Permit CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2012 -00191
Date Issued: 04/03/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 4/03/2 D01200
Jurisdiction: Tigard
Site address: 9500 SW SUMMERFIELD DR
Project: Subdivision: SUMMERFIELD NO.7 Lot: 362
Project Description: (1) 200 amp panel change and (3) branch circuits for water heater, living room and office.
Contractor: BOONES FERRY ELECTRIC INC Owner: HASS, PHYLLIS W
PO BOX 628 9500 SW SUMMERFIELD DRIVE
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE:
PHONE: 503 - 682 -4936
FAX: 503 - 682 -7946
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/03/2012 $100.70
Specifics: amps or less
3 crt Branch Circuits w /Purchase 04/03/2012 $22.26
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/03/2012 $14.76
Electrical
Type of Const:
Occupancy Grp:
Total $137.72
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 0 R - 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: Q/ti / 970,z./C-7 - 70A1
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 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.
Apr. 2. 2012 5: 01 PM RECENE: No. 8736 P. 1
Electrical Permit Application FOR OFFICE USE 0 \I.1
City of Tigard APR , - ""9' — ��i. ter, No.:
III i • 13125 SW Hall Blvd Tigard, OR 97223 v
�++ r C �� ��0�� %2 — 40? phone; 503.639.4171 Fax 503.598.1960 l r o r TI � , D p. , Permit;
,
Inspection Late 503.639.4175
TIC ; R i7 BUILD NG DIVISIQ R haw 21 SeePage2 for
Internet: www.tigard-or.gov Natified/Memod: . ( i I Sapplemenmt Information
❑ New construction 0 Addition/alteration/replacement P lease tk all that epgb (submit 7, sea of plans write= checked below) V
0 Service or feeder 400 amps or more ❑ Balding over three stories.
❑ Demolition ❑ Other
, where the available fault current Q ss Maria end
J e . . _ •' ; . . , ` ,. . r 1 J ' . ; , r . exceeds 10,000 amps at 150 volts or O Floating buildings. .
:''''',,, 7:.r .. ,.. . ,
::. ," , ,_ ; . less to ground, or exceeds 14,000 ❑ C,ommeeeisl.ase agricultural
❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building
slops for all other installations. bttl3diags,
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fee PamP• O Installation of 75 KVA or
Y r P , , ❑ Emergency systeai larger sepmateiy derived system.
.,,...:1,2.';';,: _ ._ . ._ . r _ . , . . c.,.::' .. . _, . . ., .,f,-„,!_!_: .__ .. ? ; ' . „ t _.;{ OAddddonofaew motor load of O "A "."E","1- r', "1 -r,
more ooeupstuy.
Job no.: I Y 6 `b /1, Job site address: 7 s'oo s), r .. 1,A 64 -Li d t 2--, 0 Six 1 00HP or err mo te trsidearial ugiti ❑ Rasea4ana) which pas.
City/State/ZIP: 1.41,t.,- y 4 0•Q 0 Heahhears facilities O Swab( voltage for more than
❑IIaffidons locations. 600 volts nominal.
Suite/bldg./apt. no.: I Project name: r) fit l..¢, O Service or feeder 600 amps comets.
Cross steet/directions to job site: ' es '' .' Y
Da QM boa :: ",.. T
— - New residential single- or multi- family dwelling ooit.
Includes attached garage.
Subdivision: I Lot no -: 1,000 sq. ft, or less • -r 168.54 { 4
Ea. add'/ 500 sq. ft or portion 3392 . 1
Tax map/parcel no.: Limited
energy residential 67/4
2
_� ` r , , : T _ "` Y : " (with above sq. q. ft.
Limited energy, multi- family 67.84 2
f ,/ a d' 3 cr^ kit I E...^ l 44 j residential (with above sq. ft.)
Services or feeders installation, alterat:'°n, and/or relocation
I ii, /,:i YS IG.■ I 1.9 0 6E cc 200 amps or less 3 100.70 2
201 amps to 40o amps 133.56 2
� .S . /6 / LL /s ;r a 401 am 1,
ps Do 0 amps 200.34 2
Name. ., 601 stops to 1,000 amps 301.04 2
ddress: ,M t- Over 1,000 amps or volts 55226 2
— City/State/ZIP: Temporary services or feeders installation, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
()wrier installation: This installation i3 being made on property that I own which is not 201 amps to 400 amps 125.08 2
O
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps { 16834 2
Branch (Inuits — new, alteration, or extensiro per panel
Owner signature: Date: A. Fee for branch circuits with
- a, above service or feeder fee, 3 7.42 2,Z , Z,6 2
r 5 tr r
each branch cram
Business name: B. Fee for branch circuits without
service or feeder fee, fast 56.18 2
Contact name: circuit
Each add'/ branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each City /State/ZIP: dwell ser', 67.84 2
Pbotte: ( ) I Pax: : (• ) Recomtea only 67.84 - . z
Pump or irrigation circle 67.84 2
E-mail:
a, y ... r r J `.
sign outline lighting • 67.84 2
.,.. _, . ....... . .... . .... _........ . ...,. . > , ...,.- : .,.._,. Signal ctruutKS)w estergy •
Business name: Hennes Ferry Electric panel, ahaadon, or extension, Page 2 2
Each additional inspection over allowable In any of the above
Address: P.O. Box 628 Additional inspection (I In nun) 6625/bt
City/State/ - LIP: Wilso. viI1e OR 97070 v
investigation (1 hr �) 6625/ br
Industrial plant (1 hr min) 78.1W hr
Af7CCB Phone: (593) 682 -4936 Fax: (503) .: r 7946 Inspections for which no fee is 90.001 hr
Lice: 88482 $ Electrical L . 3 -223C A Suprv. Lie.: 3 r r V l g r t� Itsitd '� _ hr mm . , `
1 — Subtotal: ( 2. 2.9 6
rv. Electrician signature, • E �
� . ri � plan review (259'0 of permit fan): rte'
Print name: g H P1`rp� Date: State surcharge (12% of permit fee): (L , 7 6
TOTAL PERMIT FEE: 13 7, 7 2 1..----/
Authorized signature: Thor permit epptin6on expires If a permit is not obtained within 180
Print name Date: days after it has been accepted as complete-
Number of inspections allowed per permit
L1HulcruePamue'ELC- PetmitApp.doc 10/01/09 440.461 St(11105ICOMIWEB