Permit p
s 4 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009-00549
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/16/2009
Parcel: 2S104DB05800
Jurisdiction: Tigard
Site address: 13273 SW MAPLECREST CT
Subdivision: Lot: 0
Project:
Project Description: Add (1) branch circuit for a /c.
Owner: FEES
WINDWOOD CONSTRUCTION INC Quantity Description Date Amount
12655 SW NORTH DAKOTA ST
TIGARD, OR 97223 1 crt Branch Circuits 10/16/2009 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/16/2009 $6.74
Electrical
Contractor:
JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123 _
PHONE: 503 - 648 -5144
FAX: 503- 648 -9723
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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. ATTE • ' : • • : • n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 r through OAR 9 -0 100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 %46.6699 or 1.800.332.2344.
Issue• By: .� !a- I ILLS -G - 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:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' � `_`� 1 / 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.
• - 10/15/2009 06:44 5036489723 JERMOE ELECTRIC INC PAGE 01
.a
k + lectrical Permit A lication CEN Recalv FOR OFFICE USE ONLY
City of Tigard F c t r i v Mmit Nn. [C2 Q �5
`
a 13125 SW Hall Blvd., Tigard, OR 97223 e � Plan Review
II ` Phone: 503.639.4171 Fax: 503.598, I . K T J 9 Date/By: Other Permit:
1 I G A It D Inspection Line: 503.639.4175 Date Reudy/By: kris: ® See Page 2 rnr
Internet: www.tigard- or,gov is A • 1GERD Notified/Method: T1 g L SapplemenMb information
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0 New construction ❑ Addition/al oration /replacement Plena clmek eft that apply (submit a seta of plans w /items checked below);
. ❑ Service or reader 400 amps or more ❑ Building over throe stories
❑ Demolition ❑ Other where the available fault current ❑ Marines and boatyard:,
1E`JFJ111!T' 1 I S I .i 1 t q.' t, -�' t+, S 1 , ' I! ,7;77,7.7. :3 Q[CetdS 10 noo amps at ISO volts or ❑ Fleming buildings
t111 114( ; ∎i.ti .., ..i Ha_ '3 - ;::. - t.,i,6. ' ,n
i .� .t1 ,�. J lJf l .. . . ., l l oss to end, or excee 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi- family ❑ Master builder 0 Other: ❑ Fin pump. ❑ Installation of 75 lcvA or
r- ,.,.,•:�: r- e. h ? t:•' i '- vis ,.1F - i 7I P ;I;I.' 7.Trf7. --, "7: ❑Emergcney larger separately derived system.
i i- .q 1 -. : 1 1; t t 1 1 l�l i 1 l .-x i l ' r''Y n 14 { : i , .a1 111!l ,` y, U aj� d/ : l ' : , t pf ? r :.
iti£: z+. t.t,.u. iu.�l,ila6ats i:.�. -, . ,?,I, - t - . ,ru v � i1.1,. .,,�t � r 1 �� �I ln, . ` ... .tit.t � rh . .w: : ❑ Addition of new motor load of ❑ °A «,' "t-3'�.
lob no.: Job site address: ix or rn m lae . occupancy.
Z 3. iffli �� II • ❑ I Six or mo :C r�ddenNal Units. ❑ Recreational vehicle parks
City /State/ZiP: if • / / ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: / I Project name: ❑ Service or feeder Ca am s M mere
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Cross street/directions to job site: Mocrlpu 9
on - 1 F..• Tots •
New residential single- or multi- family dwelling unit.
Includes attached garage. "
Subdivision: I Lot no.: 1,000 sq• ft, or less 145.15 4
Tax map/parcel no.: Ea. add') 500 sq. ft. or portion 33.40 1
Limited reesidential
energy, 75.00 2
l y a.:- 4 i t C r t vt n ' ' 1 art hr tr I, (t,i 'I t - ' • I ! ' it
i
it$ " a °31�t ll a 1 y . !e1 0 .r9 d 1s . 1 . � r1, ;- .0!.11 Ellaf,.�.;.1,.7, ...- .:l :,;:.,. ?11 :,,...:1 (with aboveSQ.ft.) .. `` w t,1, _ ,t om ..a:. , r a n * .•a Limited energy, multi - family 75.00 2
CO AL.-. a C 1i' . i a r? , 1CJ� residential (with above au. ft.)
Services or feeders installation, alteration, and /or relocation
�� } � j ��+ I i' 1 200 amps or less 80.30 2 _
1 `'Ylt,;i: r afiEli , , . i dv11. L a i ` • r,Y, i G i 1 �i rurFi r G,... 4 . .II F.t: uJlk. .,:..u1 „r Iri�ln p . ' it 201 maps to 400 amps 10 6.85 _ 2
'i t .,iJht .. e ,.�.t''�tt:. •ll,, . L, lGn :.i,, .... .. ,,w
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240,60 _ 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or Ibeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) • 200 amps or less 66.85 i I
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 salt, 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. Fcc for branch circuits with
F 7 ;ir 1 7 [_ 1 ar j t i 7 'jMF ° tip F ? + " i1' -¢r tr ' above service or feeder fee,
,., .. :73P:c'k411?t: c 3 h� z olt., .,.m .. i,., {'L.N',. ski.,. r.. F,d t .i, CILnip:. .Air_.1.,._lzra..,.l.l'll. . „ .1 6.65 2
each branch circuit
Business name: B. Fcc for branch circuits
Contact name: _ • fi branch circuit
Re. ( 54.113 2
Address: Each add'I branch circuit 6.65 _ 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 90 90 2
dwelling, service and/or fbedcr
Phone: ( ) J Fax: . ( ) Reconnect only 66.85 2
E- mail: Pump or irrigation circle 53.40 2
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... C
� r -, r % 1 e, .I , 1 i Sign or outlin lig hting 53.40 2
Signal circuit(s) or limited-
Business name:
� ypjnA. t ./ . ■ � C; ' �C ■ energy panel. alteration. or
0 ' O) / 5 extens D Page 2 2
Address: 1
City/State/ZIP: 1
- ` l SID i_ O at. 112 - Each ei
additional Insction over allowable in any of the above
Per inspection 62.50
Phone: ( o3) L - 1 1.14 Fax: (5a3) 0 ' - "7 Investigation per hour (1 hr min) 62.50
CCD Lic.: tt l q Electrical .Lie U,- G Suprv. LLc ../ tg1 i 5 Industrial •Iant •erhour 73.75
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Suprv. Electrician signature, required ::e_ .. Subtotal: � ' •
/� /4/ Plan review (25% of permit fee): la
Prirtt name: pt f ,,. � A A. 3'�r e� 0 Date: _ State surcharge (12% of permit fee): Z F'
Authorized signature; TOTAL. PERMIT FEE:
This permit application expinei its permit is net obtained within 180 R g.
Print name: I Date: deli °flop It hp. l,•on a,wnd•1 wt n,n,nlom.
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