Permit v CITY OF TIGARD ELECTRICAL PERMIT
i COMMUNITY DEVELOPMENT Permit #: ELC2012 00488
T i G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/20/2012
Parcel: 2S102BA02200
Jurisdiction: Tigard
Site address: 9975 SW JOHNSON ST
Project: Stroum Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 45
Project Description: (1) 200 amps or less
Contractor: ABC ELECTRIC Owner: STROUM, DONALD M
135 NE 9TH AVE 9975 SW JOHNSON ST
PORTLAND, OR 97232 TIGARD, OR 97223
PHONE: 503 - 233 -7551 PHONE: 503 - 233 -7551
FAX: 503 - 233 -7552
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/20/2012 $100.70
Specifics:, amps or less
1 ea 12% State Surcharge - 08/20/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 OA 9 2 -001- 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232..19 or 1.800.332.2344. 4 2..2 / &U
344. h �/ ,
Issued By: �1i� Permittee Signature: Derll T'1 PPLI C. n v .
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.
8/16/2012 10:25 AM FROM: ABC Electric ABC Electric TO: 503 - 598 -1960 PAGE: 002 OF 003
Electrical Permit Applrcatiir 'W. EIVED
l?OR OFFICE USE ONLY "
Clay Of Tigard Noccived. Penn il.No IZ
i IIG 16 2412 gate;fty:. SIyDIi s,— L
• 'r 13125 SY.' Hall Blvd,, Tigard, OR 97 Platt $cview
Phone: 503.71'82439 Fax: 503..98:1960: ' 1)ate/fly O ther Permit:
�p�
TCGARD lnspectiga Line: :503.639.4 CITY OFTIG 1)atuRead purl El See Page2for
Internet: www.tigatd- or.gov NLaiiedtMa r n rural
�p ry
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❑ New construction ',Addi lion /alteration /replacemllent G Please chect,oll thatapply.(snhn»t 2 scts of plans iv /items checked below):
❑ Servile of I'eedet 40Yl amps or molt ❑Building over three stories.
❑ Demolition ❑ Other:
xv r.,. where tl hlefautt ewrenl ❑ Marinas and boatyards,
i.r'..^,' • �,..' .1;. � +�,. trii Li• - _ _ e avail..
. ` h'IV. ; 0 1' ' 97Z�r"cs14.4,1, ;1' 8 Vsh✓^ y i:? +'I� 'lz `.4i::= `ai s>i i . mp 5 ❑Ploetin buildings:
r,, _ �k! , , a ,4 .. %h . , - .. .. _ . exceeds IO,U(1(: a sal I _0 volts in O. Floating Jim
' �' "' :' less to •round, o e xceeds 1 4,000
b ❑ Commercial use agricultural_
1Q 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory•building amps for all other installations. buildings.
❑ Multi- family 0 builder ❑ Other: ❑ Fire pump. ❑ Installafior. of75 KVA or
� I �+r`- �- n. �. R .,,, e . ; ,•,� E mrgysyslem, tar separately t ii
/4": ':4''.`' "4:x -;,=• ,rt r r : : ,. ':- - • T;IQ A - . C} 1 1 : . ,: : .: _ ; s: . r ti.:. •Air . ? c Addition bM P el a <t system.
- �:.. . ,. :: .; ns . - .^ .� ;; �'�r; .e a :. ❑ rti of new molar held of ❑., ,. .. Z ,.., I.3 ..
IGOHP rx inure. occupancy.
Job no.;V1• { Job site address: ' r ., t'
��+ • • L i s... rl ❑.Sir or more residential units. ❑ Recreational vehicle wiz,
City/State/ZIP: �--_ 01-cape facilities,. ❑Su p plyvolta eformorethan
❑ Hazardous locations_ 600 volts ��� _, r ) _� :, oltsnominal...
t
Suite /bldg, /apt. no.: Project name: tip` ❑ Service or feeder 600 amps or more.
t. LS 1 \'i v si:. i= `'-': -..�'``.` ,:;_ s : E ' t -,:u
Cross street /directions to job site: — '.'i4 'is `' , a U �'x6 1 ° :-,: -7=
- -- Description I O1Y• Fee. Total •
New residential' single - or multi - family dwelling unit.: '
Includes altnched•garage.
Subdivision: Lot no,: I ,(100 sq, ft :'less, 168.54 —0 •
ox.ntap /parcel no.:
• Fa. (WWI '06 sq. Ii. or portion 33.92 �®
s . _, a <w ,�, K ; Limited-energy 'residential
i y v ., n •' ,1'i, ;,ti � J T�7 J .i ea ;-:l. :I; �.
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.
II
. °k4 '�.n- :i, ,
•'vr r'+ •, F - H` � k v , r .. .•:;ki r. . , WlUpetlOVa sg, .�.. _
.. e . n . . multi tbm 75,00
• t 75:00 2
_) ) (� " s dt f}:)
LtT � residential (with above s4
. • • Services. or. feeders installation, alteration and /or relocation '
• 200 amps or less : d 100.70 1=211 2
:1 ::i:'. 1 I?Tli : 's :. ,,:; n,.,. - J „ . '� , „ . x 5 -4, 201 to'10,am
,._` .. ' Yt. :.: r �."k- �l%�:If &:. •:s��;+' } +v -<.° TSB:: ��11f :�1�'<�'.-';' >e^°+3�:?�-+�'v'�. amps. 0
.... ]� 13 } .5(i Z
'� 401 am to 600 am
Name:' . 3 e' c ,k { � . snips to 1 m 20 E04: 4
1 1.1a �. 601 amps 000 amps 301.0 2
\
Address:.. .
c Z)ver I arvolts 552.2G •
Tcmporery services or feeder: installation, alteration, and /or
• C rt) /Stntc/ /AP: _ (! C t ''� �1' relocation ”' ' ' .. . •: •
]'hone: { lw , I r Fax: { ~ ` ,) ..200 amps.or Ices ' 59.36
• I..,lS ,�
20 1: amju to 41)0 amps 125.08 •
Owner installation: This installation is being_made gn Property that own which i s not
i s ale,' lea rent, or exc ; : nccordm g to :ORS 447 449 ;.and'701. 4olamps:i •• 1 : • -. •
Branch' circuits -.new alteration, or extension,. er panel •
. Ownet:.Signature • :: . : : Date : . A. Fee fit branch eiriuits with .
i -= -` - ' - T ...'' t o t I '? VA.), :K<:�r.' �,�, ,, ar. - >s -� fliioveserViee efc6der • -
; . �; . -. : . . t s t • �° , . fi x : - _ ` i r ' 7.42 2
'
vach branch cl not .
Bu sin es s nam e ' a . , B. Fee fnrbranah •witllwat "
- service or feeder fee, •first
.Con `' .a . > -,...• ` ., branch :ciieuir -
.- '
A
5618 - .2: Address: - "`, ._ r J .l btpn h erred ,7.
A .Eab a c 42 2 • - Yliscellaacutls scr not hi cluded
City /State/ZIP; I laeh manulhetureOl orntoduIer 67,84
.1,P l
,+� T� - 3 tluill0� servi (ceder
Reconnect o nl 67 84
1 hone t 3 a � Fete {3) s y
l; mail - `r /. II 1'f l!A.a , Pumporlrtiganon 4784:
i �,:; ; ; Sign or out l iTIO )ar tettms; Cd 6784
..r , :,W .�, Y:A.Z I:ifi :' : fi : S igllaltic
e Uil(sbm4- en er ,: -41(015000 oreiitens.on Pa e2 .
I
•
! .... ,c PA, I - ._1' ( c.:
•;Business npine: r h . d d . i
_ . Es a do ms ec tion o r . e e In env 01' e • i DaF yr I towabl th above Eis
•
Address; "' - . • ., Additional inspection (I hr min)- :.; _ 6625/hr. : - i -
Ctiv /State/Z]P . p / //��� /} - Iovesligation {l hr mm) .6625/ hr
. a / , . : 9 ta�l � .z._ - t'l -. .
'.PJwnn (U}3 - ] ��� Fa,c { ! ) 3 - . � :Insspoottong chnofeed
1 ,- m) 9000 /zhr
.' Lic: / (p:/5) ctncai'f is .r) - .; cifiwll hsted 14.hr m R." a c# a? a x,•k°Z ;`I. ;•. C ' ).�; . ,
Sfrprv. - 1 l r eq u ired
l bt�l -,
Peititnname t1 -i: a �, i "` Date , ( Stae 12 % Ofpermit -feet / 2 f.e
Authorized signat . � _ J GF
� a r � • T6is'perru application Expires if a- penni4is notebndned i
wthin 480 - , ,
q . :Date / days after tt has been accepted as complete..
t
Print Dane a .. i.. Xl . f L. (°f 9 ( 4 � : w) fa . / / _ �!: Number -olla s'pegiuns allowed per permit: - -
muIIdisB \Permil,Wi.e- PermiiApp,doe v1
97m5 7 _ , , •44 :,401 1:(11 /osiCOausEB. • ,' -
8/16/2012 10:25 AM FROM: ABC Electric ABC Electric TO: 503 -598 -1960 PAGE: 001 OF 003
ABC Electric
135 NE 9th Ave
Portland, OR, 97232 -2912
c o n f i d e n t i a l
To: City of Tigard
Fax Number: 503 - 598 -1960
From: Anne Braden
Fax Number: (503) 233 -7552
Business Phone: (503) 233 - 7551
Home Phone:
Pages: 3
Date/Time: 8/16/2012 10:25:36 AM
Subject:
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