Permit -: --. CITY OF TIGARD ELECTRICAL PERMIT
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2 t COMMUNITY DEVELOPMENT Permit #: ELC2009-00365
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/22/2009
Parcel: 2S104CD10700
Jurisdiction: Tigard
Site address: 13835 SW HILLSHIRE DR
Subdivision: Lot: 0
Project: Cook
Project Description: (4) branch circuits for kitchen remodel.
Owner: FEES
COOK, THOMAS L & LINDA G Quantity Description Date Amount
13835 SW HILLSHIRE DE
TIGARD, OR 97223 4 crt Branch Circuits 07/22/2009 $66.80
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/22/2009 $8.02
Electrical
Contractor:
EVENT POWER & LIGHTING INC
170 LAHTI RD
WOODLAND, WA 98674
PHONE: 360- 255 -3830
FAX:
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 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 wor. ' suspended for more the 180
days. ATTEN •. • -.• - law requir -s you to follow the rules adopted by the Oregon Utility Notification Center. ose les are set forth in OAR
952- 001 -00 . through OAR 952 -0•• -r 10 .0 • obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 o 1.800.332. 344.
�i
Issued (21
_ � �_ . L_ Permittee Signature: / /��
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 INST• LLATION ONLY /
SIGNATURE OF SUPR. ELEC' �` 4 0r `/ ` 4 Date: � 7
LICENSE NO. 3 5
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.
Electrical Permit Application FOR OFFICE USE ONLY
J
City of Tigard DateB / Permit No.: t.Aadl` =e' 566
Ilk ='r w ` 13125 SW Hall Blvd., Tigard, OR 97223 Plan R view
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Pernut:
} Inspection Line: 503.639.4175 Date Ready/By: Jun El See Page 2 for
T }GAR
Internet: www.tigard-or.gov N o tified/Method: lemental Information
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- , w - • •v��2.- , ':TYPE , OF "••WOR K: , a Y ? � ..n, 2 ` - ' c a. x'` "P :IAN RE VIEW`,:, ;;: r _ .sr , a7r
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['New construction /� Addition /alteration /replacement a 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. - _
t-,-,r - v_ : ¢' °r -..--:.;.,"'4,,-`- R ' "' i .vr ' •)' t'ry ` q s °"' exceeds 10,000 amps at 150 volts or _c I=1 Floating buildings-
"') °D-?- - 'CAEGORY.. =OF ;CON STRUCTION - : . t- w -; r, .-, t -4'
, less toground,or exceeds 14,000 ❑ Commercial -use agricultural
l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family - ❑ Master builder ❑ Other: ❑ Fire pump. ['Installation of 75 KVA or
= ❑ Emergency system. larger separately derived system.
� _7 ; V.:"..; r. k a : JOBt riTbIFORIVIATIN :AND L_ OGATION i.; y _,r-`4 A «t-
>i:;; - 't m .. _ � � ,,. -. N ,wr ,.� - , O. , ��: -�.�__ , -.... sF� � �.� >„< � . �r.� , . , s .., „, ❑Addition of new motor load of ❑ .> Z „ ,. 3 »
Job no.: Job site address: 13 4s3 6 t. t �, 5 h ,'' N 100 or or more more. R occupancy.
❑ Six or more residential units. ['Recreational vehicle parks.
City/State/ZIP: 4 f ❑ Health -care facilities. 1:1 Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: cloo K K,, -c LeG ❑ Service or feeder 600 amps or more.
I ( , -. ;'=:- = 3 �- :,r.�;�� .-; �. F EE ;�SGH EDUGE_', " ',�;�.:- �.,.��,� -�:; °: s. , ;, -�
Cross street/directions to job site: s1- Me '-- I N,' I l -e Descri 1 Qty. I Fee. I Total 1
1 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'l 500 sq. ft. or portion 33.40 1
Limited energy, residential
=' 's. ;17 T 4_,,, - =a - t : > � � - n 75.00 2
- _,.,_„ _ fi r + Y , < ^ . =s _ ,. DES CRIPTIO N - OF W O R K > „ ' _ , f 1 ,- n -` ga r+':p (with above sq. ft.)
m Limited energy, multi - family
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
'',. _ = X ®= •P ROPE R TYP,O .W N E R ; . . „ .: T ENA 4- id' 201 am s to 400 am s 106.85 2
Name: 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
relocation
Phone: ( ) Fax: ( ) 200 amps or less - ' 66 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
r ;r .. _ = s =' ��[��'�APP.LIG 1 ,� : ,. ;' a. f< C ONT -PE ' / J above service or feeder fee, '
��`a�`k ..�:.` -- y ff —te -� -. ., N . -" _ , ..� �.�:F� � .`_ .. _ _7 .- .s....R
. s r, o. . a._�t$
each branch circuit 6.65 2
Business name:6 L c y .3',, l I V...0 B. Fee for branch circuits
Contact name' G `� without service or feeder fee, l I 46.85 2
Dr'1 h� first branch circuit
Address: PO Qo X 5/y • - ^ Each add'I branch circuit 6.65 2
r' Miscellaneous (service or feeder not included)
City /Sta /ZIP: C' l�.. leawta OJT ¶ ' ; )/ Each manufactured or modular 90.90 2
Phone. ( p ) ?S 3 ` 20d Fax.. (4 3) q dwelling, service and/or feeder
.3 Z ! ^ q c3�• Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
., ‘- ,W.., 7 r T .i ; GONTRAGT O R _,- 4 7 y, s;. „ „ ,: 7 -> , 1 '1 ft �v Sign or outline lighting 53.40. 2
Business name:
Signal circuit(s) or limited -
Ei6�� 4 P ) ell/ -1- ) � (/L "1 v Ze energy panel, alteration, or
((.k Address: 70 /' / .� ( ` t/ extension. Describe: Page 2 2
\ City /State /ZIP: / j��� } I g�/62v 1 Each additional inspection over allowable in any of the above
" 0 Phone: i G C / � `` Per inspection 62.50
LZO) .As �--� � Fax: ( \,\\ tQ I \ Investigation per hour (1 hr min) 62.50
CCB Lic.: /i / / Electrical Lic.: y ) � uprv. Lic.: 32. Industrial plant per hour ' 73.75
:Ogt;F_ P P R ISIWFE _ . tt. 414 -4 t;',z . - .
\ Suprv. Electrician signature, required: Subtotal:
. --------- 7D Print name: ` a ki c � /� Date:
Plan review (25% of permit tee):
'r L' t State surcharge(12 %ofpermitfee): Off-,
°7/./. Authorized signature: TOTAL PERMIT FEE: °7/./ g�
This permit application expires if a permit is not obtained within 180
Print name: Date days after it has been accepted as complete.