Permit J .
CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00477
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/11/2009
Parcel: 1 S136CA06900
Jurisdiction: Tigard
Site address: 7590 SW SPRUCE ST B
Subdivision: Lot: 0
Project: Gende
Project Description: Repair of meter for service
Owner: FEES
ROUSE, CHARLES & Quantity Description Date Amount
GENDE, DIANE M, 11916 SW ELEMAR CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/11/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 09/11/2009 $9.64
Electrical
Contractor:
DYNALECTRIC
5805 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503 - 226 -7720
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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
Q0
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.
��+ w LO cf � t��
Issued By: �in Permittee 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 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.
•
- 2009. SEP. 10. THU 07:30 DYNALECTR I C SALEM FAX No, 53-391-2817 P. 002
..
. EleOricaLkerluit_ .Ap p li c ati o 'RECEIVED - ••• - - - - ..
FOROFFIC.:E. USE I ' . .. - . -: ... : •• .. :• .
IL • City of Tigard Rec.ivNi
Dte/B: PeMit No.: e_ ?an -crbcf7 7
. .. 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
------
i ril II '.• ' Phone: 503.639.4171 Fax: 503.598,1 'm EP 1 0 2009
Date/By: Other Permit:
• TIGARD Inspection Line: 503,639,4175 Date Ready/By: Ariz i El See Pnge 2 for
• Internet: www.tigard-or.gov . CITY OF TIGARD • Notified/Metbod: Supplemeotol Information
• • ..- ....... .. ... ... .. ..
?'Of.7;gOblitOINGDINtISIVA,':::•.::(W.:;■:,. :.,:.:'......::'.• ...,...':' :' 1* ;' '.:. , : • . . : - -
ID New construction , Addition/alteration/replacement Reese check all that apply (submit a sets of plans wfitems checked below):
&j
El Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Nations and boatyards-
. . „,„
6V-jliG.s0t:44;'dt6f6t0V401Ekti‘'.21,i;'.:X::.;:i.7T....'; .7.:,7.:.-':.4':.. exceeds 10,00 amps at 150 volts or 0 Floating buildings. .
' 4.. I - a n d 2-family dwelling 0 Commercial/industrial 0 Accessory building amps thrall other instalbdons. buildings.
1:1 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
El Emergency system. larger
'' '!„.. : ;':::•?;'•it. : 1 : :;!: , .:. :: : : '....ii i i . .,'Ei#0.k:011"tt#4,41.1:: :■ :.7.A.4. 1 .ii l , XIC". 0 Addition a separately derived system. new motor load of I:3"A "B“,
m".. - 's 100HP or more. oceepancY.
Job no.: se , - 7 Job site address: 759451 .524)*rad_. 6.../..- 0 Six or more residential units. 0 Reematienal vehicle parks. -
City/State/ZIP: I •
/ ../ 0 Health-cure facilities.
El lia 0 Supply voltage for more than
.." / 9, f 0 zardotts locations.
600 volts nominal.
Suite/bldg./apt. no.: '4" a l: ' Project name: ArAFA.4,2, .M. II Inservice or Rader 600 amps or more
• • Itir i" . 4. FiSia'Xg:
Cross street/directions to job site: a eierl 'flan (LIM MOM MelillliME
NeW residential single- or muti-family dwelling unit.
Inciudes attached garage.
SubdiviSion: It no.: ,000 sq. ft. or less 145.15 . 4
— — Ea. add'l 500 sq. ft. or portion 33.40
Tax map/parcel no.: Limited energy, residential . 2
i:•••''. :C"),WA,%iktit'?!U' .. :i with above q. a.
Limited energy, multi-family 5.0
/ M 8.)// •••• \ -,/h, / ,!_g__.- residential with above - R.
Services or feeders installation, alteration, and/or relocation
200 amps or less i 80.301 eii, I 2
'" '.;.. • cy 201 amps to 400 amps 106.85 • 2
Name: 401 amps to 600 amps 160.60 - 2
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: ( ) Fax: ( ) . 200 amps or less [ 66.85 • 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701- 401 amps to 599 amps 133.75 2
13ranch circuits- new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.nrArgligWrAqi:V above service or feeder fee,
i.:•:'••'V'',•,w; ,...., .! ,:,1;• sel„- .....,45y,,,4 ...,:m..A1 6.65 2
each branch circuit
Business name: E. Pee for branch circuits
without service or feeder fee,
Contact name: /9‘, (,1 3 .
first branch circuit 46.85 2
Address: Each add'] branch circuit 6.65 2
• — Miscellaneous (service or feeder not included)
City/State/ZIP: -Each manufactured or modular 90.90 2
. — dwelling, service and/or feeder
Phone: ( 7 93 . 6 I Pax: : ( ) Reconnect only 66.85 2
_
E-mail: Pump or irrigation circle 53.40 2
.:. 1..::,• ................................................................................... Sign o outline lighting 5340 2
Signal circuit(s) or limited-
Business name: / C--" energy panel, alteration, or
Address: - - .2 1 - - - - e- I- i , 1/ 7 (2i • ' , Z/ 4 e— - - extension. Describe: Page 2 2
City/State/ZIP: e2,5 .9'7739 Each additional Inspection over allowable in any of the above
'-' J 1 Per inspection 62.50
Phone: ( ) 7,// ..".43 &.:R1 I Fax: ( 1-. 4 23 ) c l'o?'' n?6,...., Investigation per hour (1 hr nun) III 62.50
73.75 II
cc _B L ie.: ■ -... 7' Electrical Lie.: ,,,, - -, . Su.rv. Lic.:c4/4535 ' Industrial plant per hour
C.
0
I i s,rgz PIM& ' . ; ''..M.a13MWMENNSIMI
Suprv. Electrician signature, required: ,O - A ./ 1 . Subtotal: 10, 3
. 6,
, i t .•)
• , Plan review (25% of permit fee): •
Print name: 1 -
- (.1.,ti.hard. ' . - -, I Date: FA. .
„ A I State surcharge (12% of permit fee): ?Zp3
_ V
Authorized signa ,a01 1111111 ' ..- ; - — TOTAL PERMIT FEE: 2 - q
...
, -..., . . / -_..oL— 0-'••_
. ZI Date. ....,„ z ,.. , .., ....;.. Ti p Crrt1
It application expires Ira permit Is not obtained wi ulnae
Print name: ./Lor."41E.f■Prar Date days after it bus been accepted as complete.
' Number of inspections allowed per permit.
o5wildimpennial2LC-PronitApp.doe 03/7.3}06 440-1615r( i 1/03/COMAVEB
N `
4009. SEP. 10. THU 07:30 DYNALECTRIC SALEM FAX No, 503 -391 - 2817 P. 001
Dynalectric 5805 SW Company
�--� 5805 SW Hood Avenue
Portland, OR 97239
An EMCOR Company Phone: 503.226.6771
Fax: 503.226.7818
ccb: 66793
Faxsimi e
Number of pages including this cover sheet: 3
Date: 09/10/09
To: Electrical Permit Dept Tel:
Company: City of Tigard Fax: 503 - 598 -1960
From: Lynne McEachem
Message: Following is an Electrical Permit Application to be processed.
Thank you.
•
Dyna -019 Rev. 02/17/04
g' Lc, ta - o g— vzo $i 77
09 -25 -2009 06:33AM FROM- 75 O .5‘,/ 5 - 3 T -272 P / F -368
.
' Request: to Energize a Electrical Installation
'' - jurisdiction address:
P Gtr 6 /13
ripili P66 .
. Sri:.. ;;,. � _.'G= 1=R LSING7.FLECTRI:CIANr1NFQR lATIO'A� 0 A 0,a:,- .,,r'_ :::;...,�
Name of supervising electrician: �� /(1/
,. .gyQ;r) Date of request; /i /
Supervising electrician's license number: G
ti`�o,53.s Da te installation eras completed: fijosl
:31ectrical permi l no.: gf pp '� If a temporary �' y 1 f P ry perntit i.r posted at the job site, pt :rise include a CT copy � ::�;:.�. ;•:�:_. �., PJ� of it with thin form.
i:i +',:; ;. , ;; ::.itEM , !NG :' LERI,C�4'L' •'.`4C:QNTRPA'CrfOR'•;�;INFO YTM
Name of electrical � • — ' FiOA:•4TI.Oi ��. + :,�, �',• ' ��,� .�.';• ,. .• .
contractor: ____50‘ /e i4 . 2#
2 'r , � , r :;:... , ,
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3usiness address: 6 < SLC.) /, /5 -
License no_:
City: eon /2n r.2 _ State: &A" ZI~
Phone: _95- .7z76 r S'
• ( / - Fax :13 - • 77o?O E - mail: c
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MEIniNR.O'R'MACEION iti'iY `�1;.� . U:: ��':1.:.. .�''z - ry, U .
Customer's name: yn' ''y'A ;_.. ^�« jir �.;r:, y ��7.'�u ti. �:5
• Customer's _ t , • , [� � � c 5 f .ti
City: State: Of ZIP;
A :ldress of installation if different than customer's address:
C3 :y: State: ZIP:
, ; - . - N :3 ' SPE 1 FT I Y: , so P t : f oN ,, r . a. )4 .9 .., :. :et, , -1 . .
At thority having jurisdiction to inspect: ,.� �.d? Phone:
Ac dress: -
City:
State:
MM C ZIP;
.�' +;'::y�•I •i`�4:'�reS;11,y� ^'aod =.`;,t :F!'Jj �f� oCTRPC�� J ti:,. ~__-
y k •1� - �,.. : c ..., `4R E`WING: iE iUrriEli li:4NF :fi1GiA lO•N : "All:: , ' : ': i: ', : � ,
electric utility receiving `S:. , • '��. ���� ��.� F., e, � -:,•.
Name of elec _�.... • ..:. :r .� .., +�.�� :.,R= :�•yr:�' r
ing request -Pa Phone: ,, 23 - 7%
Address: /off/ Sue )�d!-y 5'7 �•
—
City: , -/41,- CZ - State: c9.E' ZIP: 97a
Fri�;.li;l1` +:1f�','71� ": R .,�_:,�� a 7;�i.F. r;:• ��.� �.,,,��j ap =— Q
,. ", ,..Y'1i V. ;; :.+ :.h1r 1 ,. � t a•uREA i 1 0 «V ' iwr�'• �;L i , r . .
• • �'- . t�. '�'� • SOAiI ':;�(�;R��'�i'EC�?:U.�ST,,.�. ,, � a; b��nn�..77�'� �t . r_ . ,.
.._ Llp ■; _I. , Y et i.L'l" �"; �(' 1 �r��; P: i::' �i,'{ j} �'. �Pi �:kF���•!, M :: f 6 ;
A. Restoring electrical service that was interrupted or disconnected because of either a:
Service change or ❑ Uncontrollable event, such as fire, flood, or severe weather
or Mc.tcr &o.5e, r4
B. Electrical service at a remote ocation needs to be:
Initialized ❑ Restored
-,r:_,; -' t ,.,:- : .;;> „ :';A: :' :••ir!,:, , �n r -
” ' , "'�� .. RU.CTI,pNS.;+�ai'vD SI:G`NQ'uTUR�E? � , P • , .:�, �,, �, �
up xb electricia r _ �.- 1 � •a• i,�� .•,�,;,• ?,, {.:�':�:;;,�;: - � .
S t!ry isi>t E lectrical contractor �
Please note — After sending this form to the electric Please note — By close of bu.;iness on the first business
utility named above, you must send a copy of this form to: clay, following energizing of a completed installation in
(1) the electrical contractor, (2) the customer, and (3) the response to the above requesi, you must: (1) notify the
pt l
:Ling au[h°rtt '
authority having jurisdiction a1 the installation has been
energized, and (2) request that the authority inspect the
1 • ('► r �� - - - O completed installation.
J
Supervising, electrician's siunatu etc
—
:IE �
U = LL)$IN :SS
'.,kKVICi fi . 1
0.0945 c:oM t9 /O8 /COM
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