Permit li CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT • Permit #: ELC2009-00380
'TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
Parcel: 2S111AA02800
Jurisdiction: Tigard
Site address: 8640 SW GREENSWARD LN
Subdivision: Lot: 0
Project: JDR Property Investments
Project Description: Panel change and (2) branch circuits.
Owner: FEES
JDR PROPERTY INVESTMENTS LLC Quantity Description Date Amount
PO BOX 404
GLADSTONE, OR 97027 1 ea Services or Feeders - 200 07/28/2009 $80.30
amps or less
PHONE: 2 crt Branch Circuits w /Purchase 07/28/2009 $13.30
Service or Feeder
1 ea 12% State Surcharge - 07/28/2009 $11.23
Contractor: Electrical
THREE RINGS ELECTRIC LLC
PO BOX 1887
LAKE OSWEGO, OR 97035
PHONE: 503 - 624 -1767
FAX: 503 - 670 -9965
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $104.83
Required Items and Reports (Conditions)
This perm' ' issue• .•.- t 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 :. 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 ATTENTION: Oregon law" -.uire y• to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 101 -0010 through OAR 952 -001 .100. o m- obtain a copy of the rules or direct questions to OUNC by calling 503.246. 99 or 1.800.332.2344.
Iss -d By: _� ∎ //— L:.�LL /(L Permittee Signature: Y
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:
CONTRACT R 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.
1 1
•
'Electrical Permit Applicati i . ECEIV FOR OFFICE USE ONLY
City of Tigard d Date/By: Received 7 9.,f( Permit No.: EtZgag•. 30
I II I I 13125 SW Hall Blvd., Tigard, OR 97223 , L I' 2 8 200 Plan Review
C Phone: 503.639.4171 Fax: 503.598.194W Date/By: ' Other Permit:
T 1 G A RD Inspection Line: 503.639.4175 Date Ready/By: tuns: M See Page 2 for
Internet: www.tigard or.gov Notified/Method: Supplemental Information
Infor
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❑ New construction µAddition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
'rK= , ,: ..� ex cee d s 10 am
°'f g _- r�,_ - ' _ = "' ,,cA�'faft : Qjd (qit hi�T:R�lC . .,, -. am ps at 150 volts or ❑ Floating buildings.
;= "` ` ~' : rN >.a _: -s = ,..ins < -a �« :,; :- . :'> :_ :.' `. - less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
1 and 2- family dwelling ❑ Commercialindustrial ❑ Accessory building amps for all other installations. buildings.
` oMulti- family ❑Master builder ❑Other: 0 Fire pump. buildings.
of 75 KVA or
4 ,s � g .:, ;y : , , , at.,:, s, , :._ f - �..;;.. .;.F�,�r r •. ;:c.,�; > _ —:,,. ;,, ❑ Emergency system. larger separately derived systt
;,
f: - i ":,,�` = •= s: ,;g� , :K :.: ,•= ..• �?:- ,�.,.�°;:«.� - c:sf" _ - 0 Addition of new motor load of ❑.. ..
Job no.: Job site address: "`
� �j C l� IoO or more. occupancy.
C C� �6 )'(J ❑ Six or more residential units.. ❑ Recreational vehicle parks.
City / State/ZIP:
//-1. / � /� El facilities.
❑ Hazardous locations. ❑ Supply voltage for more than
e 600 volts nominal.
Suite/bldg. /apt. no.: 1 Projecf name: ❑ Service or feeder 600 amps or more.
"
Cross street/directions to job site: Description I Qty. I Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or les 145.15
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.40
_ Limited energy, residential . 75.00
: + r.;, _ ;w #y ; e.�'4y -a^s2%ra.r.:.�. s- - - " ;.:,�' ¢ ; .. ; ,. x :. Wi (with above t:
..�r.;: '� >,,���:?._ -= ?.i;�`.._ .r.. �� a C♦N�� W, � y., � % ;. ..�':: "��=.N. .. � sq. ft.)
- �il multi-family
residential (with above s 75.00
`f. ago Limited energy, multi- fam i l y
C ` /%
Services or feeders installation, alteration, and/or relocation
;� 200 amps or less I l 80.30
-- - y "'�,. s , • {3 , _ r _.' :gi -_ -_ _ - :. _ i < _
E , �x% : p ,,' :" TE f 1T ., : x • amps to 400 amps 106.85
�] i�P'RO F�'l�Y ?:UIjY.'N�rR. � [�: ; � 201 taps t 0 taps
Name: 401 amps to 600 amps 160.60 :
601 amps to 1,000 amps 240.60 :
Address: Over 1,000 amps or volts 454.65 :
City/State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) l Fax: ( ) 200 amps or less 66.85
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 :
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
, A "e l .A..-` .t:.zv.. v '..R. a7 a` * �. c. 1 0Tf ;_€�- -x�.gr -r _ .
_ ., PY z YCt11�TI " : ' • ® C9N'tA1 T�s �µ,ER5�OlVS- above service or feeder fee, 2
each branch circuit 6.65 7
Business name: B. Fee for branch circuits
Contact name:
without service or feeder fee, 46.85 :
first branch circuit
Address: Each add'I branch circuit 6.65 :
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 ' :
E -mail: Pump or irrigation circle 53.40 :
f >,�.. .s 5 ='f :•t�;'- :r.'� =?fc`> .7 r ,. - s ,. £..._ ,:.3x0 : - - _ Sign 4
.h- ..:� " "' ':fir': � ��3�Cf)n1?�iA �, - ()Ii "��'�; >- _ _ ,:.: - : `� g or outline lighting 53.0
Signal circuit(s) or limited-
Business name:
f J - / _. 1, ' energy pan el, alteration, or
Address: A � -7. extension. Describe: Page 2 ,
I
City /State/ZIP: i/J/ `j i/�� Each additional inspection over allowable in any of the above
...... Per inspection 62.50
Phone: ( ' . � 1 �: � . / Investigation per hour (I hr min) 62.50
Industrial plant per hour 73.75
- :_ ` P •EL'
CCB Lic.: / — 13 �A" - Electrical Lic.773 Suprv. Lic.: ( P T
/ - 172ICAL` ;PERMIT: :FE_ES <: (fJti
Suprv. Electrician signature, required: Subtotal: 9
Print name: ��� G c � o
r n � f Date: Plan review (25% of permit fee):
State surcharge (8% of permit fee): 1l
Authorized signat e: TOTAL PERMIT FEE: /O g
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.