Permit , CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2011
Parcel: 2S110DD04200
Jurisdiction: Tigard
Site address: 15675 SW OLD ORCHARD PL
Project: ASCHENBRENNER Subdivision: SUMMERFIELD NO 3 Lot: 144
Project Description: Grounding.
Contractor: DOUGLAS ELECTRICAL INC Owner: ASCHENBRENNER, DOROTHY A TRUST
16450 S FOREST GLEN DR BY JANET HOLT TTE
MULINO, OR 97042 2768 SW TALBOT RD
PORTLAND, OR 97201
PHONE: 503 - 829 -5100 PHONE:
FAX: 503 - 829 -5100
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/13/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/13/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 -0090. You may obtain a copy of th • - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ! P ermittee Signature: _- ._
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.
, CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00257
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/13/2011
Parcel: 2S110DD04200
Jurisdiction: Tigard
Site address: 15675 SW OLD ORCHARD PL
Project: ASCHENBRENNER Subdivision: SUMMERFIELD NO 3 Lot: 144
Project Description: Grounding.
Contractor: DOUGLAS ELECTRICAL INC Owner: ASCHENBRENNER, DOROTHY A TRUST
16450 S FOREST GLEN DR BY JANET HOLT TTE
MULINO, OR 97042 2768 SW TALBOT RD
PORTLAND, OR 97201
PHONE: 503 - 829 -5100 PHONE:
FAX: 503 - 829 -5100
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/13/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/13/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 -0090. You may obtain a copy of th • - or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ! P ermittee Signature: _- ._
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.
2011 -05 -13 0823 DOUGLAS ELECTRICAL,I 5038295100» 5035981960 P 1/2
Electrical Permit Application 1'111; lll'I 1(1 I •'I' 0 \I 1
City of Tigard
• 13125 SW Hall Hlvd , Tigard, OR 97223 �. Plan Review r"
'� , 8 Phone: 503,718,2439 Fax: 503.59'- . � Date/By: c.>ther &crtmt: �'i_�137
1 I c , , 1,` I i Inspection Line: 503.639.4175 11 c Date Ready/By: runs, Fa See Page 2 for
Internet: www.ligrd - or.go v ` a? i3„) outlied/htethod, -�; i Suppkmcntal Information
TYPE OF WORK \ Q� \ 1 PLAI' REVIEW
❑ New construction ® Addition/alteration/ c,` Please cluck all that apply (submiy2 sets of plans whims checked below).
CI Soviet or feeder 400 amps or More ❑ Building over three stories.
❑ Demolition ❑other: a `. where the available fault current ❑ Mannar and boatyard's.
CATEGORY OF CONSTRU[ 1'I V ON 1 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, nr exceeds 14,000 LI Commcreial• use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other inatalleinns. buildings.
❑ Multi - family 0 Master builder ❑ Other; ❑ Fire pump ❑ Installation Si' 75 KVA or
IOg SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
1 ❑ Addition of new motor load of
Job no.: , Job site address: 15675 SW Old Orchard Place 100HP or more, occupancy
ID Six or more residential units. . ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, Or 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ilerardnuslocations 600 volts nominal.
Suite/bldg. /apt, no.: 1 Project name: ❑ Service or feeder 600 amps or more
Cross strec /directions to job site: FEE SCHEDULE
Desntptl■ 1 I Q19. I F. f Iasi I a
New realdcnthd stogie- or ma iii -feml y dwelling unit.
includes attached garage.
Subdivision: 1 Lot no,: 1,000 sq. R. ar less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax maplparccl no,: Limited energy, residential
DESCRIPTION OF WORK a (with above sq. ft.) 75.00 2
Limited energy, multi - family
Drive two ground rods residential (with above sq. R. 75.00 2
Services or (feeders installation, alteration, and/or relocation
Regrounding Service - from cut water pipe 200 amps or less 100.70 2
❑ PROPERTY OWNER , 0 TENANT ■ 201 amps to 400 amps 1 2
Name: Aschenbrenner Trust 401 amps to 600 amps 200,34 2
601 amps to 1.000 amps 301,04 2
Address: 15675 SW Old Orchard Place Over 1,000 amps or volts 552,26 2
City /State/ZIP; 97224 relocation
T po acrvlcn or feedetg InstnliatIon . alterathay and/or
Phone: ( ) s I F ax ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 am 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, alters io or extenalon, per panel
Owner signature: i)ate: A - Pee for branch circuits with
❑ APPLICANT d CONTACT PERSON i above service or feeder fee,
__ each branch circuit 7.42 2
Business name: Douglas Electrical, Inc B. Fee for branch circuits without
---� service nr feeder fee, first I 56.18 56 2
Contact name: Doug Closner branch circuit
Each add'l branch circuit ! 7.42 2
Address: 16450 S. Forest Glen Drive - Miscellaneous (service or feeder not included)
City/State/ZIP: Mulino, OR 97042 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 829 -5100 l Fax: : (503) 829 - 5100 Reconnect only 67.84 2
Pump or irrigation circle • 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal eirctul(s) or limited-cncrgi
Business name: Douglas Electrical, Inc panel, alteration, or extension. Page 2 2
Each additional iropecuoo er allowable in any of the above
Address; 16450 S Forest Glen Drive Additional inspection (I hr min) . 66,25/ hr W
_Investigation (1 hr min) , 66,25/ hr
City/State/ZIP: Morin, OR 97042
Industrial plant (1 hr min) 78.18 / hr
Phone: 503 829 -5100
( Fax; (503) 829 - 5100 Inspections for which no fcc is ; 9000/ hr
specifically listed 05 hr min)
CCR i.ic.: 3-306C l , f b (� j eel L' .. 117922 Suprv Lie.: 3790S ELEGTRICAI, PERMIT FEES
C 11hr'V PIry +Irirrw live �r / �iTi {r / •� ) ii)'t /lj SubtUtal: 56.18
A 1(�Y�- L-��11 f r.. - / Plan review (25're of pemvt fee):
Print name u 6 i - °call 0 tr. Date: 05/13/2011 State surcharge (1244 of permit fee): , .6 °-) ■-f
� TOTAL. PERMIT FEE: 62,
Authorized signature .�a'
This permlr opplkstfon expires it a permit Is net d within i80
Print name;
I �� days after It has been accepted as complete.
2011 -05 -13 0823 DOUGLAS ELECTRICAL,I 5038295100» 5035981960 P 1/2
Electrical Permit Application 1'111; lll'I 1(1 I •'I' 0 \I 1
City of Tigard
• 13125 SW Hall Hlvd , Tigard, OR 97223 �. Plan Review r"
'� , 8 Phone: 503,718,2439 Fax: 503.59'- . � Date/By: c.>ther &crtmt: �'i_�137
1 I c , , 1,` I i Inspection Line: 503.639.4175 11 c Date Ready/By: runs, Fa See Page 2 for
Internet: www.ligrd - or.go v ` a? i3„) outlied/htethod, -�; i Suppkmcntal Information
TYPE OF WORK \ Q� \ 1 PLAI' REVIEW
❑ New construction ® Addition/alteration/ c,` Please cluck all that apply (submiy2 sets of plans whims checked below).
CI Soviet or feeder 400 amps or More ❑ Building over three stories.
❑ Demolition ❑other: a `. where the available fault current ❑ Mannar and boatyard's.
CATEGORY OF CONSTRU[ 1'I V ON 1 exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, nr exceeds 14,000 LI Commcreial• use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other inatalleinns. buildings.
❑ Multi - family 0 Master builder ❑ Other; ❑ Fire pump ❑ Installation Si' 75 KVA or
IOg SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
1 ❑ Addition of new motor load of
Job no.: , Job site address: 15675 SW Old Orchard Place 100HP or more, occupancy
ID Six or more residential units. . ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, Or 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ilerardnuslocations 600 volts nominal.
Suite/bldg. /apt, no.: 1 Project name: ❑ Service or feeder 600 amps or more
Cross strec /directions to job site: FEE SCHEDULE
Desntptl■ 1 I Q19. I F. f Iasi I a
New realdcnthd stogie- or ma iii -feml y dwelling unit.
includes attached garage.
Subdivision: 1 Lot no,: 1,000 sq. R. ar less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 1
Tax maplparccl no,: Limited energy, residential
DESCRIPTION OF WORK a (with above sq. ft.) 75.00 2
Limited energy, multi - family
Drive two ground rods residential (with above sq. R. 75.00 2
Services or (feeders installation, alteration, and/or relocation
Regrounding Service - from cut water pipe 200 amps or less 100.70 2
❑ PROPERTY OWNER , 0 TENANT ■ 201 amps to 400 amps 1 2
Name: Aschenbrenner Trust 401 amps to 600 amps 200,34 2
601 amps to 1.000 amps 301,04 2
Address: 15675 SW Old Orchard Place Over 1,000 amps or volts 552,26 2
City /State/ZIP; 97224 relocation
T po acrvlcn or feedetg InstnliatIon . alterathay and/or
Phone: ( ) s I F ax ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 am 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, alters io or extenalon, per panel
Owner signature: i)ate: A - Pee for branch circuits with
❑ APPLICANT d CONTACT PERSON i above service or feeder fee,
__ each branch circuit 7.42 2
Business name: Douglas Electrical, Inc B. Fee for branch circuits without
---� service nr feeder fee, first I 56.18 56 2
Contact name: Doug Closner branch circuit
Each add'l branch circuit ! 7.42 2
Address: 16450 S. Forest Glen Drive - Miscellaneous (service or feeder not included)
City/State/ZIP: Mulino, OR 97042 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 829 -5100 l Fax: : (503) 829 - 5100 Reconnect only 67.84 2
Pump or irrigation circle • 67.84 2
E-mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal eirctul(s) or limited-cncrgi
Business name: Douglas Electrical, Inc panel, alteration, or extension. Page 2 2
Each additional iropecuoo er allowable in any of the above
Address; 16450 S Forest Glen Drive Additional inspection (I hr min) . 66,25/ hr W
_Investigation (1 hr min) , 66,25/ hr
City/State/ZIP: Morin, OR 97042
Industrial plant (1 hr min) 78.18 / hr
Phone: 503 829 -5100
( Fax; (503) 829 - 5100 Inspections for which no fcc is ; 9000/ hr
specifically listed 05 hr min)
CCR i.ic.: 3-306C l , f b (� j eel L' .. 117922 Suprv Lie.: 3790S ELEGTRICAI, PERMIT FEES
C 11hr'V PIry +Irirrw live �r / �iTi {r / •� ) ii)'t /lj SubtUtal: 56.18
A 1(�Y�- L-��11 f r.. - / Plan review (25're of pemvt fee):
Print name u 6 i - °call 0 tr. Date: 05/13/2011 State surcharge (1244 of permit fee): , .6 °-) ■-f
� TOTAL. PERMIT FEE: 62,
Authorized signature .�a'
This permlr opplkstfon expires it a permit Is net d within i80
Print name;
I �� days after It has been accepted as complete.