Permit CITY OF TIGARD ELECTRICAL PERMIT
Permit #: ELC2011 -00584
COMMUNITY DEVELOPMENT Date Issued: 10/20/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S111AB08900
Jurisdiction: Tigard
Site address: 9395 SW VIEW TER
Project: Jordan Subdivision: PENROSE TERRACE Lot: 34
Project Description: Install service ground
Contractor: ELECTRIC NORM INC Owner: JORDAN, JO A
1365 SE 10TH ST 9395 SW VIEW TERR
WARRENTON, OR 97146 TIGARD, OR 97224
PHONE 503 - 643 -3500
PHONE. 503 - 639 -8171
FAX: 503 - 861 -2157
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/20/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/20/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
Required Items and Reports (Conditions)
This permit is • -• ubject 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 pproved - -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 A ENTION Oregon I -w - quires ou to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 - 1010 through OAR 952 -00 -0090 • ay obtain a copy of the rules or direct questions to OUNC by callin 503 23 or 1 800 332 23
Issued /� e _ Perm ittee Signature:
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' t� , I 109 r J z 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.
Electrical Permit App1icati CEO. v ED � ` :' , . `�`; r ` . w 's 4 „: i` -� '¢ ,"- .a
! FOR )F 1 I(F l tiEXONI 1
111111 ' i Received Cit o f 'Ti (e / Peimit No.- �[ /� O
A. -� , c DateB �� C..��� ./ CJ 1 - 13125 SW Hall Blvd , Tigard, OR 9722@ CT 2 O 2011 Plan Renew
;I d i ■ a .. 4 Phone: 503.718 2439 Fax 503 598.1960 Date/B . Other Permit
I/ 1 1 t nn 4 Inspection Line. 503 639 4175 O F TIGARD Date Ready/By: Ions FE See Page 2 for
-iii 71i`1I In ternet: www t or.gov CITY DIVISION Notified/Method. Supplemental Information
BUILDIN0
"l %5° sa �.. . i .T-YPE OE WORK - - — , - - :. _:: - . =-_. ..`P.LAN:,REV;IEW °-.r_ .' . _ :• =._ ...: .
❑ New construction fitAddition/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 stones
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards.
1 .11 _ - •CA_ _TEGORY OF CONSTRUCTION- . _ - .1, • - exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
11- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings
❑ l\ lulti- family ❑ Master builder ❑ Other: 0 Fire pump ❑ Installation of 75 KVA or
S "t J OB :SITE INF - ❑ Emergency system larger separately denved system.
., : . - . - ." ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.. Job site address. C` c �' ` 9 �^ 1001-1P or more. occupancy
I I, IJ J W �(��� K c c ❑ Si x or more residential units ❑ Recreational vehicle parks
City/State /ZIP: / (9 /` ? 7 zzq ❑ Health -care facilities ❑ Supply voltage for more than
--1----c 1 1 ❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.. Project name ❑ Service or feeder 600 amps or more
- -` .FEE SCHEDULE=
Cross street/directions to job site. Description I Qes• I Fee- ( Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168 54 14 l
— Ea add'1 500 sq. ft or portion 33 92 1
Tax map /parcel no: Limited energy, residential 75 00 2
1,,, . i il . ': . ':- DESCRIPTIOht - WORK _ . ,.,.. (with above sq ft )
Limited energy, multi - family 75 00 2
f ce qr f ; `
) t o , J residential (with above sq ft )
J I — " " Services or feeders installation, alteration, and/or relocation 1
200 amps or less 100 70 2
0 ;PROPERT.Y-,OWNER - : - • 0' "—TENANT—,V: ..-- - - 201 amps to 400 amps 133 56 2
Name: .....„ 9 t � 401 amps to 600 amps 200 34 2
.Y 601 amps to 1.000 amps 301 04 2
iddress: Over 1,000 amps or volts 552 26 2
City/State /ZIP: I Temporary services or feeders installation, alteration, and/or
relocation
Phone: a ( 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 401 amps to 599 amps 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A Fee for branch circuits with
APPLICANT above service or feeder fee,
' _ . -. ❑= ., _ D- CONTACT - PERSON.= =`'•- . 742 2
_ each branch circuit
Business name: e4 e J � y 1 c /`.'0- (",wt.,_ B Fee for branch circuits without
✓✓✓ill service or feeder fee, first 5r
56 18 6.(g
2
Contact name: branch circuit 1
Address: Each add - 1 branch circuit I 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: ( ) I Fax.- . ( ) Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
E mail:,
Sign or outline lighting 67 84 2
44;i, "'' "4 _- it -,- : ,CONTRACTOR , ;: , `-^ - _- Signal circurt(s) or limited- energy
-r
Business name: 0 _ ` 6 c Pro gym' `-WI G
- panel, alteration, or extension Page 2 2
�,� �� � Each additional inspection over allowable in any of the above
Address: 131 S ` ` {S f . 6 i e ' ' Additional inspection (1 hr mm) 66 25/ hr
City/State /ZIP: p �a�IYC& 0 qy 4( Investigation (1 hr min) 66 25/ hr
\/ _ �./ � ` � � Industrial plant (1 hr mm) 78 18! hr
Phone: A$ Q� / k' f f Fax. 1�,3 ) ( 1 5 7 Inspections for which no fee is
o [ specifically listed CA hr min) 90 00/ hr
CCB Lic.: a W Electrical Lic.: tik1' c Suprv. Lic.: It � _ __ •. -,.=ELECTRICAL_PERMIT/FEES'; ' --
prv. Elect ian signature, required: 1' i , l Subtotal. ._ f
• ' u
bar: to 4 f Plan review (25% of permit fee).
Print name. 1,,,,
i1�1 ' 1 wrei Date -,(14 I Sta te surch arge (12% of permit fee). cp .7q
•
Authorized signature: -- , ` TOTAL PERMIT FEE
9
` � 1 'l�t This permit application expires if a permit is not obtained within 180
Print name- k� vt l_)S7 P{ Date:�� let..-11 days after it has been accepted as complete.
• Number of inspections allowed per permit
I\Buildmg'Permts\ELC- PermitApp doe 07/01 /10 440- 4615T(11 /05 /COM/WEB