Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00436
1 3125 SW Hall Blvd., Tigard OR 97223 503 639.4171 Date Issued: 08/21/2009
TIGARD g Parcel: 1S126DCO3800 •
• Jurisdiction: Tigard
Site address: 9255 SW CORAL ST
Subdivision: Lot: 0
Project: Fisher
Project Description: (1) branch circuit for hot tub
Owner: FEES
FISHER, MICHAEL Q Quantity Description Date Amount
9255 SW CORAL
TIGARD, OR 97223 1 crt Branch Circuits 08/21/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
6 da 12% State Surcharge - 08/21/2009 $5.63
Electrical (manual)
Contractor:
JARMER ELECTRIC INC
5105 SW 45TH AVE #200
PORTLAND, OR 97221
PHONE: 503 - 246 -5381
FAX• 503 - 244 -8037
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.48
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 y 1 800 332.2344 ,, /
Issued B 71 'e— - - - Permittee Signature: 40/1/ �/ / Gr e �/
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 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.CE1VED FOR OFFICE USE ONLY
City of Tigard AUG 2 0 20 Received fa /B : or � / 0- Permit No.:6Z hiso /
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review �
Phone: 503.639.4171 Fax: 503.598.1960 CITY OF 7IC/! Date/B : Other Permit:
Inspection Line: 503.639.4175 BUILDING � _ Date ReadyBy: El See Page 2 for
Internet: _ s BUILDING t Notified/Method:
Supplemental l n fo r m a ti o n
. , .. TYPE OF WORK - PLAN 12EVIEW -'
❑ New construction TA Addition/alteration /replacement Please check all that apply:
❑ Demolition ❑ Other: ❑Service over 225 amps, comm'1 ['Hazardous location
❑Service over 320 amps - rating DBuildng over 10,000 sq. ft.,
`" :',CATEGORY• OF'CONSTRUCTION , 'Z,,,; of 1 -and 2- family dwellings 4 or more new residential
I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
['Building over three stories [Weeders, 400 amps or more
❑ Multi- family 0 Master builder 0 Other:
['Occupant load over 99 persons ['Manufactured structures or
; A , : ,„,.,- :_:, : :::..: ,- ' , . ; JO_B "SITE - INFORMATION. AND'LOCATION a _ ^ ". _ RV
.. , , . , - - , -, -, ['Egress/lighting p park
P
Job no.: - 4.. tftp, I Job site address: a5s 3 card-/ ❑Health -care facility ['Other:
Submit 2 sets of plans with any of the above.
City /State /ZIP: '4 Cord 9 7 2, The above are not applicable to temporary construction service.
Suite/bldg./apt. no.: I Project name: a .-: '4, ° ' : F. e. ;S 1..4.4 - ° i;_'° •: =< ,, ', * -
Ep' °
' Pro t '� ^-:`:•, ,•� .: ,�,,,�:.
Description I Qty. I Fee. I Total L "
Cross street/directions to job site: New residential single- or multi - family dwelling unit,
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion _ 33.40 1
Limited energy, residential 75.00 2
Tax map /parcel no.: Limited energy, non - residential 75.00 2
:-.=,'..'"_ . ,DESCRIPTION 'OF WORK _ - .. • _• • , . Each manufactured or modular
T (x- I dwelling, service and /or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
,= l:_ ROPERTY - O WNER - i :: ' 2
201 amps to 400 amps 106.85
° ' ���P
AID' ` -' - - - TEN ANT-- rxr: , �.j;;
0 K " 401 amps to 600 amps 160.60 2
Name: //rL0 L /f�i ' 601 amps to 1,000 amps 240.60 2
. Address: ?..2 SS' 5 e — s --, Over 1,000 amps or volts 454.65 2
��/ Reconnect only 66.85 2
City /State /ZIP: T C " OW — 9 7a .23 Temporary services or feeders installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
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 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
,.. ,=1,V - r 45, , j _r : _0<- APPLICAN T�'. :, - CONTACT:» PERSON A. Fee for branch circuits with
� service or feeder fee, each
Business name: branch circuit 6.65 2
B. Fee for branch circuits
.� without service or feeder fee, 46.85ic 2
Address: each branch circuit
Each add'l branch circuit 6.65 2
City /State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax :: ( )
Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E -mail: Signal circuit(s) or limited-
CONTRACTOR ,'. .: -. ', ° - energy panel, alteration, or
Business name: :771-,Q ,n.x ,E /2- , — , extension. Describe: Page 2 2
Address: ^-�`� Each additional inspection over allowable in any of the above _
4�/ 0 -,� 6 j (-c� ey S . S!e 2_U Per inspection 62.50
City/State /ZIP: / ).-,¢ /0 4 ( ;1 2 9 7 2 2 f Investigation per hour (1 hr min) 62.50
Phone: (Sii3) 2 1/ (> -- to 3 & / Fax: (S-03 ) 2 e/€( - c o J 7 Industrial plant per hour 73.75
I
L o C L � ,, ' ,: s ; ., ' EI:EC'TWAC'P.ERIVIIT. FEES : ::Y �? .°yz.&
CCB Lic.: y Electri Lic.: y6__ / `f Suprv. Lie.: Z/C) Subtotal
5)s
Suprv. Electrician signature, required: � ffG, - .. — ,_ Plan review (25% of permit fee)
Print name: (55 - z'1 4- /a T ,m.%� ,' Al ,V.,.. l ate: g_ f Q pt State surcharge ($ f permit fee) t 3
J TOTAL PERMIT FEE 5 , 2, (kV
Authorized signature: � Thi permit application P ermit a lication ex ires If a permit is not obtained within 180
r i / / /I / i P
days after it has been accepted as complete
Print name f) a, .. ar Date: g'— F--09 ■ Fee methodology set by Tri- County Building Industry Service Board
•* Number of inspections per permit allowed.
i \ Building \ Permits \ELC- PermitApp do 03 440-46 1 5T( 10/02/COM/WEB