Permit CITY OF TIGARD ELECTRICAL PERMIT
1 11 - = • - COMMUNITY DEVELOPMENT Permit #: ELC2009 -00434
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2009
Parcel: 1 S 134BD07400
Jurisdiction: Tigard
Site address: 11605 SW PENN CT
Subdivision: Lot: 0
Project: Konty
Project Description: (3) branch circuits
Owner: FEES
KONTY, LARRY F & MARY LEE Quantity Description Date Amount
11605 SW PENN CT
TIGARD, OR 97223 3 crt Branch Circuits 08/20/2009 $60.15
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/20/2009 $7.22
Electrical
Contractor:
VANGUARD ELECTRIC INC.
3800 MORRIS ST
NEWBERG, OR 97132
PHONE: 503 - 537 -5006
FAX: 503 - 537 -5019
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: Permlttee Signature: eV /97°,4/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 603.639.4176 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project
Approved plans are required on the Job site at the time of each Inspection.
Aug 19 09 04:54p Vanguard Electric 5035375019 p.2
Electrical Permit Application FOR OFFICE 1 SF ()NIA
City of Tigard Received • , .
13125 SW Hall Blvd., Tigard, OR 97223 Data$ : • .2Q ft; �f J
0 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date,B : Other Permit:
T ! G A R. D
Inspection Line: 503.639.4175 Date Ready/By: 53 See Page 2 for
Internet: www.tigard -or.gov Notified/Method: SuppleoentalInformaton
TYPE OF WORK PLAN REVIEW
9 New construction ddition/alteralion /replacement Please check all that apply (submit 2 sets of plats whams checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Q Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to gourd, or exceeds 14,000 ❑ Commercial -use agricultural
(,r1_ and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for an other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ [astaliatioa of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "1', "1 -2 ", "1 -3 ",
Job no.: k Z " I Job site address: I ej � C, loots or mote. R occupancy. r ion
` ❑ S ix or more residential emits. ❑ Recreational vehicle parks.
Ci /StateiZ[P: r '` ❑ Hea lth-care fatalities. ❑ Supply voltage for more than
r..�t!7A2� 0 2- 47a�. .
❑ Hazardous locations 600 volts nominal.
Suite/bldg./apt no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: . 5- r.. .... oh R.T ti l7i rcseJ744 Description i Qty. I Fee. I Tour I •
J Description New residential single - or multi - family dwelling unit.
SL- 1/ 5 / . - Y...9 26;01V C 1- Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less T 145.15 4
Ea. add'I 500 sq. fl. or portion I 33.40 I
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R) 75.00 2
..- 6-A-72.4496- W--C .PT Limited energy, (with above
"F- residential with above ft,)
75.00 2
ec \ Q Services or feeders installation, alteration, and/or relocation
�J n tQ ( PCL�f. q'- Fed; ecxlvs
Afr— 200 amps or less 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
Name: ice Nil v / �� 1 401 amps to 600 amps 160.60 2
/ !•r L 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders Installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1 1
Owner installation: This installation is being made on property that [ 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 133.75 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
egLAPPLICANT ❑ CONTACT PERSON above service or feeder for, z- 6.65 3G 2
each branch circuit
Business name: U,4N v q 2. l�C.tFC'7 r2,rr =A.) (r. B. Fee for branch circuits
without service or feeder fee
Contact name: e r„ � �' � e_ first branch circuit , 46 85 o f gA r 2
Address: G G c . ) I" 1Z--7- S 57 Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/Stale/ZIP: pt. ` o j� C .. /2_ C 7/ 3 2 Each manufactured or modular
90.90 2
11/43 dwelling, service and/or feeds
Phone: ( ) �+ Fax:
SGT S„S � b - (� $ 3 7 SO /rj' I Reconnect only 66.85 2
E -mail: 049 r� Sr, a•N !/ (b.-oleo, s -_ , j s "t- Pump or irrigation circle 53.40 2
CWIRAL OR Sir or outline lighting 53.40 2
Business name:
Signal circuit(s) or limited -
energy panel, alteration, or
Address:
extension. Describe: Describe: Page 2 2
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) ( I Fax: ( / Investigation pa hour (1 hr ruin) 62.50
CCB Lic.: /6y
II Lic.: j - • a Suprv. L .: fps Industrial plant per hour _ 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signatur , required: / �= Subtotal: , ( .-
Print name: r '- Plan review (25% of permit fee):
/ C4 State surcharge (12% ofpermit fee): 7. Z a
Authorized signature: TOTAL PERMIT FEE: 7, 3 7 it
Tbis permit application espires if a permit is not obtained within 180
Print name: I Date: days after it bas been accepted as complete.
1: 1GuildiaglWrrnib \F.I,GpexmitApp doe 05/2306 ° Number of inspections allowed perpermit.
440. 46157'(11 /OS/COM! WEB