Permit 4
` ,, CITY OF TIGARD ELECTRICAL PERMIT
. : - • ,. • 711
_ . It COMMUNITY DEVELOPMENT Permit #: ELC2009 -00500
T1G 13125 SW Hall Blvd. Tigard OR 97223 503.639.4171 Date Issued: 09/24/2009
. Parcel: 2S111AB05100
Jurisdiction: Tigard
Site address: 9100 SW INEZ ST
Subdivision: Lot: 0
Project: Conder
Project Description: Add /alter (1) branch circuit for HVAC.
Owner: FEES
CONDER, ELDON LAMAR & ROBIN K Quantity Description Date Amount
9100 SW INEZ
TIGARD, OR 97224 2 crt Branch Circuits 09/24/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/24/2009 $6.42
Electrical
Contractor:
CUSTOM ELECTRIC CONTRACTORS LLC
6715 NE ST STE 103 # 175
VANCOUVER, WA 98661
PHONE: 360 -608 -8029
FAX: 360- 750 -6873
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 throug- h�� (
J ` 1
OAR 9952- 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: C n--(. (L9 ( £LI k klUN Permittee Signature: Q Apto
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. ..
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.
II - ♦ t'
RECEIVED
Ele Permit A lication ��yy e I OR ()mil. I �L, ()Nix .
( r ���� Received Pe mtit No.: y 2 o c" m
City of Tigard S Receiv ` 1
• 13125 SW Hall Rlvd.. Tigard, OR 97223 Plan Review
l Phone: 503,639.4171 Fax: 503 .071400F TIGARD Date/Et ; Other Permit:
i ft i Alt Inspection Line: 503.639.4175 B UILDING DIVISION f)nle Ready/ny: lurk: See rage 2 far - --
Internet; www.tigard- or.gov Notified/Method; ' j ( Supplemental Information
TYPE OF WORK Print name: 1
❑ New construction ,Addition /alteration /replacement
111 Demolition
❑ Other: PLAN REVIEW
Please 'Meek all that apply (submit 2 sets of plans w/itetns checked below):
CATEGORY OF CONSTRUCTION r ❑Servico or feeder 400 amps or more ❑ Building over this
f24 and 2- family dwelling ❑ Commercial /industrial U Accessory building where the nwtilabte fault current stories.
❑ Multi - family O Master builder ❑ Other: exceeds 10,000 amps at ISO volts or ❑ Marinas and boatyards.
less to ground, or exceeds 14,000 ❑ Floating buildin s
JOB SITE INFORMATION AND LOCATION rr� for all other installations, 8
0 pump. El
O
Job no.: Job site address: ' j t,/ � - P• agricultural
t — ❑Emergency system, buildings.
City /State /ZIP: T • /0 �� (7 / 7 %. (-/ ❑Add i tion of new motor load o f ❑ Installation of 75 KVA
Suite/bldg. /apt. no.: Project name: IOOHP or morn. or
❑Six or more residential units. larger separately derived system.
Cross street/directions to i
job �o site: CI "A ", "F ", "1 -2 ", "1.3 ",
l ❑ Health -cart facilities.
occupancy. Reefealietlal vehteln
❑ l lnzttrdous locations.
— — ❑ ❑ Service n, feeder 600 parks.
Subdivision: Lot no.: � amps or more. ❑ Supply voltage for
morn t
Tax map /parcel no.: 600 volts nominal.
DESCRIPTION OF WORK
. (Jt) I l PG t''- Ct.' t/, V// p t-- r'l. I I / t 7- FEE SCHEDULE:
D.4.:,,,.., f Qty. I - Fee, J Tatat I '
New residential single- or multi - family dwelling unit.
Includes attached karage.
❑ PROPERTY OWNER ❑ TENANT 1,000 sq. 9. or less 145.15 4
Name: Ea. add'l 500 sq. ft. or Portion 33.40 1
Limited energy, residential 7500 2
Address: (with above sq. ft,_
Limited energy, multi - family
City /State /Lll': residential (with above bq, ft.) 75,00 2
Phone: ( ) Fax: ( ) Services or feeders instaliationolteraiion, and /or relocation
200 amps or less 80.30 2
Owner installation: 'This installation is being trade on property that I own which is not 201 amps to 400 amps 106.85 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 „s to 600 amps 160.60 2
Owner signature: Date: _ 601 amps to 1,000 amps 240.60 2
❑ APPLICANT 1 ❑ CONTACT PERSON Over 1,000 amps or volts 454.65 2
Temporary services or feeders installation, alteration, and/or
Business name: relocation
Contact name:
200 amps or less 66.85 1
201 amps to 400 amps 100.30 2
Address: 401 amps to 599 amps 133,75 2
Branch circuits - new, alteration, or eXtenelon rReer P anel
City /Statc/LIP: A. Foc for branch circuits with
( ) above service or feeder fee, 6 65 2
Phone: ( ) Fax: :
each branch circuit
E-mail: B. Fee for branch circuits i �—
CONTRACTOR withou service o feeder fcc
first branch circuit 46,85 2
Business name: C S f ,,,,, 64 t,',' 6.:. r. t . 1 . 5 L, 4 C Each add'l branch circuit 6.65 2
e Miscellaneous (service or feeder not included
Q. Address: 7l c N 1 7 f 5 , ,,,, �'
�3 /7.5-- Each manufactured or modular
90.90 2
City/State/ZIP: c dwelling, service and/or feeder
C,10 0 * c.c , G-C� cwt/ i � 6 s��
f D --- - Reconnect only 66.85 2
Phone: hone: ( ) - Fes (36' _ 3 Pump or irrigation circle 53.40 2
r - Sign or outline lighting 53.40 2
—]
CCB C ie.: i i J 7 y et Electrical Lie C 2 r 1 Suprv. Lic.: 5 z 67 5 S i ”'
Signal p an e l,(a) er t o n, or
l Suprv. Electrician signature, required: l� r / eas energy panel, alteration, or
extension. Describe: Page 2 2
t I Print name: ,e` rt o �f e _Date: � Z _� Each additional inspection over allowable in an of the above
I 0 Authorized signature: r• Per inspection 62,50
.. I . Investigation per hour (I hr min) 62.50
l 0 I:V BuildinglPermitrlWl.C- PennitApp doe tt /Z1 /q6 n n L'o
4 59 t� ^7
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