Permit ' CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00456
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/04/2009
Parcel: 2S104BA11700
Jurisdiction: Tigard
Site address: 13529 SW LIDEN DR
Subdivision: Lot: 0
Project: Nguyen
Project Description: Install (2) branch circuits for a/c and sump pump.
Owner: FEES
NGUYEN, TONY DUNG & Quantity Description Date Amount
VUONG, TIFFANY TUYEN, 13529 SW LIDEN DR 1 ea 12% State Surcharge - 09/04/2009 $5.62
TIGARD, OR 97223 Electrical
PHONE: 2 crt Branch Circuits 09/04/2009 $53.50
wo /Purchase Service or
Feeder
Contractor: 0 ea 12% State Surcharge - 09/04/2009 $0.80
MILESTONE ELECTRIC Electrical
1800 NW 169TH PL. SUITE B700
BEAVERTON, OR 97006
PHONE: 503 - 645 -5323
FAX: 503- 690 -4843
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 - • - - h 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. ' ENTION: Oregon or., re• ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- through OAR 952 -0 s —0 1 00 o may obtain a copy of the rules or direct questions to OUNC by • 03. 46.6699 or 1.800.332.2344.
Is ued By: / L 1_ I .L�_�� Permittee Sign. e: _ �_','' ✓ %� %?
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' t , .4 Date:
#11110111112o-- .
, �
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 sits at the time of each inspection.
• Electrical Permit AplJlieationRF i
Ft c 4 I ('Run lct I SF O I.V •
City of Tigard S EP 0 3 2009 9�0 9 % 4 Pe.,a�aNe.: (44 ' 1°4191°
1111 4 0 13125 SW Ball Blvd Tigard OR 97223 ga
C ' Phone: 503.639.4171 Farr: 503.598.1960 1, _ : Ot er Permit
1 t tj A h I - ) Inspection Line 503.639.4175 CITY OF TiG RD l>awaeadl RIMIAERRES
Internet www.tigard -or.gov j1 din r w,r s, Noti6ediMethod
Bl1,LDir a Dir I �.� .
' .••. TYPE OF WORK P AI`i, Y21E1P'IEW .
[] • New construction Addition/alterstion/rep1acement : P� cheek all that apply (arrant Z sets of plans w /stemscberked below):
Demolition Other: O Service or feeder 400 amps or more LiBuilding over three stories.
where the available fault current Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or E lFloating buildings.
dwelling t ;o tnmereiaUindtlstrial Accessory building leis to !round, or exoeeds 14.000 Ca Commereial -use agricultural
1 -and 2—family
Y g Q . Q rY g amps for al other instalbrions. buildings.
Q Multi- family 0. Master builder (3 Other: : DEra PwnP• Qlnsmlhtion of 75 ICVA or
J46 SITE INFORMATION AMID LOCATION Ll�ereenoy system. larger separately derived system.
QAdditioa of new motor load of Q "A" "B", "1 -2 "1 -9",
w( Job site address: ' �a9 � ' f ix or or more, Rec
Job no.: O .� er^
y � . w � � ' Q Six oc more residential units. Q Recreational vrLicle p
City /State/ZIP: ^ t t1 4 a . QIiealth - care facilities Q Supply voltage more than
!. r : • . - DIfarardous locations. 600 volts nominal.
Suite/bldg /apt no.: Project name: v ir � irle �* " i IService or feeder 600 amps or more.
• Cross street/directions to it
b o se: F SCE y-
� 1 Oh - i Pen F .Toter f •
New residential single- or multi- fllmily dwelling unit.
Includes. attached garage.
Subdivision: I Lat no.:
i 1,000 sq. R or less : 145.15 - 4
Ea. add'I 500 sq. f. or portion . , 33.40: 1
Tax map /parcel no.: s
.... .. 75 00 2
• .. ,. . ... - :
{
...:.: :. . , ; :.D LION-. O>F ,!GVOBK�:: �' = .. L.t � t w ith abo
� sq - il�
11 .... Limited energy, mtrhi- famr7y 75.00 2
AS{a'l` 1 loral�c - Gird mil- for A.c . ( I) • residential (with above sq. tt .)'
• Services or feeders installation. alteration, and/or relocation
rJ 1A m Q P p Rt? c e A G 1Q. 200 amps or legs 80.30: 12
PRbP) RTX OQVNE .'. .. . : . .. . �.:'FENANI : 201 amps to 400 tamps 106.85 2 '
Name: 401 amps to 600 amps t : 160,60 : 2
' 601 amps to 1,000 amps • 240.60 2 :
Addles: ' Over 1,000 amps or volts E ' 454.65 2
City/ State/ZIP: Temporary ser vic s or feeders installation, alteration, and/or •
relocation 1
Phone: ( ) ; Fax: ( ) 200 amps or less ` 66.85 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 exte lion, r panel
A. Fee for branch circuits with
.Q APPLICA • : NT .' , , Q, CONTACT ;KliiSON. •• . above service or feeder fee. 6.65 • 2
each branch circuit
Business name: b. Fee for branch circuits r ,
Contact name: without sice or Seeder fee, I 46.85 . 4] 6
ery • 2
first branch circuit
Address: Each add'I branch circuit . I 6.65 ' (,6 2
Miscallandens (service or feeder not included)
City / State/ZIP: Each memnfacnued err modular t
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax:: ( ) : Reconnect only : 66.85 ' 2 •
E -mail: : Pump or irrigation circle . 53.40 , 2 '
CONT . 2
RAC FOR Sign or ourtliae lighting 53 40
Signal circuits) or /united-
Business name: V ' - . I - • le r t : energy panel, alteration Or '
A dress: gp0 Ow 69 +6 Ri r / � �Ss � � /* — 7 tab :extension. Destribe: Page 2 a •
. City / State/ZIP: g P.O►(� t°.r �' OY1 Or. 9 / 0 O b • Each additional- inspection over allowable 1n any otthe above -•
Per inspection - 62.50 .
Phone: (903) 6115 _ . 2-, 3 : Fax: (9u. ) ((J H 4 L.r 3 : Investi per hour (1 hr min) • - 62.50 ,
CCB Lie.: 153 L1? 0 Electrical Lie.: Y f -- GI / C Suprv. Lie.: a 73.5 : Industrial plant per hour : 73,75
/ ELECTRICAL 1PERMIT> FEES..
Suprv. Electrician signature, required: Li t i A &m...i„� Subtotal: ' 3
!
Print name: Date:
9 / ' / 0 9 Plan review (25% of permit fa):
w i i to IVY La = I Stare surcharge (12% of permit f a): . 6 t y a
Authorized signature: TOTAL PERMIT FEE: S9. 9 1
Print name: Date: 'ibis permit application expiem It a permit is not obtained within. 180
says afterithas beenaccepted or.mmptete
• Nrmrber of inspections allowed per permit.
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