Permit CITY OF TIGARD ELECTRICAL PERMIT
IN ° -- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00290
Date Issued: 06/16/2009
T j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S105DD06800
Jurisdiction: Tigard
Site address: 1.3435_SW SANDRIDGE_DR
Subdivision: Lot: 0
Project: Loverro
Project Description: Install /alter (2) branch circuits for a/c and GFCI.
Owner: FEES
LOVERRO LIVING TRUST Quantity Description Date Amount
BY LOVERRO, ANTHONY/MARYANN TRS,
13435 SW SANDRIDGE DR 2 crt Branch Circuits 06/16/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/16/2009 $6.42
Electrical
Contractor:
HILLSBORO ELECTRIC LLC
21185 NW EVERGREEN PKWY #110
HILLSBORO, OR 97124
PHONE: 503 -439 -9666
FAX: 503- 601 -3680
Type of Use: SF
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.
4\P n
Issued By: �� ��__ I 0 . ♦ Permittee Signature: m / 1 '
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 603.639.4175 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.
.'.
06- 12 -'09 14:15 FROM- Hillsboro Electric 503 - 601 -3680 T -655 P0@2/002 F -110
Elect Per mit Applic_ atio r
IN City of Tigard EJ L U �L Iteceiwa
�' 13125 SW Hatt Blvd., Ti gard, OR 97223 _ I UN 1 2 2009 Plan Review
VA rmmtt Na.: C A C 2 ZQ 0
Phone: 503.639,4171 Fax. 503.598. I9[ f Date/By. Other Paint
Internet u a�3�oY
CITY OFTIGARD narets�ay/ay. a seePage3for
Alit.:
N, '�6edrnrereod:
T! ' ` ` ' 1 ` i '14 Supplemental information
TYPE O ' : I PLAN REVIEW
—
❑ New construction Z.v, Addition /altGfation/reptacemc-nt Plant oho* all that apply ( bmi sea of pleas wiitems Wrecked below):
D service or &cedes 400 amps or more ova Owe Building ovroo stories
❑Demolition ❑ Other:
where the
.
CATEG OF CONSI'RUCFION molds 10.000 available fault 50 I Marinas g and dings. boatyards.
romps at 150 wilts or (] Floating buildings.
1- and 2- family dwelling a Commercia /industrial
❑ Accesso budding le" tO �, a e�wooda 14,000 d Cor4mrrciel -else agricultural ❑ Multi - family [] Muster builder tbs all other i asta ilat i ons. buildings.
❑ �' pros pwn p' D Installation of 7s KVA or
JOB SITE INFOR1111ATION AND LOCATION ❑B system. separately derivedsystem•
CI Addition anew motor load of Q "A ", "E". - 1- 1... -3
Job no,: ►i Il rob site address: tY�� , 1 100111a or more. Wy.
/. 1 /f, r q Sit a mom readeatial amta. d lturr oml wrhicla
City/Stale/ZIP: A , -t/ I D Fio01tira ra faadities, p Supply parks.
t D11aasdoas locations, t ltsanomina1, more than
Suite/bldgJapt. no.: Project name:
0 Service or fielder 600 amps or mote.
•
Cross streeddirection9 to job site: FEE SCHEDULE New r e ___ _ l l 9tr Vi fora,
single- or multi- 1Jam1Iy dwelling nett.
Includes attached garage.
Subdivision: Lot no.: 1 ,000�Iws 11--- _ 145.15
'1500 sq. ft, or lemon 33.40 4
Es, add
Tax map /parcel no.: I
DESCRIPTION OF WORK Limited energy, residential
�/' (w e d above sa R.
_
) - 75.00 2
Limited taetgy, multi- family
n:sr d(with abovis eq. It.) 75.00 2
Stryker; or feeders installeion a teratio� and/or relocation
. . El PROPERfl OWNER I . . . ;' • Q M` TENA " • . 20 amps or less 06.30 2 •
Name: m _ 106.85 2
401 =Ps to 600 amps 160.60 2
Address: — — 601 amps to 1.000 amps 240.60 2
Over 1,000 maps or volts 454.65 2
City/State/EP:
• s pot Ary services or feeders lasgaltndon, alteration, and/or
Phone: ( ) l Fax: ( )
200 ads or less 66.85 + 1
Owner installation: This installation is being made on property that I own which is not 201 antes to 400 amps 100,30 1 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 4018mpa to 599 133.75 1 2
Owner signature: . Branch Aran �eircalts_oew or t:tenstoa, per panel
bale: ----- brtmah circuits with
.. APPLICANT a • Q CON'I'A :'PERSON , : about: servioa or feeder fee,
Business name: each branch circuit 6 . 6 5 2
—_—__ B. Poe Mr branch circuits
Contact name: With 4ocu service or Deder fee, 1 q
Address: fast bench circuit 46.85 , U� 2
Each add'! branch circuit II■ , , t " 2
City/State/ZIP: M1ealGaeoae service or fee de not Included)
Each d or modular
Phone: ( ) Fax:: ( ) • . dwelling, service and/or feeder 90.90 2
E - mail: Reconnect only 66.85 2
Amp or irrigation circle 53.40 2
CONTRACTOR Sign or outline 53.A0
Business atllnc: HT . $ } R • • • C Signal circuit(s) or limited- 2
Address: - ' panel, alteration. or
2118 5 NW EVERGREEN PKWY #110 extension. Descrtltc; Page 2 2
City /State/ZIP: HILLS$ORO , OR 97124 EathiddlN iaspectlon ova ooweble In irro of the above
Per � 1bO6C ( S 0 3) 439-9666 F( )601-3680 ins ` - 62.50
5 0 3 Investigtatio n per hour p br arm) 62.50
CCB Lie.: 134487 Electrical Lk 34_499 ' SuPiv Lic.: T ndnrstrial lane
49418 p per hour 73.73
Suprv. Electrician signature, required: ELECTRICAL PERM FEES
- — Subtotal: L.7
Print name: JOEY VITACCO I Date: iital OA Plan it view (25% of permit fee):
-
Authorized signature: Staff surcharge (1296 Of permit fix): (j1
Print name: — TOTAL PERMIT PEE: -.6r1-4
Date
This permit application eapires if a permit is not obtained withlo 180
1
• days after it has been accepted as complete.
t :lEailaieglppm�`QI,Gr�m;tApp.dx os/t,7ro6 Number of lmpectiom allowed per permit
440.ae i sTO irosrCOnvwt?e