Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00402
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/05/2009
Parcel: 2S115AA03100
Jurisdiction: Tigard
Site address: 10740 SW KENT ST
Subdivision: Lot: 0
Project: Platt
Project Description: (2) branch circuits for A/C
Owner: FEES
KARLA PIATT Quantity Description Date Amount
10740 SW KENT ST. 2 crt Branch Circuits 08/05/2009 $53.50
TIGARD, OR 97224 wo /Purchase Service or
PHONE: 503 - 504 -3963 Feeder
1 ea 12% State Surcharge - 08/05/2009 $6.42
Electrical
Contractor:
GRF ELECTRIC
15460 S PARADISE LN
MULINO, OR 97042
PHONE: 503 - 829 -4146
FAX: 503 - 829 -5747
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 through OAR 952 - 001 -0199. You 'ay obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800 332.2344.
Issued By: Ad - �1T% /l /L - Permittee Signature: OZ/ i/ 7'T Z/ /0
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.
Au 09 11:45a GRFELECTRIC 5038295747 p.1
Electrical Permit Apvlica vC EIVED ■ 1.1 tlf pi( l' l 1/4.1 5)11,1
City f Tigard 0 3 2009 Reecived / 't��-
131 SW Halt Blvd., Tigard, OR DateB : , s p S f/� Parnit N('''
Phut Review
Phone: 503.639.4171 Fax 50 Da o Pamir 1It.. :\l! Inspection Line: 5(13.639.4175 U11 1 6. jIG � R � Ma
Reedy/By. h e m fil Sea Poles far
lncemer, www.tigard- ar.gor ' UILDING DIVISION NotiGadl1etl.od: r / . 1 Suppkmcntallnfoneatian
E OF WORK ' FLAN REVIEW
0 Now construction dditionlalteralion/replaCemont Plwca check all that apply (ratans(a sets of plans wttmns checked below)_
❑ service of fc do 400 mope ar more 0 Wiling over throe atoriar.
0 Demolition ❑ Other: where the available fault eurmatl ❑ Mfainsr and boatyard:.
CATEGORY OF CONSTRUCTION mud, 1.0,000 env et 150 volts m ❑ FloatiaK buildings,
la at to pound. or exceeds 14,000 CI C mm-radl -aec terkulanl
1- and 2- family dwelling ❑ Commercialfindustrial ❑ Accessory building /IRO for all other installations. building,.
❑Multi- fami]y ❑ Master builder ❑Other: 0 PIaFTrntM1 0 1o00.12tiae
JOS SITE INFORMATION AND LOCATION 0EincrFcocyryeun. larger scpwatelydcrivedtrnan,
❑Mditionofnaw mom toad of ❑ "A','E'.'l•Y'.
fob no.: 1 Job site address: L o p ) le-__ ON? or more. occupancy.
L7! (N I Cr a Six tor more widrnrul units ❑ Recreational vehicle parka.
City /Statr/ZIP: T C ? 2Z- If- Qkleaadt -cue rnailiria+. ❑Suppl vdeago fa rope than
l 1 � ❑ moux Hard Ioauonc. 600 vnnss nomionl.
pt
Suite/bldg. /ano.' P ro ( ` ject name: ;ld 0 service arreader GOO slips ormore.
FEE SCHEDULE
Cross street/directions to job site. or,rrirlinw I Qq. t FA. ( Taut I • .....
New readeutiel siogle or m ulti - ramify dwelling wait.
Includes attached garage.
• Subdivision: f Lot no.. 1,000 SQ. ft or less 145.15 f 4
' Tax map/parcel no : a add' 1 500 sq. ft. or portion 33.40 l •
Limited energy, reside:leaf 75.00 2
DHSCRLPTION OF WORK ,with obese fq. ft)
7 j _ -1-7Z-1 Limited energy, multi - family 75.0!1 2
`'- C .1./4/ 414.1.A £ A Cl / � yY residential (with above sq. R.)
1 Services or faders installation alteration, aodJor relocation
l 200 amps or less 90.30 2
O OWNER J ❑ TENANT , 201 amps to 400 amps 106,85 2
Name: I_ 4 ! Jv f 4 A 401 amps to 600 amps 160.60 2
J ( 601 amps to 1,0011 amps 240.60 2
Address: ) `� S V-- '1-1X... Over 1.000 amps or volts 454.65 EIMIl2
Cir ¶' / '1"7-- 2-i - Temporary servficesorfeeders instal/anon, alteration. a udrnr
ti' _/ relocation
Phone: ( ) C 0 - 3 .r 3 Fax: ( ) 200 s or less 66.65 1
Owner iWtallatioa: This installation is being made on property that [ own which is trot 201 amps to 400 amps 100.30 2.
intended for sale, lease, rent, or =Hinge. according to ORS 447, 449, 670 and 701. 401 amps ea 549 amps 133.75 l 2
ltraneh circuits ntw. alteration, or extension,
Owner signature: Date.
APPZIGNT A. Fcc Gar branch circuits with
❑ CONTACT PERSON above service or feeder fen.
6.65 2
each branch circuit
Business names • B. Fcc for branch circuits
Contact ngmo; wRhoHt nausea or feeder Ice,
first branch circuit 46.85 ' { f2 � �. 2
Address: Each add'1 branch emus 1 6.65 .1r i 2
Miscellaneous (service pr feeder nor include
City /State/ZIP: Each rnanufacrwsd of modular
dwelling. service tud/or feeder
Phone: 90.90 2
( ) I Fax ( ) Reconnect only 66.85 i 2
Email: Pump or irrigation circle 53.40 2
• CONTRACTOR Sign or outline liglsing 53.40 2.
Business name; C 6 Signal ciretnt(s) at I mired-
L energy panel. alteration or
Addresa:. ] C/ () r 1 otcocnaien. Descra)ac: Page 2 2
L
CitylSmze/1IP: LA 1 ' f 0 Oft- .-. a Each additional la tpcction over allowable in in of the a ba r
• Phone: ( 9.)) 2-- inspection 62.50
g9 Fes ( � ) . nvcstigatian per hour ft t,r min) 62.50 �'
CCB Lie.: `76 ElectricalLic.4 Suprv. Lie,: " , Industrial ptanr per hour 73.75
Suprv. Electrician signaalize,required: .. • ELECTRICAL PERMIT s
Nrs • - .*1 Subtotal: AIM.
• Print Rome: L + ' S Date: '� d
Mal (25 ° /.ofpermit fee): MIMI
+ State surcharge (12'A of permit fee): 111111/212.
Authorised signature /
TOTAL PERMIT FE . . _ %
-- - ate: - pplicnaon tepiref If a.perreia is M e
.kuinerte tt .tg0 -- -
Print �att1C: -. -- - D This pervele a tlays a fter is has beet Reamed as cemplatr V f
• Numba of inaprct allnwai per perm(.
VaviYdjiheranIgUalGPmtnimvf.loc 115111 a • '410.4d IST1114.1,COMIMr£9