Permit IN CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT ELECTRICAL
ELC2009 -00451
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/03/2009
Parcel: 2S 110AA01200
Jurisdiction: Tigard
Site address: 14300 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Dr. David Wilson /Hygiene Remodel
Project Description: Replace X -Ray with up date version Swap out 6 fixtures for new .
Owner: FEES
CAIN, JAMES L Quantity Description Date Amount
27775 NW WILLIAMS CANYON RD
GASTON, OR 97119 2 crt Branch Circuits 09/03/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/03/2009 $6.42
. Electrical
Contractor:
TIMBERLINE ELECTRICAL CONTRACTORS •
PO BOX 918
LAKE OSWEGO, OR 97034
PHONE: 503- 459 -4089
FAX: 503 - 254 -4227
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•
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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: 04/AL-at Permittee Signature: - tO /LC12 lU 4 '
OWNER INSTALLATION ONLY u
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.
, i ._.
. . Elec 1 Permit ADDli 1: , CT-I\IED ; .. .
C of Tigard • - R hzdveid Pe No.: - ' 1
a
. _ . I3 SW Hall Blvd, OR 97 P1ao Review ��
-`x :r Phone: 503.639A171 Fax 503.59€1,_ 9J 0 1 20 ,�: Other Parole
- Inspection Litre: 503.639.4175 Date Ready/By: moo: I VI See Page 2 for .
Internet www.tigard•orgov Ty OF TIGARD Nom: Supplemental Information
•
❑ New construction . .... V Addition/alteratioNre 1 Pleaeo dart all that apply (submit 4 era of plans 'Ammo checked below):
r ❑ Demolition ■Other D Service or 400 amps or mare O Building over throe stories.
where the available butt current O Marinas and boatyards.
' ,r mopeds 10,030 amps at 150 volts or O Flowing bm1dings•
lean to gimme, «e :ceed,14,000 p comma aa! acre asioal
❑ 1- and 2- fhmily dwelling .71 Commercial/industrial ❑ Accessory building amps for au other installation. buildings. .
❑ Muhi- fibmily ❑ . Master builder ❑ Other. Mae FEW. D installation of 75 KVA or
bract Moab* derived aYeieok
>Y ... :! D Additi o f t oa d o f O ,
Job no.: _. A Job site address: - A . (.., • ■ 10011P or mote. occupancy.
O Six cc more reside:Wel units. O Recreational vehicle parka
City /State/ZIP b ` p taatth-cera ca - D s q iy f« more than
❑ Hazardous tocatroav 600 volts nominal.
Suitelbldg/apt no.: . Project name: OR. t 'Ell + • , D Smvioe or der lea rioo amps ar mars.
Cass street/directions to job site: 5" 17 ' 1212444-0 ` ' !1' ` •. - -<; w _ ; Darramon
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'1500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
,.1, , _... ,w; .k (with above eq. ft.)
hr[.l,G - , — y 0 ': s i i Limited
dentiel (with above ) 75.00 2
l • • 1 � Services or feeders insWlation, alteration, and/or relocation
Jt,v ek-) 200 tarps of less 80.30 2
- - _..1 .{;, ..•2,1..._:, . ' . ..•. . � ' .e _. • . . : 3 201 amps to 400 a mps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Address. 601 amps to 1,000 amps 240.60 2
Over 1.000 amps or volts • . 454.65 2
City/State/ZIP :. Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I 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 amps to 599 amps 1 133.75 .2
Branch circuits — new, alteration, or extension, per panel
Owner Date { A Fee for branch circuits with
above service or feeder fee,
:;n ...... _ _ : s __s, each branch circuit 6.65 2
Business name:
B. Fee for branch circuits
Contact name: without service or feeder fee„ l
first branch circuit 46.85 2
Address: • Each add'l branch circuit I . . 6.65 b, 6_,1 2
Miscellaneous (service or feeder not Included)
City/S: Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
B Pomp or irrigation circle 53.40 2
.. l J = t •
.._ _, .,....,_.._ _. i . _ / . , : r. ., ; y � .. � h i `? .: , , Sign of ou lighting • 53A0 2
- Business name: u. �' _ 1 \, . . 1 ` ' I 4 Lill L,_, energy panel, alteration, S tea)rlim d- .
or
Address: II t► 12)0 extension. Desexibe Paget 2
City/State/ZIP: . '.f otft . y i a 0 , - ( 33. Each additional inspection over allowable in . of the above
. Phone: j3) 1 . ''� Per inspection 62.50
� =��( ∎ Investigation per hoer (1 hr min) 6250
CCB Lk.: / , / 0 7 °Electrical Lic.: 1, Industrial pleat per hour nil 73.75 . limos
• Sum Electrician signature, required: �i : '. _ ._ _... z
• L . . I 11/,‘ .►_ Subtotal: - 6 . Al
Print nklae: lot i elk, a A ( -.,; i Date: l N 4.9 S Pan ravi g .( ot
2% pQ fee): , 1a
Authorized signature: �
�, A i TOTAL PERMIT FEE: err
Print name: i „ & Date: s D ,, • This permit application aver it expires a permit s not obtained •
.L • .— ..1..wl i— .....N.:.....h. -..■ ...........
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Z 00 /Z00 21 XVd ZT :60 600Z/T0/60 ,