Permit CITY OF TIGARD ELECTRICAL PERMIT
111111 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00220
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/14/2009
Parcel: 2S102CA00233
Jurisdiction: Tigard
Site address: 9540 SW FREWING CT
Subdivision: Lot: 0
Project: Iverson
Project Description: Alter (1) branch circuit.
Owner: FEES
IVERSON, JAMES C & ANNA L Quantity Description Date Amount
9540 SW FREWING CT
TIGARD, OR 97223 1 crt Branch Circuits 05/14/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/14/2009 $5.62
Contractor: Electrical
OWNER
PHONE:
FAX: •
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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: c Carp Q J 1i_S ( { � 1 X Q i ,t Permittee Signatur ���� 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'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.
Electrical Permit Applicatio>I> V D . ' FOR OF FICE,IiSE ° O LV
1 d{�� 44���1
Received
Permit No
II
. City of Tigard Date /Bv: a ' o._ - • • d
a 13125 SW Hall Blvd., Tigard, OR 97223 MAY 1 5 2009 Plan Review
Phone: 503.639.4171 Fax: 503 598.1960 w Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 CITY OF TiGAR® Date Ready/By See Page 2 for
Internet: www.tigard- or.gov RI III nimn f?i11iSION Notified/Method: Supplemental Information
`Y..3.r. : 'k.;v- ;•F,�,r .. F : ,:;x„ a1`�Ykc',s'� `. YiS4:}'.v" y — ; .:.;�.,:, rrC:`.:>.,:s.s � as x,t!' aeala" a +•L.
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` _:��`.. ,•�,- ". v. ti ., ,PLANS < .RE�'IEW �� � .° �.
,`. :�"°: §.,i ..:¢ >'�.`,'-i'i`r;><w:,, c, �.> .. `;�� ;'nl�t' �t ,.< :�z -:2� �!•h.. .,;� } !iv "'<%�c.; .^8�:;..i , -,�. :8;� ... a. v
.. x �e.-� a�z, _� s - > . x a .rX., ...xK ..,..l. Al== �� .. ,C�"��:�'.���'se �°3 - ". - x . �-��:4 s-0.... ;R`�m� 9T1»Y1"�.`:gry3�Xw.r ,.. ., _. zsaz- swsa'w.E h- �a'4"� �� , : °:�TC�' -���
❑ New construction Addition terati0r eplacement 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.
.s'r. '�,. . s�ecx•r =a.s: . -: `" ';2_�'";r £, e�.'� ��:�'
>_' P" , `` y '` >z` "'^` P sat 150 volts or Floating ;`,' s'" °a G =ATEGpRY "'OF CON •, `.. exceeds 10,000 amp ❑ o g buildings.
t, � � �$ �`� STRUGTION "�- `� °;
" ",e „_�. ± ",eyyr', � xva .,.,- .. >. ^.:,az >u =a.:e.wx:;r� =. ; :<.,..:. gym•.- .,:;. <M�....`'+e- =`'r.r in�::=d ";:`.- •>':;. ti '.
y "'" '" less to ground, or exceeds 14,000 ❑Commercial -use agricultural
or
1- and 2- family dwelling ❑ Commercial /industrial El Accessory building amps for all other installations buildings.
❑ Multi- family El Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
m ` -,,, _;,_.<,� , ;:, - .- ❑Emergency s stem. lar er separately derived s stem.
�, a - r Y B P Y >
:=JOB srs INFOF�4LATI AND t?OCATI � r
' �;� �._: w- „ .;axxteun..., ? � :< :,x'�: � � <, ...,a._�t�� �'�. *�h'�,:��.ar ❑ Addition of new motor load of ❑
Job no.: )(Job site address: v S .y 100HP or more. occupancy
C75" �� p� j rj l ❑ Six or more residential units ❑ Recreational vehicle parks.
City/State /ZIP: 0 /� / ❑ Health -care facilities. ❑ Supply voltage for more than
/ (��� r q-77 3 ❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
firenfat t FE_E :SCHEDULE Ntr in
Cross street /directions to job site: Description I Qty. l Fee. I Total I ”
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'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
,,. ''i =t�;�„ :'�4 _t�:M " °E `�`- - ,N�m <... :. -�•s �: - =:a =_' ¢a'_ �:,, - -cru Limited energy, residential
i sib" k° ` , ` DESCIZLP 1.6" V;, ,O `F , 41 W 5 114 , t e- (with above sq. ft.) 75.00 2
\� , p � Limited energy, multi- family
75.00 2
1\\\€ _ ( \ \ U J' a 0 ` , /' (rf U ,� residential (with above sq. ft.)
V Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
s � y v
! i. POE *OW,NER�� ajlit r g ,:.F ? , > k
,:�.f��� � P ,.�,�.>xx��:.:� �.,- '��- .��'��Yrx..4 °�,;. �, r..' ;,;:".��ENANT,�,s���`.�•_��,3�z 201 amps to 400 amps 106.85 2
?Name: �- . f r -- - �� 401 amps to 600 amps 160.60 2
J ` "` 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /Slate /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
)(Phone: (503 ) 6 3 c Li 3 6 3 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
AP
,,, thr-A I'il AN , n, ,w'` == ® CONTATC:PEROSN � kq above service f
ce or feeder fee,
. _.�f.��...v...- '. ;,�_: a'� , _ sr; r, �..k. a "- .'....,. `:.,- ,.....�. _ -,... -,." 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name. first branch circuit 46.85 2
Address: Each add'I branch circuit 6.65 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
>F;is"'." "�'` 9r�ex'`:ti;,'` 7 ` - �e'�< >;a_ , "..e .5a;{'ig;>;; >r�' r Si ,
= , , _: . , ,' ,e ; CO19 OI2 == . <w`. ='r' t ,v=•..> s'i " '' 16,, :j r Sign outline lighting r.s�.�,4' �.�- ,....,a,c, ...auaz.�a:c�; g g g 53.40 2
Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: ° 1 -n t--. extension. Describe: Page 2 2
City/State /ZIP: vim/ �� Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( )
Investigation per hour (1 hr min) 62.50
CCB Lie.: Electrical Lie.: Suprv. Lie.: Industrial plant per hour 73.75
: 4; M InIVIVOMPORWITMAIMitra
Suprv. Electrician signature, required: Subtotal:
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: / , / TOTAL PERMIT FEE: h',(_f 7
l— j / G / / This permit application expires if a permit is not obtained within 180
1 J
X, Print name: . c"____. ( -1 / , J el-544A- el-544A- Date: 7( a days after it has been accepted as complete.
* Number of inspections allowed per permit
I :\Building\Permits\ELC- PermtApp doe 05/23/06 440- 4615T(I 1 /05 /COM/WEB
Electrical Permit Application - City of Tigard I I Other
Page 2 - Supplemental Information Total number of commercial systems:
LIMITED ENERGY PERMIT FEES: "No licenses are required. Licenses are requir
for all other installations
„REM0100 L W :017.N .Y . E _,. ,.k. , ._. ai-Y. 4
Fee for all residential systems $75.00
combined
Check Type of Work Involved:
I Audio and Stereo Systems»
Burglar Alarm
Garage Door Opener»
I I Heating, Ventilation and Air Conditioning
System»
I Vacuum Systems»
n Other:
7a) M.ERCIAL WDRK :.a N"'�4' g` f'
... _. � ,� . ��:.�< .ONLY �..... a �:�����;� 7���, . ,
Fee for each commercial $75.00
system
(SEE OAR 918- 309 -0000)
Check Type of Work Involved:
Il Audio and Stereo Systems
Boiler Controls
n Clock Systems
Data Telecommunication Installation
n Fire Alarm Installation
I I HVAC
I I Instrumentation
Intercom and Paging Systems
Landscape Irrigation Control"
Medical
I Nurse Calls
Outdoor Landscape Lighting
I Protective Signaling
1 \Buildmg\Permits\ELC- PermitApp doc 03/23/06
Property Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit applicants who are not licensed with the
Construction Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.055 (4))
This statement is required for residential building, electrical, mechanical, and plumbing permits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this statement. This statement will be filed with the permit.
Please check the appropriate box:
I own, reside in, or will reside in the completed structure and my general contractor is:
Name CCB# Expiration Date
'X I will inform my general contractor that all subcontractors who work on the structure must be
licensed with the Construction Contractors Board.
or
)4 I will be performing work on property I own, a residence that I reside in, or a residence that I will
reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. If I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the office
issuing this Building Permit.
I have read and understand the Information Notice to Homeowners About Construction Responsibilities,
and I hereby certify that the information on this homeowner statement is true and accurate.
`-c2-:-3 � `1 'QvS UV`
Print Name of Permit Applicant
1 � — �- s /(y 0 7
Sig re of Permit Applicant Date
Permit #: o F o
Address: *� ,i.;
I " .:,. iflilaYS 1 : 4
Issued by: Date:
This Copy for Permit Offices