Permit c •
CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT
• �� Permit #: ELC2009 -00408
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/07/2009
Parcel: 1 S133AD03800
Jurisdiction: Tigard
Site address: 12750 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Mitchell
Project Description: 2 branch circuits - bath remodel
Owner: FEES
MITCHELL, JOHN EDWARD AND Quantity Description Date Amount
KAREN KAY, 12750 SW SPRINGWOOD DR
TIGARD, OR 97223 2 crt Branch Circuits 08/07/2009 $53.50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/07/2009 $6.42
Electrical
Contractor:
A & J ELECTRIC
PO BOX 330
FOREST GROVE, OR 97116
PHONE: 503 - 359 -5891
FAX: 503- 359 -1981
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 95 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. \`
Issued By: Permittee Signature: i w � � i
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.
, 4ALS 06 09 12:47p Leeann Greason 503-359-1981 p.2
i lect6cal Permit A licati CPIVFn FOR OFFICE USE ONLY
City of Tigard ,,, I .1 —.-,
Rginin11111111 p.mil tb.: . - ,
.1111 ...-- m 13125 SW Hall Blvd Tigard, OR Plan Review -
1 - ' Mona 503.639.4171 Fax 5015 G 0 6 2009 Date/13 . Ma Permit:
Inspection Line: 503.639.4175 Dale ReadifIly: hair la See Page 2. for
Internet wsvw.tigard CITY OF TiGARD Notified/blediod: Supplemental Information
t.,-, • :••:•-•:, -....=:,- ,: : - -:': -, 41.0e0 i i,,,,.) ,- y ,e „::: - -, - .,.. • _ • • .. • : • .-. -,- -, 7 - . ::.,:•:- ,.. oti
0 New construction 14 Addition/a1teration/replacement Please check all that any (sahmit a sets of plans wrdems checked below):
0 SaViee or feeda ano an:cos.:1r more 0 Budding over three stories.
0 Demolition 0 Other: - who the available fault awned 0 Marinas and boatyards.
.:•.- : . - : • woo =apse isovoksor 0 Floating buildings
less to groan& or mauls 14.000 0 Commacialtue agricultural
t3 and 2-family dwelling 0 Cotrunereialfindustrial 0 Accessory building mops for aa other installations. bar/dings.
El Multi-family 0 Master builder 0 Other: CI Firepump. 0 Inman ion 0175 KVA or
larger separately derived symm.
.:::• •• ' 'f • -JOB:i.SiTB:INFORMATIOW .,:- •;•-•-•; , - 0 Addition of Dew motor load of 0 "A 2" - I - Y
-, "V*, "I - ,,,
. ,. . . ... • • ... • : -- _
I - \--...... , - _....., ••••,, 10011Por atom. OCOJIMEICy.
Job no.: illik Job s address: 7--. :-.-.,■•-,, , 4..,-,,.-, 0 Six or more residadial units. 0 Recreational vehicle park City/State/ZIP: ----, ..,-<-,-c„: S-...., S., .... --- \, -- e-- -,---3----2.--) ,, ,, — ....3 C, 011calth-eare facilities. 0 Supply voltage for more than
0 Itaardous locations 600 volts nominal.
SuitelbldgJapt. no.: I Project name: • 0 Service or feeder 600 amps or more.
Cross street/directions to job site: Deseriptioa 1 Qty. I Fee. 1 TeL I •
New rcsitkotial single-or multi-fmnily dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 .._ 4
F.a. Sidi 500 sq. ft. or portion 33.40
Tax map/parcel no.:
Limited cnagy, residential
- • - 75.00
•• -4 .z.•: •••-..,-- -..- :-. ,:: ...•:: • DE~FroistqF WORE: • - • • :.- • • • -. : . -. - -.,,.. (with above sq. a)
Limited energy, multi-family
residential (with above sq. 0-) 75.00 2
Services or feeders log12112608, alteration, and/or relocation
200 amps or less 8030 2
. , .....
„ . . ...-
# -- -:- . 77 ,- )::...:-. :-... - .::...-:.-•.,.-: 201 amps to 400 amps 106.85 2
160
401 amps to 600 amps .60 2
Name:
601 amps to 1,000 amps 240.60 2
.
Address: Over 1,000 amps or volts 454_65 _ 2
Cit/StateJZ1P Temporary services or feeders installation, alteration, and/or
y : .
relocation
Phone: ( ) I Fax: ( ) 200 amps or less i 66.85
Owner installation: This installation is being made on property that 1 own which' is not 201 amps to 400 amps . 100.30 2 _
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps - 133.75 2
Branch circuits- new, alteration, or extension, e ar panel
Owner signature: - Date: . A. Fee for branch circuits with _
•
- 7 : --- . . r : - • - • . • . • aAtioatT*1 above service or feeder fee,
6.65 2
- •
each branch circuit .,
Business name: .
• B. Fee for branch circuits
without service or feeder fee,
Contact name: first branch circuit \ 46.85
Address: • Each add'I branch circuit N. 6.65 ‘ 2
miscellaneous (service or feeder not included)
City/State/ZIP: Each manufbaured or modular
90.90 2
dwelling, Serviccand/or feeder
Phone: ( ) I Fax: : ( ) •
• -
Reconnect only 66.85 2
E Pump or irrigation circle 53.40 2 .
....; = toNts.01 •,-,: 7 " . ?; :.. " -'.:: .7;: ... :7'7 .-:.:':.." Sign or outline lighting 5340 2.
• Signal circuit(s) or limited-
' Business name: A&J Electric
energy panel, alteration, or
Address: PO Box 330 • extension. Describe: Page 2 2
City/Statc/ZIP: Forest Grove, OR 97116 Each additional inspection over allowable in any the above
Per inspection 62.50
Phone: (503) 359-5891 I Fax: (503) 359-1981 . Investigation per hour (I hr nip) 62.50 . .
CCB Lic.: 959 1 , i )„._ I Electrical Lie.: 34-1c 1 i h I Stiprv. Lie.: 5055S 1 1 . li, , hi dusto , .. . plant__ ' per hour . . 7175
1 IN " • : ... '•'... s.:...•-• ' : ELECTRICWKR8IFt.VEES'.:4=';:c.:•.;•:-.Tr.:
Suprv. Electrician signature, required: ... 0 Subtotal: S
---`• ---,
Print rum= Tony Wilson I palm N)1 Plan revi 2
ew (25% of permit ix):
State surcharge (12% of permit !cc):
Authorized signature: . TOTAL PERMIT FEE: ez ..F..,..C\
Print name:
I D'ate: . This permit appfteadon expires if* permit is not obtained within 180
. days after it has bees accepted as complete.
• Number of inspeaions allowed pa permit.
1:1BoikEnglArnnit6ELGPoncitAppdoe 0923/06 440-161SIXI VOSCOMiWEB