Permit /o 9
CITY O TIGARD ELECTRICAL PERMIT
11 - 1 1 ° ` COMMUNITY DEVELOPMENT Permit #: ELC2009 -00292
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/16/2009
Parcel: 2S1 11 DCO5000
Jurisdiction: Tigard
Site address: 15671 SW SUMMERFIELD LN
Subdivision Lot: 0
Project: Mortensen
Project Description: Install /alter (2) branch circuits for a/c and GFCI.
Owner: FEES
NELSON, GARY & Quantity Description Date Amount
SANDRA M, 15671 SUMMERFIELD LN
TIGARD, OR 97224 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:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
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 accor 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. ATTE ON: Oregon' law • uires you to follow the rules adopted by the Oregon Utility Notifi • • Center. Those rules are set forth in OAR
952 -001 -0 0 through OAR 95 *11-01 0. • u may obtain a copy of the rules or direct questions to OUNC by . • . 03.246.•699 or 1.800.332.2344.
Issue By: � Permittee Signa are �. 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' C 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.
•
Electrical Permit Application FOR OFFICE: I: S ONLY.
City of Tigard day Permit No.: ,20 0 9 cab a 9�
n 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
7
Date Received
Other Ptnnit:
C Phone: 503.639.4171 Pax: 503.598.1960
Inspection Line: 503.639.4175 Date Ready /By: In ® Ste Page 2 for
T I G A R p p K
Internet: www.tigard or.gov Nolined/Method: I Supplenrental Information
TYPE OF WORK • PLAN REVIEW
Please cheek all hat apply (submit 2 sets of plans w /items checked trims):
❑ New construction jaAddition/alterationlreplacement ['Service or feeder 400 amps or more ❑ Building over three stories.
Demolition 0 Other where dm ay ;table fault current ❑ Mantras and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.0 ,0 amps at 150 volts or ❑ Floating buildings.
less to group ., m exceeds 14,000 ❑ Commercial -use agrioulturil
g 1 and 2 - family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all ther installations. buildings.
(] Fire pump. ❑ Installation of 75 KVA or
❑ Multi- family ❑Master builder 0 Other DEatcrgrrny system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of - ew motor load of ❑ "A ", "E ", "1.2 1 -
r (� p/ 1 or m re. occupancy.
Job no.: 1 Job site address: ( 6 j r- i 5u Sid meri•; I. tale ❑ S ix or more csidenlial units. ❑ Rcercational vcftide parks.
❑ Health-care acilities. ❑ Supply voltage for more than
City/State/ZIP: 2. ❑ Hazardous 1 carious. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more_
FEE SCHEDULE
Cross street/directions to job site: urtrript:oc - 14t" I Fee. I, Total I •
New residen ial single- or multi - fancily dwelling unit.
includes ant ched garage.
Subdivision: • I Lot no.: 1,000 sq. ft. c r less 145.15 4
nn j tt�.., ^�, Ea. add'I 50( R or portion 33.40 1
Tax map/parcel no.: Ot I �O'J w • Limited enery- residential 75.00 2
• • DESCRIPTION OF WORK • (with ahov`stt. lt.)
L / Limited entry, multi- family 75.00 2
• G( r i C e •`` c- i i-L. rte' ✓ - G ('
residentia (with abo sq.11.) ;
Services or ceders installation. alteration, and/or relocation
200 amps or-less 80.30 2
❑ PROPERTY OWNER , I ❑ TENANT 201 amps to 400 amps 146.85 2
401 amps l 60 amps 160.60 2
Name: r T) e ( 50 in 601 amps tc 1,000 amps 24 2
Address: !�/ Over 1,000 arms or volts 454.65 _ 2
Temporal" services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps o less 66.85 I
201 amps lc 400 amps 10030 2
Owner installation: This installation is being made on property that 1 own which is not 2 01 tunes n 599 amps 133.75 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch ciruits - new, alteration. or extension, per panel
Owner signature: Date: A. Fee for 1: anch circuits with
❑ APPLICANT I El CONTACT PERSON above se-Vice or feeder fee, 6.65 2
•
each branch circuit
Business name: B. Fee for trattch circuits
tvtthoul ervicc or feeder fee, 46.85 J./ 6 . 5 .5 2
Contact name: first bra] ch circuit
Each add'l Branch circuit _ ( 6.65 (04,5 1 2
Address:
Miscellaneous (service or (ceder not included)
City /State/ZIP: Each tnanilactured or modular 90.90 2
dwelling. a, rvice and /or Reeder _
Phone: ( ) Fax: ( ) Reconnect only (16.85 2
E -mail: Pump or irigalion circle t 53.40 2
• CONTRACTOR • Sign or ou line lighting • 53.40 2
�i 1 m�aon � � � t u Signal par 1 el, al alteration, limited-
Business name: or
1 tI ( � , energy par el, etion, or
Address: a1,46 NE rineD,3altief 1-r) (7519 e extension. Describe: - Page 2 1 2
City /State/ZIP: a) e m 1 or-1 Q 9-712e Each add ional inspection over allowable in any of the above
inspecion 62.50
Phone: ( s 4 - 72 __ • Fax: (5z) 4. -. I Investigat_ort per hour (I br min) 62.50 _
Industrial plant per hour - 73.75 _
CCB Lic.: Electrical i g2c Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: t Subtotal: 53. so
- / J Plan review (25 %ofpixmit fee):
ce[ 1/
Print name: i i k S/�yt Date: 4 (I S /Uq State surcharge (12 % of permit ice): 6. Lip
Authorized signature: '�`"� `
Print name: , Date: TOTAL PERMIT FEE: G( . 9' .
This permits application expires if a permit is net obtained tiithin 180
days a fter it has been accepted as complete.
• Numbe of inspections allowed per permit.
I. ■Buildiny \Pcrmite',i:LC- PamitApp.d°c 05.43/06 440- 4615T(11105/COM/WFS
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•
CITY OF TIGARD ELECTRICAL PERMIT
3 s COMMUNITY DEVELOPMENT Permit #: ELC2009 -00292
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/16/2009
Parcel: 2S104DA20400
Jurisdiction: Tigard
Site address: 13058 SW PRINCETON LN
Subdivision: Lot: 0
Project: Mortenson
Project Des • .tion: Install /alter (2) branch circuits for a/c and GFCI.
Owner: FEES
MORTENSON, ROBIN Quantity Description Date Amount
13058 SW PRINCETON L
TIGARD, OR 97223 2 crt Branch Circ.its 06/16/2009 $53.50
wo /Purch • e Service or
PHONE: Feeder
1 ea 12% S'. to Surcharge - 06/16/2009 $6.42
Ele cal
Contractor:
SIMPSON ELECTRICAL CONSTRUCT AN
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 -472 -2530
FAX: 503 -435 -0157
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 containe• 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 permi 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 folk w the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 - 0010th •ugh • R 952 - 001 -0100. You may o•tai• a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: ,■ _ , I :/ V I �.� Permittee Signature: -
OWNER INSTALLATION ONLY
The installation is being made on property I own ich 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.
•
- . 0, . - r.
•
•
Electrical Permit Application ,
E D FOR JFFIC I•: 'uSE O '
City of Tigard Date/By: Permit No.: k C ,
13125 SW Hall Blvd., Tigard, OR 97223 Plan Re iota•
20
Phone: 503.639.4171 Fax: 503.598.1960 JUN 15 2009 Date /Bv: OtherPemtil:
TI G A It D Inspection Line: 503.639.4175 Dale Rca d a y /By: rw 121 See Pa trio-
Internet: www.tigard-or.gov ❑'rI Notified/method: 11 C I Supplemental Information
• TYPE OF OR t li 11I�NG PLAN REVIEW
❑ New construction [Additionlalteratio }rrepl Please check all hat apply (submit 2. sets of plans wlitenu checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition
❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,0 0 amps at 150 volts or ❑ Floating buildings.
(� dwelling less to groom . or exceeds 14.000 ❑ Commercial -use agriculturat
I - and 2 g ❑ Commercial/industrial ❑ Accessory building amps for all ciher installations. buildings.
❑ Multi family ❑ Master builder ❑ Fire pump. ❑ Installation of 75 KVA or
❑Other:
JOB SITE INFORMATION AND LOCATION ❑ Emergency sstem. larger separately derived system.
❑ Addition ofr motor lead oC ❑ "A " "E' "I - 2 ".`I -
Job no.: I Job site address: ( 305 V S(/..) D 1 IOOHPormere. oc .
crc anry
1 ('� �1 l�✓1 �-�t ❑Six or mote rsidcnlial tracts. ❑ Recreational vehicle parks.
City /State/ZIP: - G r ,, j 12__ 0 Health-care &eililies. ❑ Supply voltage for more than
❑ Hazardous Icatiors. 600 volts nominal.
Suitelbldg. /apt. no.: Project name: ❑ Service or fe 600 amps or more.
Cross street/directions to job site: Description FEE SCHEDULE
I
J I Qn. Fro. 1 Trawl I
. New resident at single- or multi - family dwelling unit.
Includes atta bed garage.
Subdivision: - Lot no.: 1,000 sq. ft o less 145.15 4
Ea. add'l 500 ;q. fl. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above q. ft.)
' , 9 // Limited energ', multi- fantitly 75.00 2
a c ^ c:
r / C , C 1 {'b' .r 'L� r - e Co
♦ FT residential with above sq. ft.)
Services or fenders installation, alteration, am/or relocatio
200 amps or I ss 80.30 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 41)0 amps 106.85 2
Name: 401 amps to 00 amps 160.60 2
601 amps to L000 amps 240.60 2
Address: Over 1,000 apps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or Ins 66.85 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to rJ0 amps 100.30 2
intended for sale, lease., rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 99 amps 133.75 _ 2
Owner signature: Date: Branch cires.ts— new, alteration, or extension, tamer panel
A. Fee for bra tell circuits with
❑ APPLICANT I ❑ CONTACT PERSON above sere ce or feeder fee, 6.65 2
Business name: each brand circuit
B. Fee for ben ich circuits
Contact name:
without service or feeder fee, 46.85 N6 s- 2
first brand circuit
Address: Each add'I brinch circuit ( I 6.65 (04,5 2
Miscellaneots (service or feeder not included)
City / State/ZIP: Each manufa turgid or modular
dwelling. sec ice and/or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect ot4y 66.85 2
E -mail: Pump or irrigation circle t 53.40 2
• CONTRACTOR Sign or outlire lighting ' 53.40 2
Business name: ( / -�,y� /! Signal circuit s) or limited -
IJ3o'v't p �� ��[3Y l�l ► � L( {Y� � Ot energy panel alteration, or
Address: �45 n') / ,L Q / .•n ( ( extension. Describe: Paget 2
re
City /State/ZIP: � j')') fl r i,d i ' C O j? - / 2 e Each additional inspection over allowable in any of the above
472-- r t R ,�� + I 1 ! Per inspeetioa 62.50
Pbone: ( 5 5 ? ) t() �
Fax: (� ) `135 — D 15 - 7 Investigation per hour (1 hr min) 62.50
CCB Lic.: r 53stic 1 E lectrical ' — 82c... Suprv. Lie.: 5rcl Industrial pint per hour . _ 73.75 e
ELECTRrCAL PERMIT FEES
Suprv. Electrician signature, required: a Subtotal: 53 SD � ,' Plan review (25% of permit fee):
Print name: 14.-/ I n S-•� Date:
Vt State surcharge (12% of permit fee): (;,, i jp
Authorized signature: . . TOTAL PERMIT FEE: 5 I .9'9.
Print name' This permit ,pplication expires if a permit is nor obtained within ISO
Date: lays after it has been accepted as complete.
• Number of sspections allowed per permit.
I:\Build:nglPrnnit& LC- PamiiAp.doc 05121/06 440- 4615T( 1 1105 /COM/WL•tl
1 L91.0 NOSdWI NIA3N 0 147:l4 60 91 unr