Permit 1 ,
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00123
T I GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 03/16/2009
Parcel: 1S125DC06400
Jurisdiction: Tigard
Site address: 9663 SW SHADY PL
Subdivision: Lot: 0
Project: Windwood Homes
Project Description: Add circuit for a /c.
Owner: FEES
WINWOOD CONSTRUCTION INC Quantity Description Date Amount
BY ASH CREEK PROPERTIES LLC, 12655 SW
NORTH DAKOTA ST 1 crt Branch Circuits 03/16/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/16/2009 $5.62
Electrical
Contractor:
JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
PHONE:
FAX: 503 -648 -9723
Type of Use: SF
Class of Work: ALT Type of Const: VB
Occupancy Grp: R -3
Total $52.47
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. AT ' • 1 • -, • law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0. -0010 through OAR 95 :• , .11 . You may obtain a copy of the rules or direct questions to OUNC by calline .246.6699 or 1.800.332.2344.
Is ed By: _ Permittee Signatu b 4,1rarigr!
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' �7 _a-A Wara - Date: A 4fro
LICENSE NO. at 7 7
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.
,L.
Electrical Permit A. lira ' CENED
FOR OFFICE USE ONLY
Received 3 1 Le o Permit No.: Le_e 2d0 DD/ 3
1
City of Tigard Deceive:
- 't 13125 SW Hall Blvd, Tigard, OR 97 j 16 20 Plan Review Other Permit;
° • Phone: 503.639.4171 Fax: 503.508 Date B
Inspection Line: 503.639.4175 �! A� Data Ready /By: lens. ' Bl See Page 2 fur
TIGAItD Pe OF a : i Notifed/Md . otho !C•," Supplemeatallnformation
Internet: www.tigatd- or,gov Cl l + 1`s
r. Now construction ❑ Addition/alteration/replacement Please chedr all that apply (submit 1 acts of plans wNtema checked below);
❑ Scrviw or feeder 400 amps or more ❑ Building over Throe stories.
• Demolition ❑ Other: where the available fault current 0 Marinas and boatyards.
•, - _ r 1 excacds 10,000 amps at 150 volts or ❑ Floating buildings.
r t of i � t tai : .? i ' lid: Commercial -use agricultural
�! � • ... ' ': � I Teas to ground. or exceeds 14000 ❑
lit and 2- family dwelling ❑ Commercial /industrial • Accessory building amps for all other installations buildings.
� Fire pump. In installation of 75 KVA or
El Multi-family D Master builder Other. FdiorgeaeY sync larger separately deriv.
:... -,. . .. -�� i .. "V, "1-2","1.3", d
system.
!. ' •.- ,• - itnl�il =virii� :f�;` /;i;il;�s`;W ?_� r: �ed ; ul °1' . .. .. ,... ❑ Addition of now motor load of Q "A
":_. ,: ... . , . t001W or man, occupancy.
Job no.: Job site address :el L0 ti sit/ 3 f i t P1 6 ❑ Six or or residential units. ❑ Reeroat l •chicto parks.
Q 0 1•tealth-earn facilities. ❑ Supply voltage for more thou
CIay /StatrJZIP' tJ X i (�' 0 Hazardous r moro 600 volts minima.
dots
Pro'
Sui[e/bldgJapt no.: I Project name: in servioo or feeder �" ...._ ''' 1 1?
. ..... .... ......
Cross strectldirection.s to Job Site: _ n:erj• . t .1 '
— New residential single- or multi- family dwelling unit.
Includes attached garage. ,
^
I Lot t no.: 1,000 s11 ft. o less — 145.15 4
Subdiv Ea. add'l 500 sq. R. or portion 33.40 1
Tax map/parcel no.: : energy, residential 75.04 2
,.,,:. iolax'.i',lt�e :1;fif� ! ' !'i' ' .... ' (with above so.l�
- - Limited energy, multi-family above SCI. ft.)
Sery
MCI C � ^u C�� A.!�' rv i i ce s s or (with feedersInat a 11 a ti
J•idl �W L- / /� ie or feeders lnattltioa, altentioa, and/or relocation
200 amps or less 80.30 2
t ps t0 amps
',...:':-,•;'-'• I ;(.1t,�dliY.ls i , .6.,,s�`F i!, _ 1 Ji �y � , .. ' . ti - � .
. 201 am 400 - 10685 2
",_ -.:... :.. :: ,. 401 amps to 600 tun 160.60 2
Name: , a • ( w u______ 601 amps to 1,000 amps 240.60 2
Address: ig . 5 x L Or tar 1 1!..-. 14 Over 1,000 amps or volts 454.65 2
Temporary services or feedera installation, alteration, and /or H Ciry /StatdZIP: . �'� relocation
U
Phone: (5z) ., Fax: ( ) 51 0 -J(djt 200 amps or less 66.85 I
201 amps to 400 amps 100.30 • • 2
Owner installation: This installation is being made on property that 1 own which is not 133.75 2
intended for sale, It ass, rout, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps Branch circuits- aew or extension, per panel
Owner signature: _ D ateC A. r '' „:,.,...,.. ; :. • ; _ i .. .I; . — (.3'.: I :;.:'fC '.a;i;ur.. r fee. 6.65 2
Fee for branch circuits
I ..,� "1 : �. V:i� above service or fa
I :
a ry
_ each bran ch circuit
d./A. I B. Fee for branch circuits
without service or feeder fee. ' 46.85 - I GaS 2
Contact name: cha r" 1 . _ first branch circuit
Each add'l branch circuit - 6.65 1 2
Address: -
Miscellaneous (service or feeder not inc luded) „_
City /State/ZIP: - Eachmanufacturedormodular 9 p . 90 2
dwellin: service and/or feeder
66.85 2
Phone: ( ) Fax :: ( ) Reconnect only 53.40 2
tion cirole
E tline lighting 53
P
i ': - .:::, .', .._, :: : : .. ... ,, ,..�.,. .,.._ .. ........ ... .. ._.. .... rcuilS or limited-
ro ts
...... Siganl et ( )
Q - ( ' ' e/ 4 ' c., • s energy panel, alteration. or 2
extension. Describe: Page 2
Address: I ! if 1:: 0Y..... -1 i — �
City/State/ZIP: '116 borlr7 I
' ,rf ' 2 Each additional inspection over allowable ii any of the above
Per inspection 62.50
Phone: (
503 Phone: Or . ` 414 Fax: (50) i 1 . '' PI 1 investigation per hour (I hr min) 62.50
S Industrial • lint per hour 73.75
� 15 • lr i 1 Electrical Lic.:31F.1 G Suprv. Lic../ 2%11 i_ s�� >i s;ri . ii:;i =��;'r :. • - n _ :
Suprv. Electrician signature, CCB Lic.: .. »i tic ?,'�'i: • ;i. _. ..
.
Subtotal: signature, required :::' „J - '
Plan eeriow (25% o lgit a:
� 0 Date. State surcharge (12% of permit fee): 5a (o2. —
Print name: TO a�j A t TOTAL PERM IT FEE: 5'), - Yl
Authorized signature; this penult applindoa expires if • permit Is act obtained within 1a0
I Date: • d.vs It h,u two eermWl RR .two d.F..
Print name:
Z0 39dd CNI 0Ia10313 30W63C EZL68179E09 8E :90 600Z/9I/E0
A