5 J W Ch etc L p ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 5 rG U t ( Z• r ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 60Qamps or more.
. - F EE _:SC_REDULE' .. . •
Cross 'street/directions to job site: Description I Qtr. I Fee. 1 Total 1 '
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'1500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited ener gy- residential 75.00 2 DESCRIPTION OF`,WORK I: : - :', ., (with above sq. ft.)
t Limited energy, multi - family
//) 75.00 2
ee ,-1- p “ I I n ' - 6 F residential (with above sq. ft.) l Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
❑_,PROPERTY :OWNER ❑ TENANT NANT 201 amps to 400 amps 106.85 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, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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
Branch circuits – new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.
❑ ::APPLICANT I El CONTACT PERSON above service or feed er fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee ( 46.85 46,.q 5 2
first branch circuit
Address: Each add'I branch circuit I 6.65 ( -6 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only , 66.85 2
E -mail: Pump or irrigation circle ( 53.40 2
CONTRACTOR • ' , Sign or outline lighting 53.40 2
Signal circuits) or limited -
Business name: s( rr o-v €jQ +-Vj� ( - st - u/r i energy panel- alteration, or
Address: c 211.45 IQ n ,"e r r � cSie. C ✓� extension. Describe: Page 2' ,_ 2
akin City /State /ZIP: ak j �}� ) � , / /) n . �'�Q` B �/ 2e- Each additional inspection over allowable in any of the above
e j 11 J 6 Per inspection i : 62.50
Phone: (50:24 472. �_r� M� Fax: ( ) 435 - 0157 _
CCB Lie.: 1 33 Investigation per hour (t hr min) 62.50 ,
p-p t Industrial plantperhou{ '. ' 73.75
A0 Electrical �0: 82c Suprv. Lic .: �
CD r ELEETRtCAL PERMIT FEES
5, 11 e
up . B lectrician signature, rec'uile' 1 1 • 1 • 10 .. Subtotal: 5 j 3. 5' t
Print name. Yn Date: S (2v /0 Plan review (25 %of permit fee):
A5l � State surcharge (12% of permit fee): (Q. L a.
Authorized signature: r . TOTAL PERMIT FEE: 59 -'
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.
I:\ Building \Permits\ELC -PermitApp.doc 05 /23/06 440- 4615T(11 /05 /COM/WEB •