Permit I - V CITY OF TIGARD ELECTRICAL PERMIT
N 2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00137
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/13/2012
Parcel: 2S 114BA02600
Jurisdiction: Tigard
Site address: 9750 SW SERENA WAY
Project: Cohoon Subdivision: PICK'S LANDING NO.2 Lot: 113
Project Description: (2) branch circuits
Contractor: CONDUIT ELECTRIC Owner: COHOON, DAVID G & LENORA R
19461 SW 89TH AVE 9750 SW SERENA WAY
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -1428 PHONE: 503 - 788 -8868
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/13/2012 $63.60
Specific Service or Feeder
1 ea 12% State Surcharge - 03/13/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total .$71.23
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 of issuance, or if work is suspended for more the 180
days. A NTION: Oreg• I- . •qui .s you to follow the rules adopted by the Oregon Utility Notifi - on Center. Those rules are set forth in OAR
952 -001 -• 110 through OAR 9' /- 001 -00 - r ou may obtain a copy of the rules or direct questions to OUNC by calla 50 232.1987 or 1.800.332.2244.
Issued ' Pe rmittee Sig / " a .,4 '. ' /
_- .
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' , 4,S / ; Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
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.
From:CONDUIT ELECTRIC 5036923652 03/09/2012 09:43 #255 P.002 /002
Electrical PermitAppllc.� ol,,c IvE® FOR t)I. ;S1 O\LI''
City of Tigard CC1"ed z Q�� IN 9 ateB : Permit No.: �� I /2 SOD f 3 012 p 1 • 13125 SW Hall Blvd., Tigard, OR 17 Plan Review II Phone: 503.639.4171 Fax: 503.598.1960 DateB : Other Permit:
•1 ic;,\i Inspection Line: 503.639.4175 CITY OFTIGA�D DamReady/By: kris: la See Page 2 for
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Please check all that apply (submit j sets of plans w /ites checked below):
❑ New construction ( Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
am at 15 vo lts or Ftoatin buildln s.
CATEGORY 'OF: 'CO� UCTION���: B 8
. >, G OR ,:.. _ ._ NSTR..,._,:_..:,_. _ ,::::;:;::::: >' %: ; ;<<a: ?; : ; > ,.';,: <;.;
dwelling � teas to g round, or ex cee ds 14 ❑Commercial - use a
744. and 2-family g ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi - family ❑ Master builder ❑ Other: °F ire pump. ❑ Installation of 75 KVA or
:;.:'. ..,.:,,.::., ,, ... .. Emergency larger separately derived system.
,.. :.,.�...;-.::�J B. 1.7UN..< :..CA,.:o,.
�, ❑ Em system
-.. , -, , IT., _�, .,RMA , :: „ ANl),W„ ,- �•,• � - . , ,. ., ... ,. ❑ Addition of new motor load of ❑ "A" "E", "1-2^ "1 -3"
Job no.: 1 Sirs Job site address: 779 i IN, 5- e 4 - ‘R t t t sit "?°}11' ermore. ecca"ey.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP : . ° * -o Ot cr 3• 7._2 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations- 600 volts nominal.
Suite/bldgJapt. no.: Project name: eet-- / a ❑ Service or feeder 600 amps or more.
...:t ErR , ;.a.,. - ..
Cross street/directions to job site: Description I Qty. I Fee. I Tow I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 r 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: mired ever residential
:': ;, .,t,;, .. t.; <. : (with above . ft)
n
t 67.84 2
.. ........ DESCRIPTION r: OF ; ,WORK ,.;.,:; . ;� `� ; .:. h :�� ( sq )
Limited energy, multi- family
,4 C. 'r Ft et 14Wiri Pc. 'r'3 S / l4 c& »,' .. C.rt,�( residential (with above sq. R-) 67.84 2
O d Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
•:.
' PRQPERTY':OWNER • . :
.. :...... .._'.:.: :.0
.'TENANT; .: > `:, 201 amps to 400 amps 133.56 2
Name: �pr._+t p i-t,.-0N not amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: •5 iirr —e.— Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: (5 ) 7-£? - * 6 Can Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
::•:: ®:;APPLICANT s?: ::: >: :' .:<:.I "; ;.n: :i0 CON ..ti4.. N`:. `:, ^ :' :.; ere hce o r er fee 7.42 2
...... T ACT =P . O .::.. each branc c
Business name: B. Fee for branch circuits without
service or feeder fee, first ' r
Contact name: branch circuit 56' 18 51,o 2
Each add'/ branch circuit ( 7.42 _ 7 Z 2
Address: Miscellaneous (service or feeder not included) i
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
(i." �' ,: COIVTRACCOR , Signal circuit(s) or limited- energy
Business name: WNNUiT ��, c71ke panel alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: i ? ((/ cO / 5, W (t 4.t.,< Additional inspection (I hr min) 66.25/ hr
i Investigation (1 hr min) 66.25/ hr
City/State /'LIP: W D � �- `l 7Z. •L
e Industrial plant (I hr min) 78.18/ hr
Phone: ( (° ? 2 - (V Z & Fax: ( 5• ( 2 — 3 QS L Inspections for which no fee is
b - specifically listed (Vs hr mil) Lic.: / 90.001 hr
7- G` Electrical Lic.:
9 2 ° S Suprv. Lic. � / s G`�? y _ ` !<t1Vil I_I+JI✓S;N� ` , `;.
p � S ..,.. ,. .,, -, � 1Q ': p
Subtotal:
Suprv. Electrician signature, required: r C72-r‹.....________ Plan review (25% of permit fee):
Print name: C4-( f�AR Yom' Date: 3/7/ I Z State surcharge (12% of permit fe .� � ° 3
Authorized signature: ci...- T OTAL PERMIT FEE: ZS
,( This permit application expires if a permit is not obtains within 180
Print name: -e_ ? 0// days after it has been accepted as complete.
S Date: �. • Number of inspections allowed per permit.
1: 1auildinePermitstEl -C- PermitApp.doe 10101/09 440- 4615Ttl l /os/COiww®