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Permit 1 CITY OF TIGARD ELECTRICAL PERMIT p " I COMMUNITY DEVELOPMENT Permit #: ELC2009 -00175 Date Issued: 04/21/2009 T 7.GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S109DD11400 Jurisdiction: Tigard Site address: 15702 SW GREENFIELD DR Subdivision: Lot: 0 Project: Sakaguchi Project Description: Install (1) branch circuit for hot tub. Owner: FEES RUF, CLAUDIA U & Quantity Description Date Amount SAKAGUCHI, TERESA L, 15702 SW 1 crt Branch Circuits 04/21/2009 $46.85 GREENFIELD DR wo /Purchase Service or PHONE: Feeder 1 ea 12% State Surcharge - 04/21/2009 $5.62 Contractor: Electrical BEAR ELECTRIC PO BOX 389 DONALD, OR 97020 PHONE: 503 -678 -1355 FAX: 503 -678 -1108 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $52.47 Required Items and Reports (Conditions) This permit ' issued su•' -ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be do in accordance with a.. oved plans. This permit will expire if work is not started within 180 days of ssuance, or if work is suspended for more the 180 ys. ATTENTION: Or=•• la - .wires you to follow the rules adopted by the Oregon Utility N• i cation Center. Those rules — gm set forth in OAR 952 001 -0010 through OA' 952 - 101 • i r You may obtain . copy of the rules or direct questions to OUN .y ca g 0 .-' •.6.• ' or 1.800.332.2 •4. Is ed By: _� fL / J -' Permittee Si. •.ture: —:- �+ f/ l /ferc_______/ 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: 1(1t, /19 LICENSE NO. 'j v 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. x RECEIVED Electrical Permit A13pl'lcation I OROFFICE USE ONLI' li City of Tigard - APR 2 0 20 E - '; rcnn ;l No.: e ...Co _et)/ 5 13125 SW Hall Blvd., Tigard, � D � R 97223 . Plsn Review Other Permit: 2 • ' Pbonc: 503.639A 171 Fax: sr q 140 TIG r I. . i s Inspection Line: 503.639.41�(� / ( "r c tiesdyltly: r the I' ® for see 5cc rate a ce r 2 2 taforwaatoo TLGARD Inicroct: www.tigand•orgovaav'�IN DI Notificel/Method' TYPE OF WORK PLAN R P lease c heck all that apply (submit $ sets of puns whinms chccked below): ❑ New construction Addition/aiteration/mplacrment 0 Service or feeder 400 amps or more 0 Building over three stories. Dcmolltion ❑ Other: _ where the available fault current 0 Marinas and boatyards. CAT - . RY OF CONSTRUCTTa1'1 s 10,000 amps at ISO volts or 0 floating buildings. Se es m ground. or exceeds 14,000 ❑ Commercial-use agricultural I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps tar all other installations. buildings. Q Fire pump. Q ;asaaltatioa of 75 KVA or [] Multi family 0 Hasler builder ❑Other _ ' ,10 0 n<Y WstO tow sepaatcly derived system. 11 SIT I A - N N, D LOCATiOPI ❑ Addition r 1 anew motor bad of ❑ "A ". -E•. -1-2". - I.3", I l L_ S "J \ 0 I Oche or mmc. occupancy. sou i Job n0.: Job site address: Snt Mott retidcatirl wits. 0 Reaeatiarul vehicle parks. 0 Hauhtarc Paciliues. ❑ Supply voltage for molt 1100 City/State-21P: * .. ❑ Elarardeus locations, 600 salts nominal. (' Service or feeder 600 amps or more. Suitc'lbldgfapl no.: Project names , FEE SCHEDULE Cross strcd/dir ctions to job site: p.m 0a0 0.- Fee �d .— New residential single. or multi - family dwelling unit. includes attached garatr . Lot n o.: 1,000 sq. 6• or less 145.15 ill Subdivision: l Ea. add SQ. IL or portion 3340 II Tax map/parcel no.: Limited energy, residauial II. 75.00 III -.-•. . F f0 F. WO), . • with above • . a. :r,_ ...:;'f ., -... • Limited , multi - family residential withabove n_ El 75.00 ME 81 - Set 1ecsor feedess lnslallatlo •tteralio and/or relocation 200 amps or less IM 8030 11.1111110 1' =':.' NANT .. . , 201 amps 1o400 amps 106.85 all :® PROPERTY' OWNER ❑ TE 160 60 ' 401 amps w 604 amps Nara a• �� � .'. �. Ai amps to l,000amps 240.60 — • Address: , Over 1,000 amps or volts In 454.65 �© 1 `-h 1 Q _. Temporary services or feeders Instal khan, alteration, and/or G iry/StatdZ11': _ q� relocallon 66.85 Min 3) ()1 -^ 29 L Fax: ( ) 200 amps or less 201 amps to 400 amps 111111 100.30 NH Owoer installation: This installation is being made on property that 1 own which is not 40t amps to 599 amps 133.75 intended for sale, lease, Matt, or exchange, according to ORS 447, 449, 679, and 701. Owner signature: pate~ A. Fcc for branch circuits with above service Of [ceder rec. 6 �II APPY IGABfr, .,' 121 COMTACIf PERSON above branch circuit Business name: B. Fcc for branch circuits , — — without service or feeder fee, 46.85 "I ( 2 Contact names — rust branch circuit Each add'1 branch circuit MN 6.65 2 Address: - Miscellaneoussservice or feeder not included Ci /State/ZIP: Each manufactured or modular 90..90 2 ty dwellin:. service and/or feeder Phone: ( ) i~ I Fax: : ( ) _ Reconnect only II. 6' 85 ern • Pump oricigstioncircle 53.40 Mill !~ - mail: Signor outline lighting 53.40 MO 2 ,•.- '' COIt[RR � ?1GIOR Signal Sisnaleircuit(s) arlimiled- Business Hare: Bear Electric, int. _ S panel, alteration. Or 2 extension. Describe: Page 2 Address: PO Box 389 City/State/ZIP: Donald, OR 97020 — PCr Each additional ins. cetion over allowable In an • of the Anus pection ntpor 62_50 MIMEO Phone: (503)678-1355 F714:7(C503) 676 -1108 1»vcsl igation per hobur ou tt r hr mire) ti2.50 EMIll � leg J Itadu pta CCB Lk.: 20919 Electrical Lie.: 24 Supra. Lie.: T ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: Ni .r�1yr. - Subtotal: IC � L -�" i Plan review (25 %of permit fee): Print name' �� Zs i� \'f D ' t : 4 ` � `-' State surcharge (12% of permit (my 6. (Q TOTAL PERMIT FEE: *`Z,.. 1 Authorized signature: Fhb permit application evicts' ifs permit H ..et obtalaed wirtrrn 150 Print tame: Date' r days after It has been teceptrd as coml:We • Number of inspections allowed per permit. r.11aTesorP+vmaa ta.C•tt C61.3 fM 440.46157111 es CQVt