Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00479
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/11 /2009
TIG1R13 Parcel: 2S110BB02200
Jurisdiction: Tigard
Site address: 14340 SW HAZELHILL DR
Subdivision: Lot: 0
Project: Wilton
Project Description: (4) branch circuits, to correct previous electrical work done by done others.
Owner: FEES
WILTON, LANE H Quantity Description Date Amount
14340 SW HAZEL HILL DR
TIGARD, OR 97224 4 crt Branch Circuits 09/11/2009 $66.80
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/11/2009 $8.02
Electrical
Contractor:
WILSONVILLE ELECTRIC INC
PO BOX 845
WILSONVILLE, OR 97070
PHONE: 503 - 638 -5353
FAX: 503 - 638 -8804
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.82
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 la,... All work will
be done in ac • - - I approved plans. This permit will expire if work is not started within 180 days of issuance or if wor.. suspend-. for ore the 180
days. ATT TION: Oregon =w -q.'res you to follow the rules adopted by the Oregon Utility Notification c . ter. rules a - set ,orth in O; R
952 -001- 10 through OAR 952 -r • 1 -0100. Y I may obtain a copy of the rules or direct questions to OUNC by calling 503.246 • .A,j : z c. 32.2344.
Issu d By: Permittee Signature: I `
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:
NTR CTO r INST, LLAT ON ONLY
J �1.
SIGNATURE OF S UPR. ELEC' - �, ���= Date: 9X/ F,
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.
• l
Eictrical Permit Applicati ECEI\ ED FOR OFFICE USE ONLY V
I 1 . I Received Q Ch ��o� / /
ic. City of Tigard Date/B : [N
I' 13125 SW Hall Blvd., Tigard, OR 9722 C Plan Review Pe rmit No.: s/ C
, ° Phone: 503.639.4171 Fax: 503.598.1 ' 1 2009 Date/B : Other Permit:
:TI GA '
D. Inspection Line: 503.639.4175 Date Ready/By: El See Page 2 for
11. . ' Internet: www.tigard-or.gov CITY Notified/Method: Supplemental Information
TYPE OF [ I:DING DIVISION PLAN REVIEW
❑ New construction jJ Addition/alteration/replacement ' 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
gt1 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
• Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "l - ", "I - ",
I00HP or more. occupancy.
Job no.: Job site address: I L/34W
.6.0, i, p 1 n � �t` n ❑ Six or more residential units. 0 Recreational vehicle parks.
City/State /ZIP: Tit a, I o 9 . q 9 a2 - 4 d � � ❑ Healthcare facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: uu t t__- ) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
a WI, Dl kJ G 10 a Ai 0 y 0 5 residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 2
.- PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: (• .--0 l L._ /0 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
tY relocation
Phone: ( ) 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
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, / 46.85 / / s
Contact name: first branch circuit C a
Address: Each add'l branch circuit 3 6.65 J 2
Miscellaneous (service or feeder not included) r i
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
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
f 7 1S �/ C (_,�. � i 6, energy panel, alteration, or
Address: ?- 6 ) r e) 0 z" �' !� extension. Describe: Page 2 2
City/State /ZIP: 1 I- �4 p AP e J Each additional inspection over allowable in any of the above
{ f / J 14 �' / N Per inspection 62.50
x <
Phone: ( ) b ?r < j 3 v- Fax: SI . 63 t,/ Investigation per hour p hr min) 62.50
CCB Lie.: 75 -7 q Electrical ic.: 3 v A Lie.: Industrial plant per hour 73.75
WAIIII /^ 7. ��' ELECTRICAL PERMIT FEES
Suprv. Electrician signature, resui .. ' ' 'F ... Subtotal: 4, // , can
Plan review (25% of permit fee): Q ,X
Print name: , -� f �� /. Dat : / % State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 91 . r,
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.