Permit CITY OF TIGARD ELECTRICAL PERMIT
1 1- . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00199
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/06/2009
Parcel: 2S104CA02000
Jurisdiction: Tigard
Site address: 13711 SW LAUREN LN
Subdivision: Lot: 0
Project: March
Project Description: Install (2) branch circuits in kitchen.
Owner: FEES
MARCH, HENRY J & VICKI G Quantity Description Date Amount
13711 SW LAUREN LN 2 crt Branch Circuits 05/06/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder ..
2 ea 12% State Surcharge - 05/06/2009 $6.42
Contractor: Electrical
FULL CIRCUIT CONSTRUCTION
3325 NE 29TH AVE
PORTLAND, OR 97212
PHONE: 503 - 249 -5095
FAX: 503- 249 -5089
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 --= _ : • - - with approved plans. This permit will expire if work is not started within 180 days ' suance, or ‘ wo ' is - 'ended for more the
180 day ATTENTION: Ore. I equires you to follow the rules adopted by the Oregon Utility Notifi a on Center. ■ose ule. - set forth in OAR
952 -0 0010 thro gh OAR 952 -OJ, -0101 I ay obtain a copy of the rules or direct questions to OUNC by calling 5 . 699 or 1.801- 32.::I, • � A
I -d By: \ — - - - , At .� L`.l .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:
CO t,TR 0 OR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N : , i , Date: ^ ((' U
LICENSE NO. 5 0 4 1Y0 S __ __ _,_
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.
1.
It
Electrical Permit Application - + FOR OFFICE USE ONLY
C of Tigard Date /B Q Permit No. 44011. t i
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date /By: Other Permit.
TIGAR`D Inspection Line: 503.639.4175 Date Ready /By: luris El See Page 2 for
Internet: www.tigard - or.gov Notified /Method. / Supplemental Information
TYPE OF -WORK " >.,,.it =tom •_PLAN. - REVIEW
❑ New construction 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 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1 -and 2- family dwelling ❑Commercial /industrial ❑ building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ `A ", "E ", "I - ", ' l -3 ",
Job no.: Job site address:
3 `? I S Le021.-1-4 G. N 10OHP or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP: `/ T` 2 2 3 ❑ Health -care facilities. ❑ Supply voltage for more than
`-r J ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
- - -FEE SCHEDULE
Cross street /directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. 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
RI{
DESCRIPTION OF � WO ,„ , ' _ _; " „ , 7.. (with above sq. ft.)
g
l i
,-7 Limited energy, multi - family
A YY(, fl z. Lid V �V t�. c j R. C. V V T residential (with above sq. ft.) 75.00 2
( � Services or feeders installation, alteration, and /or relocation
F x - rte )v,(1 I I C- )14?/ 67 Cl t"'C U ' t` OC umd ercAhmer /I4hz3 200 amps or less 80.30 2
PROPERTY OWNER: `, " ' °❑' TENANT' ; ' 201 amps to 400 amps 106.85 2
Name: e vt r4 d., Ui GK t ta�c,k 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: S A- teV". -e__ 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 66.85 l
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
. NAPPLICANT - '❑ CONTACT PERSON , `,:_ above service or feeder fee, 6.65 2
each branch circuit
Business name: Vv C `e CV t - C .,,. r v c ._-c - l O `ti B. Fee for branch circuits
without service or feeder fee, L 46.85 l/ 6-� y
2
(,O s 1,N, Contact name: , , p \\.€, r e. r first branch circuit
Address: 33 2 t- 1 I " 2_0 fl / -V Each add'I branch circuit I 6.65 6 . 65 2
t !� t Miscellaneous (service or feeder not included)
City /State /ZIP: qt> P \ppvt. CO — q 1 2 2_— Each manufactured or modular 90.90 2
dwelling, service and /or feeder
Phone: (.50 )2 .... � � Fax: : (5 Z 5 ) L(� 7 9Cf Reconnect only 66.85 2
E -mail: .J� V 1 1C lrGtl C. Y\e, -1, Pump or irrigation circle 53.40 2
' CONTRACTOR ' Sign or outline lighting 53.40 2
` Signal circuit(s) or limited -
Business name:
�J 1 ' is. ; 1 / 1 I A vt I energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) 4� 16\\I\ Fax: ( ) y 1( Investigation per hour (I hr tin) 62.50 CCB Lie.: 1 S4{ t % VElectrica 'c.: 26.,111') prv. Lie.: 50. 6 Industrial plant per hour 73.7
r � ( U
v ;' .' - ELECTRICAL: PERMIT :FEES -
Suprv. Electrician signature. required: " \ CA (0 / r Subtotal: S C 9 3 5
Plan review (25% of permit fee):
Print name: 00 S S G N./A L L C g eR Date: E. 6. 0 e
` State surcharge (12% of permit fee): & 2
Authorized signature: 1 Z, dye TOTAL PERMIT FEE: 2
rl • �w cp. (� [` r • This permit application expires if a permit is not obtained within 1
Print name p G K K Date: J t� days after it has been accepted as complete.
* Number of inspections allowed per permit.
I \Building \Permits \ELC- PermiApp.doc 05/23/06 440 -46 15T( I 1 /05 /COM/WEB