Permit w
CITY OF TIGARD ELECTRICAL PERMIT
II 2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00357
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 2S102DC00506
Jurisdiction: Tigard
Site address: 9190 SW OMARA ST
Subdivision: Lot: 0
Project: Rolph •
Project Description: 200 Amp service
Owner: FEES
MUELLER, ROLPH K & NANCY J Quantity Description Date Amount
9190 SW OMARA ST
TIGARD, OR 97223 1 ea Services or Feeders - 200 07/21/2009 $80.30
amps or less •
PHONE: 1 ea 12% State Surcharge - 07/21/2009 $9.64
Electrical
Contractor:
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 $89.94
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: / Permittee Signature: 5if{ A .rr4,4
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' 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.
RECEIVED
1
Electrical Permit Application 'JUL 17 200 FOR OFFICE USE ONLY
_
City f 'Tigard k «',rived
Y L' ) tl m ter (NI,.: 1141000-
b z. C • OF TIGA '!, y. 00317
I 111 S SW I hall I)Ivd.. •I'i 'ant, OR 9727. { )au t I <e •
!'hone: 503.039.4171 Fos: 503,598.1 96l1BUILDING DIVISI I t-Vo/I +y: other ?conic
Inspection Line: 501,619.4175 ITate l(c:ut /It boor i'IGAl2ll Y Y� f1i) tit.'c rage 2 fur
Inlcm.1: w ww.ti'ard- or.'ov NWilietVMClhlal:
- 6 !; ....__. lupplcmculal Information
-
'rYPF, OF WORK 1'1..AN REVIEW
❑ New construction ddition /alteratioit/replacen,ent rlessecheck utl lieu apply(.uh.uh 2...fs.,rplans w /itcnty Cherkcu below):
❑ krv,cc or Iw:drr 4(8) amps or murc ❑ Building uSe! dime stories.
❑ I)e111U11h1111 - Other: _ where the available Emil current ❑ Manua. and boatyards.
CATEGORY OF CONSTRUCTION L•kt'I•IVI\ 111,1881 tnnps at ISO volt3 ur ❑ Pleating buildings.
—•. _._.— —. .
le , s to ground. or 1.. \CCCdc I- 1.081 ❑ 1'uuwlcrclol tow ar,ricul'
and 2-family dwelling ❑ Accessory g ;10101 for all other installation, buildings.
-' y � U Commercial/industrial Assessor building
Multi -llu nily ❑ Master builder ❑ Other: ❑ Pile pump. ❑ Installation of 75 KVA or
❑ I ;nlergcucy sysICw. larger separuteIy derived,;yelenl.
JOB SITE 1NFQItMATIUN AND LUC'A'1'ION
.. _.. ❑ Addition anew motor load of ❑ "A 'C' , •I - ••I -l"
` ror• 100111' or more. tx:rupaticy.
Job no.: L t ub site address. , 1
... � l � V � le it, �' ] ///--- ( ��� -. � v vVl,pl/ a 4. [] ;:,x or more nsidanl ;d unite. Q Hn:rr.atinnal vehicle parks. City /ti1.11C//..I I'� C � r / �. ❑ I Ic111h.,:, n c ati lk, . ❑ supply voltage for more th; n
}' / ` / ��_ _ ❑Ina /sedans hti GOO volts nominal.
Suite/bldg. /ilpl. no.: I,'rU)ltilllulllt: / (4 0 - ❑ Seiviec lar de((IOU amps 11( fIM'IL - - -- Ole
FEE SCHEDULE
('runs strcct/directitms to job site: Orwrlt. a... .. I..2 . E !'eel I Total I •
-- - .._... _.. New residential single- or multi- family dwelling unit.
Includes attached Curate.
Subdivision: 1 Lot Ito.: 1.(110 sq. 1'1 or less 145.15 4
" - I.'i. add'! 5(10 sq, ft. or portion 11,40 I
Tax neap /parcel no.: —
- •- --.._.... --__ -- Limited energy. residential 75.110 2
DESCRIPTION OF WORK , (with allow sq. 11.)
1 limited energy, multi- family
75,00
- - V - ) L4 s...--e l c. L D+ I , e .______ _.... _ _ n'sidenti :d (wish nhov sq. II.)
services or feeders installation, alteration, and /or relocation
2(0 :amps or less ! 80.30 20. I 2
PROl'ER'I'Y OWNER ❑ TENANT' - - 201 amps In 400 amps _ 100.85 2
Name: ( 401 amps to (d1() amps 16).60 2
AL__ .. 601 amps In 1,(881 amps 24(1,141 2
Address;
G kA"re^ Over 1,000 amps or volts 454.65 2
City /Slate/ZIP: Temporary services or feelers install alteration, and /or
relocation
Phone: (f t))) "1 I 0 r 5 I (7 L4 Fax; ( ) 200 amps or less 6(1.115 I
Owner installation: '!'his installation is being made un properly that I own which ix nut 201 amps In 4(10 lumps 100.30 2
intended Ibr sale, lease, rent, ur exchange, according to ORS 447. 449, 67O, and 701. 401 ;imps to 599 amps (11.•5 2
Kranch circuits - new, alteration, or extension, per panel
Owner signature: Dale:
• _...... _ --- .._ -_ _ A. Fee for branch circuits with
ID APPLICANT I ❑ ('ON'I'A(" r PERSON above service or 'ceder fee• 2
-- eaatl !torch eirlluit 6.05
Business name; It, Itce for blanch eireuils
Contact name: without service or feeder lees 40.85 2
first branch circuit
Address: Each add'I brunch circuit NO 7.
- — Miscellaneous service or 'ceder not included
City /Stale / /,1P: Iiach manufactured or modular
90.9(( 2
- --
I'hone: ) Fix; llwl;l nlg, errVice iultl /ur cc1 cr
_ _- .....__ _ . ....... Recun t only (x0.85 2. •
trail: Pump or irrigation circle 53.40 2
-- CONTRA(:TOR Signur oullinclighting 53. 2
Signal circuit(s) or limiled-
liusinexti name: WEST SIDE ELECI•RIC: CO.' energy panel, alteration. or
Address: 1834 SE 8111 AVE, extension. (leseribe: Page 2
City /State /ZI1'; PORTLAND, OR 97214 . Each additional um/Trion over allowable In any of the above
_ . .. _.._ _.. .. ..
Per ulspecbun 62,511
Phone; (5113) 231 -15480 Fax: (503) 736x0677
Investigation per hour (I hr out) 02.50
CC'13 Lie.: 13306 I Electrical Lie.: 26-135C Suprv. Lie.: 46545 Industrial plant per hour 7335
_ ..._ ............ .... . ........ ... _. . . . — — - -.._ .... ELECTRICAL rRI AI PER Mar FEES
5uprv. Electrician signature. required: ! (. :f,. �,. - i- . 2 / t ) r Subtotal: _ c _Q..3.0
Print Hanle: I(ANI)ALI. Rt7I11 !gale: G t`w
7 / f ' / D , Plan evi (25% of h ermit lire):
- -• -••
... .. Slate surcharge (12% of pennit lee): /„(, #•
Authorized signature: 'I'OTA1. 1'IiKMI'I' llil : el e t_1
._'1'hic p mnnit applirulinu eu if u permit is nut uhluilnd within 180
Print name: Date: days aver ii has been aaecplid as cmuplute.
' Nwul'L•r or iu ps:4:1 stowed per lsnmit.
I:U lviltli ,'u \Imnil,\FI,(' npu.iu App , 11$01/06 4411.41.1414II/n{ /111M /WI/Il
2' LL90 9EL(COS) •03 ot.11oai3 apTg .4sap( eES :60 6O LI Inc