Permit •
•
CITY OF TIGARD ELECTRICAL PERMIT
Permit
° COMMUNITY DEVELOPMENT #: ELC2009 -00164
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/14/2009
Parcel: 2S112BA05900
Jurisdiction: Tigard •
Site address: 14058 SW MILTON CT
Subdivision: Lot: 0
Project: Westcom
Project Description: • Install (3) branch circuits for TI.
Owner: FEES
GOODHEAD; DAVID & JAN M Quantity Description Date Amount
9846 SW PEPPERTREE LN
TIGARD, OR 97224 3 crt Branch Circuits 04/14/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/14/2009 , $7.22
Contractor: Electrical
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 -624 -3631
FAX: 503- 624 -2938
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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 AR 952;001 -0100. You ay obtain a copy of the rules or direct questions to OUNC by callin 46.6699 or 1.800.3 2.2344.
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Issued By: ��� � � � Permittee Signature: n r � ��(�/ I
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'N 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.
^ ,. 64/10./2009 FRI 8:35 FAX 5036242938 Willamette Electric 11002 /002
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Ii i " 1. 5 S\n' idull Rlvd.. Ti•`ar;i, OR 97263 -° - -" -° � -
APR 2009 D I (�
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t�s t...F: 2 ;:'' P i ot;e: 503.639.4171 Fax: 303 19/.6 () Dale /t3 ()them Pclntit:
,,r r .::vxr t CITY O F TI Ready/By: y' _� . _ - - --
�' Inspection Line 503.639.41 • l:i Date 1
j;�:• tp 1 j 'i 4 .. f5 See Pogc 2 for
e <" ?=' °v4_'! Internet: www.tigard-or.gov Notificdime,hod: j � Supplemental Information
- -- __... -_ -. � BUILDING DIVISION --- - - - -__ � 1 rl
TYPE OF WORK PLAN REVIEW
❑ New construction ❑' Addition /alteration/replacement Please cheek all that apply (submit 2 sets of plans wlaems checked below): 1
❑ Service or feeder 400 amps or store ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Contmcrcial•use agricultural
❑ I - and 2- family dwelling Commercial /industrial ❑ Accessory building snips for all other installations. buildings.
❑ Multi - family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 25 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", 'E ", "I.7" "I -3"
. Q .:� y10 �a�
1001-11' or more. occupancy.
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Job no.: / Job site address: / f • -5-•' ; i °-•n ,? ,:
- -__ ❑ S ix or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: �, J a - ❑ Health-care facilities. ❑ Supply voltage for more than
❑ HaZar<lous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: (A/ es / , a ,,, ❑ Service or feeder 600 amps or more.
-- - • FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fro. 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
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
•
Limited energy, multi- family
- 75.00 2
..1. residential (with above sq. f1.) _
- - Services or feeders installation, alteration, audio r relocatimt� _
____I ---
200 amps or less -- 80.30 -- - _ 2
0 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 106.85 2
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 /Statcl7_[P: Temporary services or feeders installation, alteration, and /or
relocation _ _ _ _
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 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 atnps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
-- - - - - - -- A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
_ each branch circuit 6.65 2
lusiness name: _ 8. Fee for branch circuits -
Contact name: tpirhour service or feeder fcc i 46.85 F/‘ -ii 2
__ first branch circuit
Address Each add'l branch circuit 2 6.65 /':7- 2
Miscellaneous (service or feeder not included)
City /Statc/ZIP: Each manufactured or modular
- dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( )
Reconnect only _ 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Willamette Electric Inc. Signal circuit(s) or limited-
energy panel, alteration, or
Address: PO Box 230547 extension. Describe: Page 2 2
City /State /ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 624 -3631 Fax: (503) 624 -2938 investigation per hour (i in min) ^� 62.50
CCB Lie.: 75059 Electrical Lie.: 34 -283C Suprv. Lie.: 4226 -S Industrial plant per hour 73.75
-- --• - -- -- ..._.. -• -- __ -...- __.._ - -. ELECTRICAL PERMIT FEES
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Suprv. Electrician signature, required: .�.,... ^ "" Subtotal: G 0 r,r,
Print name: David Fife Date: `% 2 - ra;• Plan review (25% of permit fee): z _
-------- • - - - -•- --- -. - - --
- State surcharge (12% of permit fee): 7 ?
Authorized signature: - - -_- - TOTAL PERMIT FEE: b % s '? __I
Print name: This permit application expires if a permit is not obtained within 180
Date: days after it has been accepted as complete.
° Number of inspections allowed per permit.
\ nuildmglPornnis `t:I.C•l`c: doe 03173106 .l. I /05/CONWE0