Permit j l
CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPM Permit #: ELC2009-00490
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/18/2009
Parcel: 2S 111 CC09800
Jurisdiction: Tigard
Site address: 15760 SW GREENS WAY
Subdivision: Lot: 0
Project: Vanlente
Project Description: (3) branch circuits for kitchen
Owner: FEES
VANLENTE, SUSAN H Quantity Description Date Amount
15760 SW GREENS WAY
TIGARD, OR 97224 3 crt Branch Circuits 09/18/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/18/2009 $7.22
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 - 266 -1349
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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: Permittee Signature: ,f' ° / 90 ' P & /
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:
LICENSE NO.
Cali 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 Appli 1" , Ell/ED F OR FOR USE ONL
City of Tigard Received , ��
I r Date/B : � ♦ , Permit No.: '- h
13125 SW Hall Blvd., Tigard, ID m4 8 2009 �'� ��
2 Phone: 503.639.4171 Fax: 50 1 0 Plan Review
Date/By: Other Permit:
7I G A t D Inspection Line: 503.639.4175 Date Ready,By r rls ®See Page 2 for
Internet www.ligard -or.gov CITY OF TIGARD NotifiedRvlethod: 7-7 6 Supplemental Information
TV A% IVISION ,
PLAN REVIEW
El New construction r tddifion/alteration/replacement Please check all that apply (submit 2 sets of plans w(ileuts checked below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ O ther: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- and 2- family dwelling less to ground. or exceeds 14,000 ❑ Commercial -use agricultural
g ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder
0 Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A "E ", "I - ", "1 - ",
Job no.: I Job site address: i 5 760 5v) G r e _ KS ��/ I OOHP or mare occupancy.
Iv / ❑ Six or mare residential units ❑ Recreational vehicle parks.
City/State/ZIP: t t� h� ❑ Healthcare facilities. ❑ Supply voltage for more than
[(Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: I Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Oncrilwion I Qty. I Fe,. ] 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
Tax map /parcel no.: Ea add'] 500 sq. ft or portion 33.40 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. f) 75,00 2
/ r fA Limited energy, multi- family
J [ ` 't I� residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
EiP OWNER L] TENANT 201 amps to 400 amps 106.85 2
Name: fJ /9711L giV -- S — CeS / 9„ / 401 amps to 600 amps 160.60 2
Address: � / a � 601 amps to 1,000 amps 240.60 2
�er ' r i C Over 1,000 amps or volts 454.65 2
City/State/ZIP: r Temporary services or feeders installation, alteration, anti/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
Owner signature: Date: Branch circuits— new, alteration, or extension, p erpanet
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, I
Business name: each branch circuit e � 6.65 i 2
B. Fcc for branch circuits
Contact name: wlthour service or feeder fcc, ` 46.85 tit, 17 L I
first branch circuit I
Address: Each add'] branch circuit J 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone dwelling, service and /or feeder 40.90. 2
( ) Fax:: ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: pp D f ■ s - -- E — �`� Signal circuit(s) or limited -
�+.+ -f Fl.f. =C. 1 r W- energy panel, alteration, or
Address: ( I ) - CI r b 31 LI p J extension. Describe: Page 2 2
City /State/ZIP: t ,yriter if i t e _ p c eC/! j0 Each additional inspection over allowable in any of the above
Phone Ill) 3 8 i ` I I v Fax: ( '7' ( � �1 ! ' I Per inspection 62.50
(04 1 ( 3'7 1 Investigation per hour (1 Ire min) 62.50
CCB Lie.: Vb 0 1, Electrical Lie.: g ` Suprv. Lie.: 5-1D7 -5 Industrial plant per hour 73.75 I
r •
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
•
t ...-N_____`
Subtotal: ► . le.,
Print name: ` _ t��� Die: Cry review (25% of permit fee):
Authorized signature:
I v ! State surcharge (12% of permit fee): � r �ii
TOTAL PERMIT FEE :`'.
Print name: Date: This permit application expires if a permit is not obtained within 180
! days after it has been accepted as complete.
r:\Bu 1d. g1Pe m is ELC PmnitApp,doc OS/ 7ro6
• Number of inspections allowed per permit.
440- 66l5T(I 11051COM/WEB
Z'd 617C 699ZC09 o!aloala rain cad dC0 60 60 L I- daS