Permit CITY OF TIGARD ELECTRICAL PERMIT
` °'- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00038
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/25/2012
Parcel: 2S110AD90019
Jurisdiction: Tigard
Site address: 14864 SW 109TH AVE
Project: FEDERAL NATIONAL MORTGAGE ASSOCIATION Subdivision: CANTERBURY WOODS CONDO Lot: 19
Project Description: Reconnect only.
Contractor: Owner: FEDERAL NATIONAL MORTGAGE ASSOCIATION
888 E WALNUT ST
PASADENA, CA 91101
PHONE:
PHONE: 503 - 495 -4945
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/25/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 01/25/2012 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 se\ forth in OAR
952 - 001 -0010 through OAR 95 -r01 -0090. You may •btain a co• of the rule•-ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
i
Issued By: — f_�` Permittee Signature: _
/1110. ..���.�
' 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 the next available inspection date_
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.
JAN-23 -12 18:11 FROM -RE /MAX EQ Grp SSPI 5036268994 T -249 P.002 /006 F -890
Electrical Permit Application hoit oi'i'i 'i.: util•: 11NI.1'
Q\� Received
City of Tigard l Perm No — _ r
/B ; �Gf�„ .
-- '4 13125 SW Hall Blvd., Tigard OR 97"123 r'+
at
Illit o
�\ � � p
M Phone: 503.718.2439 Paz: 503 - 598.119,6 & Q \ �GQ` ' � ` . n -
Other Permit:
. r t ' A it D inspection Line: 503.639.4175 , c ��\ '' Date Ready /fay; lit See Page 2 for
Internet: www,tignrd- or.gov O ' Notitied /Medtod; !FM Supplemental Information
, ;1 -:r,7:i � ;
' C.: ie::c �. M „�75 1 7.. •.p 1 C .. ..r '� .. ; '1 ! r(�, °." ;r ":Y;rl'. - , ,7
'.1� i' .,.` " - t ., 11 . ff .v, U '" r fi I LI „rt 1 k , 't{ r ,, 1 1� 0 •' r �L AtlG 1 r i i;
:a..J� . : S 0 � 0 i .L � {�� J ' f 'i ' T1f��.,4T 7 .ly , ':��`. �.�,.e
: :,,;. ' , r ''-� ” �• � "1 ri .. � .a�, y v/ � .. � r r ,v . ,M.nr� �.. t' �. #1 'r,a�.�,.. r � yr 1
❑ New construction ❑ Addition /alteration /repl`••- ntont Please check all that apply (submit Isola of plans w /items checked P below):
� � t �1 service or feeder 400 amps or mein ❑ Building over three stories.
. Demolition I* Other: V.-t.' A t - . k where the available fault current ❑ Marinas and boatyards.
,,, L :.:.:, ;;;'., ,. c- : a r Noll � .T F . iiif ii" , 10,000 amps nt150volts o Q tilt r Floa gbuildings.
't s 1;N_,{ n tL t1 • � r ,: 1 1 t �' fits;y : �,.Id;,jT lll' 4ir,I,,, exceeds
• -�I - - - - •�'{` { t ° ^'� less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial /industrial Q Accessory building amps for all otfml' installations. buildings.
❑ Multi- family 0 Master builder ❑ Oilier: 0 Installation of75 KVA or
..a..- .-"'. ' ' ''-•:':' .. : ::•• . .... ..... ;F'.-- "�- "" -''''1 ,• ••••r 'W � , »,r W. �. , , ElEmer Emergency system. larger separately derived stem.
n r r c° p r system.
L' z . t ,.. t � • 1' 'l a t ' c
'r. , '� ""'''--.
.L' o t tr I,!s 'off u �" �^V; 1' . i a o �C 1W'� t i � � ^ ^h; 1 ' l .tr
1 l� °i }�' ^l� I T I:„ - -, • if r. „ � ' , h � ... i .tn • , ❑ Addition of new motor loud of D
`� I00HP or afore. occupancy.
Job no. :)_ - /At• Job site address: j 7 _ t . -) L , t v ❑ Six or more residential units. Cl Recreational vehicle parks.
City/State/ZIP : �' e• I ID H facilities, ❑ Supply voltage for more than
�1 Iii _ t/� _ 1] Hazardous locations. 6 volts nominal.
Suite/bldg. /apt. no.: - Project name: � ,) i' `"l . •m,t,
4 ❑ Service or feeder 600 amps or more.
}.' U ��;;.�11 • "•. � },'f.A"I:'; : "�,1 ` 7,1 1 Il I'i�� �'f!^�i!�ai;,j °' - �Y �
T 7 :f
Cross streetldirections to Job site: [ 'r t Y 1� ✓• ( a (' � ` ? De,criptlon Qtv. Fes 1 Toni
�fl � Y New residential single -or multi - fatally dwelling unit.
L ov -(0- -l I' :5>- Includes attached garage,
i 1.000 sq. ft or less 168.54 4
Subdivision: I Lot no. :' -_ -
En. add' 1 500 sq. fl. or portion 33.92
Tax map /parcel no.: D '1 4- � , Limited energy. residential
.,,,, . :,, C • "::I:J 1 -. .i '-,•mt. , J 'i!� L_r, w t� y t t _/ r 75.00 2
?: �: :iii,• ,,:�%, -1 ( :'+ t 1 �~� 4 n -�l •� ' }I C : ,J �., t! 1.
:;:;, �: �_,� ... , .4�1 '
� , S„ , ,1611,LIA. ; t
41.4� z, , ,
r �r t r S ,i!. . , I' 1. u 'a', (widt above s0.. t3 )
Limited energy, multi - famil 75.00 2
A 4 l kJ „ '( c t/ I _ LI / v e `i , / ALuf l I � r �, fi � - residential (with above sq. IL)
I Services or feeders installation, alteration, and/or reooeation
A r ,i a , P AN - a - ' A3` {I amps east 100.70 2
�- , �,: ^ ���. �,
,, i - 200 raps or '
{.. t eak.. u " ' ; .' r ! .. tr ' ra' ran y f r " 4 ' , ,r'!' 400 . 2
':I''; . 4.. ; 0 t 71 `C .. ' 1� , , L ' .0 '1 t.. �t. .4..,''i,,.t r ! 11 �' G. :,i4.:,lr' I 201 amps t04 amps 13356
'.a..:..r.....,... SL�i ,:�I . ), e tl .r � } ,,L. '.t "4; :It � 'i• i;.,�:rr, ,I -
Name: ' c 401 amps to 600 amps 200.34 2
. ,;r • a ' • I d A .. i . at I A ' - 601 amps to 1,000 amps 301.04 2
Address: Cp T , L 5 � — Over 1,000 amps or volts 552.26 2
"� s d- j! Temporary services or feeders Installation, alteration, and /or
City/State./ZIP: p(i,4 /� �Cti, Cam- ( �r relocation —
Phone: 60$) "I% - 45 Its Fax: (ED � / 40 59.36 1
S ) //f5 5 200 amps or less
201 amps to 400 amps 525.08
Owner Installation: This installation is being made on property that I own which is not
intended for sale, lease, c 1, or exchan e, accordit)g to ORS 447, 449, 670, and '701. 401 amps to 599 amps ,
Branch circuits — new, or extension, per panel
168.54 2
n .. ,, l alteration.
signature: Mj.L ' _.. r - r 6111 ;.4 i cidlA Date: ._ , A. Fee for brunch circuits alto
li :C '
u r��i, .m wlFc all C ^ f::�.'ts S " .- r � atJ - i �w a bovesarvieoorfecderfee.
''' . L.+t . :s 131: ;il ;w :
)1, � t5^' e `'. f ,tl� n. y, •t . egg 11,P , 7.42 2
each branch circuit
Business name: II B. Fee for branch circuits without
name: /A19,1 J I n 6„,,,,,,..:10,,, 5 service or feeder fee, first
Contact name; j.-ZI ( 5 4 branch circuit 56.18 2
j Each add'l branch circuit 7.42 1 2
?Q �w
Address; y•.r,'11 / L,t/„ , 7 Miscellaneous (service or feeder not included)
' " -_ , !!l44LL'' p� Each manufactured or modular 67.84 2
Phone:
City/ State /ZIP: �j' � f q `lad Q dwelling, service and/or feeder
' -+ R . J� 2
Kai / �_.ie I Fax: (�j �1 'i��l� c L econnect only , 6784 — —
E � ' Pump or irrigation cirClr: 67,84 2
,,,,,..,..,..1.,..;,.:....,:n.;.:. A,A C i . A CG 111 .� a ' Sign or outline lighting 67.84 2
;�1'• vh ' rU � `C 0 r, ';: n• I :: : j`Y',� r 4. ir1���9 1',IP
_._'LW: _--= i.:'_�L' '. r . � t.fl1 1l ll ..., I'• lt•h�r..l''' 'l 'yP'a.l :.a3i'rri=`ui1 .71U1' i Signal circuit(s) or limited - energy •
Business name: panel, alteration, or extension. Paget 2
each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66,25/ hr ,_
City /State /ZiP: Investigation (1 hr min) 66251 hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00/ hr
CCB Lie.: Electrical Lie.: Suprv. Lie.: , r v (L min Ali g1 t'r„
Subtotal: f7 .
Suprv. Electrician signature, required:
Plan review (25% of permit fee):
Print name: Date: _ State surcharge (12% of permit fee):
TOTAL PERMIT FEE: J_
Authorized signature: This permit application elpires Ira permit is not obtaInc ht wit tin 180
Print name; Date: days after Ir has bean accepted as complete.
N um b er of inspections allowed per permit.
1:\auildln2WmiuIa' LC•PermIiApp.doo 07/0 hb 440- 4615T( I I MS /COM/WEB