Permit CITY OF TIGARD ELECTRICAL PERMIT
„
€'! COMMUNITY DEVELOPMENT Permit #: ELC2010 -00063
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/05/2010
Parcel: 1S135CA90312
Jurisdiction: Tigard
Site address: 11040 SW GREENBURG RD 312
Subdivision: ASH CREEK CONDOMINIUMS Lot: 0
Project: Grady
Project Description: Panel change.
Owner: FEES
GRADY, PAT Quantity Description Date Amount
11040 SW GREENBURG RD #312
TIGARD, OR 97223 1 ea Services or Feeders - 200 02/05/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 02/05/2010 $12.08
Electrical
Contractor:
A & J ELECTRIC
PO BOX 330
FOREST GROVE, OR 97116
PHONE: 503 - 359 -5891
FAX: 503 - 359 -1981
Type of Use: MF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is iss - • -. _ •to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done '• - ccordance with app • ed 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. - TENTION: Oregon la -u es •-u to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
95 801 -0010 through OAR 9 -- 101- 01! Y .0 ay obtain a copy •. the rules or direct questions to OUNC by cal . .s 'r .24•.6699 or 1.800.332.2344.
ssued By: L = ! / � . J Permittee ' .l. ._�! Ll
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:
--limo": Air
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.
F 10 08:55a Leeann Greason 503-359-1981 p.2
'' CEIVED . .
ElectricarPermit Applica I i . . , FOR OFFICE USE ONLY • '' .: .
II ' . City of Tigard EEB 0 5 2010 Da Received. ilijfilni-M Permu No.: eke,..,9ettf9 3
I 13125 SW Hall Blvd., Tigard, OR 9 f2.1.3 Plan Review
; 1 : . Phone: 501639.4171 Fax: 503.phiro-
t TIGARD • Dat t Other Permit:
TIG D
inspection Line: 503.639.4175 l.- Date Ready/By :
AP, BM El Sec Page 2 for
lntemet: XliWW.tigard-or BUILDING DIVISION
gov biotifiecVMelhad: Supplemental Information
:.::::' ' ' - ' . . 7 '...-ITAN .- 0 7 Y.:;-;;:--
0 New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wfireuls cbx3ted below):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition Other: where the available fault current 0 Marinas and boatyards.
:-...::- :..,....:.:-f.•:-.YeAttd:o*t.;#-;,-00$-**0.t N
iOkfti :::...;.-7--.:,.;::::;,--.-:.,::..: exceeds 'OO amps al 150 volts or 0 Floating buildings
4 .
less to g,round, or exceeds 14,000 0 Commercial-use agricultural
1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire piliaP- 0 Installation of 75 KVA or
._,._ iiiiiiii , ii ii.i . ......„ ...'= , . • . , .. • , . , . , : . - 0 Emergency system. larger separately derived system.
-:- • : i .i : . • ..• : :. .13(i t l iii.Sittiii*t 1 0 1 RMATIt*:'AiNili , .4;101CATION =',': . -:".--. ,"'-:.:,'.' :' ,--;" : -.. ' " 0 Addition of new motor load of
- 1001IP or more. occupancy.
Job no.: Job site address:N..z...%,__N.s... -7-,‘,._._,.::, C-\.k.... 0 Six or more residential units. 0 Recreational vehicle parks.
-.6 ,,. 0 licahlt-care facilities. 0 SIIPPls' voltagr for more Dian
City/State/ZIP: cz ..,.
El Hazardous locations. GOO volts nominal. -
Suite/bldg./apt_ no.: - b'" , .... — 'e3- Project name: 0)9..er-r•-/ . ci Service or feeder 600 amps or mare.
iFEE:SCHEOUCE : . '''' :-• . - " • • :
Cross street/directions to job site:
Description I DP I 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'l 500 sq. ft. or portion 33.40 i
• Tax map/parcel no.: -
Limited energy, residential
W!SCRIPTU)N OF WORK 75.00 2
(with above sq_ ft
Limited energy, multi-flunily
75.00 2
residential (with above sq. fl)
. Services or feeders installation, alteration, and/or relocation
200 amps or l 0.30
ess ■
3
71:....: ..................... iiiiin■itrt ''= . '...';.;. ::: , 201 amps to 400 amps 106.85 2
Name: PPrr aack-q 401 amps to 600 amps
601 amps to 1,000 amps • 160.60 2
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: ( ) I Fax: ( ) 200 amps or less 66.85 I
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
.:- Ef: 811 . ..:: : ; :.;:•:: ! ..- .:.:- above service or feeder fee,
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 1 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
90.90
dwelling, service and/or feeder
Phone: ( ) . Fax: : ( ) • Reconnect only 66.85 2
E Pump or irrigation circle 53.40 2
'' - . : 1 : I: -- . . . . .. , :'.- . .„ : • .-....-.: ,',::-',-..-:::, I.. cotsFyft„.k.,cTOR:. :::„ . :, .".,: , - : i. ';, : ..:,..,:.,,. Sign or outline lighting 53 AO 2
Signal circuit(s) or limited-
Business name: A&J Electric
energy panel, alteration, or
Address: PO Box 330 extension. Describe: Page 2 2
City/State/ZIP: Forest Grove, OR 97116 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 359-5891 Fax: (503) 359-1981
Investigation per hour (I br min) 62.50
CCB Lic.: 959 Electrical Lie.: 34-le Suprv. Lie.: 5055S Industrial plant per hour 73.75
- ""` .i. ...: . • ;. . •-.., .1 ELEU.M.I.CAX TPERMIT FEES::: . . . " ..
Suprv. Electrician signature. required: 4 011110 111r .-- --- , Subtotal: 'C\Itz,
I Plan review (25% of permit fee):
Print name: Tony Wilson Date: ' - ,.. 1- \.\ 1 , . \
State surcharge (12% of permit fee):
Authorized signature:
TOTAL PERMN FEE: 1\
- rats permit appikation expires it a permit is nut obtained within 180
Print name: Date: days after it has been accepted as complete.
' Number of inspections allowed per permit.
I 113 u ilding).PennitstELC-PormiiAppoloo 05,23 440 /051COMWED