Permit CITY OF TIGARD ELECTRICAL PERMIT
11 : . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00210
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/12/2009
Parcel: 2S 111 AB02400
Jurisdiction: Tigard
Site address: 9340 SW MOUNTAIN VIEW LN
Subdivision: Lot: 0
Project: Hern
Project Description: Install (3) circuits for a /c, furnace, and GFCI.
Owner: FEES
HERN, MICHIKO Quantity Description Date Amount
9340 SW MOUNTAIN VIEW LN • 3 crt Branch Circuits 05/12/2009 $60.15
TIGARD, OR 97224 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/12/2009 $7.22
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 -231 -1548 •
FAX: 503 - 736 -0677
Type of Use: SF
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 OAR 952 -001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: f 1 1nA `iNWL1i L \ Permittee Signature: S.c 0 `A rcAZim
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.
Electrical Permit Applic. FOR OFFICE USE ONLY
City of Tigard C E lU E D aetvivCd , w
Ikrlr/11 5r Las.' OIL 41, Penult Nn.: � 7�} - O O �1
- ° 111 )S tiW 'lull Blvd., Tigard. ()It (�`� 0 2U�9 P1m I( w ie.w `VW ` l
I'hune; 503.639.417) Fax: 511,1,5 0 I)atr Illy Other Permit:
TIGARD Inspection Line: $113,639,417$ I lan , I(rady(Ity: fir. HI See Page 2 for • .. --
Imernel; www,ligard- or.gov
CITY OF TIGARD ) ` "'fI /M ( C - I SU ul ticmcntul IuIuemaliou
'l'Vi•E ' DIVISION _PLAN REVIEW
_
_
❑ Nov construe-lion ddition /allcrai ion /replacement Pleas., sh,Ik all (1411 apply (subm L cIn o pl uls w /IIrue; chcckcd Iw1uw I:
❑ ❑ S rvii.e Or feeler 400 amps In more ❑ !Wilding over nl me slurmx.
❑ Demolition Other:
- - -- - ... where the aVUII:IhIc 6.1ull e'ui nail 0 Marine and boalyardc.
CATEGORY OF CONSTRUCTION exeeedi I0,00U:111Ips. UI 1511 vllili lu ❑ Floating huildinge.
- - II:S'1 III EI'Inllld, Iu ' • • Ili 14.11(51 ❑ ('Ununer:inl -Ilse agrietlhural
6. I- and 2- lainily dwelling ❑ C.ornmerciul /indlpslrial ❑ Accessoly building amps lirr all other inctattatiol buildings.
0 Multi - family ❑ Master builder ❑ Other: ❑ hire ru ❑ Ill lailaliun of T KVA m
- "— - ISner l larger ac iletn.
JOB SITE INFORMATION AND LOCATION ❑ f ere y Iwalla ' Y dclivcd .s Y
... ❑ Addition of new Motor load of ❑ "A" "li "l. ^, "I. ( ,
J(111 no.: L4 l!J Job site addre,s: q ( f 1111 e 100111' ur no uttupallcy.
_ ..._— ❑ Six ur uurc Ioullnual nnu+. ❑ Rum:mam al vdncic park:,
('il /tilillc/ZIl '� , ❑ Ilcal ll rcare Ilx:dilicc ❑Supply vullige lie nurrc 111;111 - - - - Y _ ( (;cJ �7 ZZ � � ..
/ , o El lla�r nluux Im, ui 600 arils nominal,
S 1111c/11l<I l,./itp(, 110,: bPf(1,t:ct name: e./ - / ��Vti(M `i ❑ Serviccnrlivvlerr, N O Amps.0' more.
('runs slreel /direcli0115 to job site: C o .'vi -- Ixrrupnon 1 l)Iy. I sr.-. I •r,.r.l I •
Now residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: - 1 1 (tl no,7 1,0(10 sy. It ur Ic_ . 145.15 4
Tax map /parcel no.:
1 -- Ea. add'I 5110 sot IL or portion 1),4(1 I
- ._.__._.._ ._...... .. I ,inrlteel energy, ncsidcn141) 75.110 2
DE`CRIP•rIoN OF WORK (withaluwe,uti.j.._._..
nq ( rf 1 � Limited ene mule -1 trul
� - f { .. _. ( I � J ! t �� C-ef .� rC ( 1 ) ... 75.00
(
-
7 C r u• I ' .A 7 rc dcn(i r with aluwe u . n.
Services or feeders installation, alteration. a n l/or relocation
- 2(11) amps or less 80.30 2
PROPeR'I'Y OWNER ❑ 'I'ENAN'I' 201 amps lu 40U atups I 06.J5 2
-- -
NanName; : �(e !, . C , ! l ,Ci � , ( 61 j 401 amps lu (AU amps 160.60 1_
_ 6(11 amp:: (u I,($)0 amp :: 240.00 2.
Address.
-� ,? 0,.. vLA..4 Over 1,0(8) amps or volts _ 454.65 2
City /State %LIl': Temporary services ur feeders insta alteration, and /or
relocation
Phone: O 2) `I U Z. -' Lf ;j C Fax: ( ) 2011 amps or less 66.85 _ -..__ - 1
Owner installation: This installation is being made on property that I own which is not - 201 amp to 400 nnups 100.30
intended lilr sale, (case, rent, or exchange, according to ORS 447. 449, 670. mid 701. 401 amps to 599 amps 133.75 2
ate:
r Itr nch circuits - nrw, dltl eclenxiun, lu•r panel
(honer st),1lature: -- -- - -. - -.- . .
. .... . .... ... . . ..... ...... ..... . . . . . 1) .-- A, Fee for hraneh eireuilS wit
❑ AI'1'LICAN I ❑ (;ON'CAC'I' Ph RSON above service or feeder lit,
each branch circuit 6.65 2
Business name;
B . Fee l ift b ranch circuits
Contact namh: lvi(lrn(u service or relater [cc, 1 46.55 , J 1
first hunch circuit '/ v � 2.
'
Address: Each add'I branch circuit 2- 6.6V77.511 5 V77.511 2
- -- Miscellaneous (service or older nut included)
C'ily /titilte .1 %IP: Each nt nul'acturclJ er modular 90,9(1 2
Iw ut. sery nd /or fe er
Recoil/feel only 611,85 .._
l:• mail: Punlp or irrigation circle 5 }•40 2
__ _ ___ __ SlD CONTRACTOR Sign or u liy,htine; 53.41 2
I�ucnlCKS n;mtu WF;SIDE M:I.F:( "1'KI(' ('U, - — - - __.__........._ _... Sitnal circuil(v) tlrIimilcr•
. .. .. _.. _ energy panel, :MI:ration. ur
Address; (R;�4 tit: R AVI . extension. Descrihe: Page 2 2
('ity /Slate /ZIP: PORTLAND, OR 97214 Each additiomd inspection over allowable in t of the ;Ihove
Per inspection 62.511
Phone: (503) 231 -1548 Pax: (503) 736 -0677 _•
Investigation per hour (I hrmin) 62.50
('('R 1,k.: 13306 I Electrical l,ie.: 26 -135(' Suprv. Lie.: 46545 Industrial plant per hour 73.75 ! �q
Suprv, Electrician signature, required: ( i , r ( �. ('' ,,t17,.��( -5,_ - - CA f RM h T n FR1S t'a V r(
_ F I P •
Plan review (2s% of permit l'ee):
Print name: RANDALL ROBERTti pate: y //) [^/
- __._ ._._.. _ _ 1 Slate surcharge (l2 %I of permit li:e); - 1 , 7 z
Authorized signature: TO'I'AI. PI EI?li; /_•7. 3 7
•Phis penuit applicaliou empires ita permit in nut obtained within 1M
Print name: Datc: days atter it has bltn oCCepted ax complete.
• Numtu:r ur invution. allowed pkr pk:rrltil.
I: UfuilllingU PcnnilsWI.('•PrnnilAla• doc i'l,Vlx 4411.4/4.l(111115 /l•11M /WI•A t\ / ! /
- 7 2
2 d LL90- 9EL(E0S) '03 0T- 120ai3 eptg zsa0 d92:fr0 SO 990RaWW