Permit rr CITY OF TIGARD ELECTRICAL PERMIT
1 11 1 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00454
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/04/2009
Parcel: 1 S 133DA01900
Jurisdiction: Tigard
Site address: 11055 SW SUMMER LAKE DR
Subdivision: Lot: 0
Project: Woodbury
Project Description: (2) branch circuits for NC
Owner: FEES
WOODBURY, LOUIS Quantity Description Date Amount
11055 SW SUMMER LAKE DR
TIGARD, OR 97223 2 crt Branch Circuits 09/04/2009 $53.50
wo /Purchase Service or
PHONE: 503 - 869 -0098 Feeder
1 ea . 12% State Surcharge - 09/04/2009 $6.42
Electrical
• Contractor:
GRF ELECTRIC
15460 S PARADISE LN
MULINO, OR 97042
PHONE: 503 - 829 -4146 •
FAX: 503 - 829 -5747
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 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. ,,
Issued By: Permittee Signature: 6/ / ��G✓ ('��0 "
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 603.639.4176 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.
Sep 02 09 11:32a GRFELECTRIC 5038295747 p.1
Electrical Permit Application E. VED • p;,,t,,,,.,11: , „.. 0...I.1 . •
• City of Tigard Received
Dims i . , S
13125 SW Hall Blvd., Tigard, OR 97223 S E P 0 2 2009 t . q Al .;,� PamitNa.:
. ; = i ; Phone: 503.639.4171 Fluc Dbt e/BY 503.598.1960 Pla nily: Cabe PtaNr r/t�irnGJo
t•: tt Inspietion Line: g 03.6394176 C OF TIGARD �°°�'�'' aa'a la see Pale 1 for
Intranet wtaw.ti ard or V Ntaifm4A4 tbo4;
174- 9uppeenenmlInformaion
r\ .+n. nn I
TYPE OF V� iORI( -JIi U v vI - t ar N REVIEW •
❑ Now construction ddition/alreretion/rep lacement Amu cbtdc all that apply (submit 1 tau of plaaa waft= t It chedccd below):
❑ Demolition Other: (2 Scry ce a We' 400 amps or mac Q Building aver three stories.
where Om available fault current ❑ Marinas and boct aMs.
CATEGORY OF CONSTRUCTION J =cab 14000 amps at 150 tutu or ❑ Flowing bdlditag•
l - ltd 2 - family dwelling ❑ Commercial/industrial lets to pound, or exceeds 14,000 CI Co untecial•ut.e agricultural
❑ Accessory building amps foran oiler instillations. buildinjta.
❑ Multi•fcmi]y ❑ Master builder ❑ Other: ❑ Fire plow 0 hissollatiwr o(75 KVA or
30B SITE INFORMATION AND LOCATION ❑Eirt�rgenry m largo sepvauty fairtd .
p Addition a/ new maw load of l] "A - , - E - . - i.r. •r
I o01i0 er nen.
Job no. Job site address: ) ( �>aory•
`� S ( A , S tut vet party /44 i ❑ Sir armors residential uoia. ❑ 1tea,mtiunal achicla pada.
City/Stare/ZIP: / 4. 1 £1 -) Z --3 V l � `ChissIUt -c c (aoi o . Q Supply whop fa rube dun 1 U ❑►Samtdaus locations. 000 ego nominal.
Suite1bldgdapt. no.: Project name: l 1 O 9avia a realer 600 reps or mote.
V I f A r/e-YJ (d .�i _ FEE SCHEDULE
Cross =eel/directions to job rile: rimrr:,,aa
New residential siogic or multi - tami l y dweUit bait. l
Includes atsaebed gauge.
Subdivision: Lot no.: 1.,000 s0. R or less 145.15 1 4
Tax ma Fa add'I S00 sq. ft. or portion 33.40 t
p/parcel no.: Limited energy, residential
DESCRIPTION OE WORK (with above sq. IL) 75.00 2
•
/ - Limited enemy, mulo•fannly 75.00 2
24,./ I2 wA A-C.- l 0,,, /-P residential (with shwa ,c. R)
Serv,ces or feeders (nstnllation sa4M relocation
200 amps or less 80.30 _ 2
OPERIY OWNER ' r] TENANT _201 rumps to 400 amps 106.85 2
Name: / 401 crops to 600 amps 160.60 • 2
-- /A 1 s v/ aa.-1-) 117._ 601 amps to 1 : 000 amps 240.60 2
Address: / i ....as-5-
. Sf S J Over 1,000 -
(� n , t ✓�. y - - amps or volts a54 6 s 2
•
City /State /ZIP: } Temporary rerrierd or feeders ins ta ,laboo,alt� don,. and/or
t �'�- L -� relocation
Phone: ( ) g Lo ' 0 J I Fax: ( ) 200 amps err less 66.85 f 1
' Owner installation: This installation is being made on property that I 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 ands 133.75 2
Breech circuits new. Were B ° ,
OWDQ signature: Pate:
or omission. er panel
APPLICANT A. Fee far branch circuits with
❑ APPLICANT
J ❑ CON TACT PER SON above service or (o der fee. 6.65 2
each branch circuit
Business Haute: B. Fee for branch circuits
Cont wifhosd service or feeder foe,
_ first branch circuit 46.85 4 • ��I
c � 2
Address: Each add'I branch circuit , _r _ 6.65 ie. I. '2
City/Sane/ZIP: _Mtseellaneous (service or feeder cot included)
Each marwfaended or modular 90.90 2
I Fax : ( ) dwelling. service ad/or feeder
Phone: Reconnea only ' 66.85 2
E•mail: _p or irrigation circle . 5.3.40 2
CONTRACTOR i Sign or oudikc ligteing 53.40 2
Bu3i11ess name: 6, P. /. Signal dcaut(s) a limitad- I
C �l *'r I energy paaet, alesaion or
Address: 1 �j �'eo 0 . . Pa v l�, , i--e. L am } ( extension. Describe: doge 2 Z
City/Slate/21P: / • l r.4 ` r P O L, G Each additional Inspection over Allows bit in an�f the above •
5t 2_9 t +
Per inspe on 62.50 I
Phone:
( � Fax: ( , - lnvtstiguiun per hour(l br min) 62.50
•
k CCB Lie.: to -7 S 1 Electrical Lic.:3- Suprv. Lie.: j Lo S-C ' Industrial plea ant I - 73.75 ,
ELEcn ICAL PERMIT 1FEIS '
Suprv. Electrician signature. required: ' , `, Subtotal 57 ‹ .... Q •
Print name: VII ( Date: ' (^ Plate review {25e /. of permit fee):
V r j l Gt rv J !�1 , f I , [i l� l Starr surcharge (12'/. ofpennit fee): L
Authorized signature:
TOTAL PER•IT FE y
This panels application spins tr • Pt++aa u ant aau:sad a t
Print name: L
I Date: ^r daps alter it mess been marmot as ee.aplate r
• Humba of laudations allowed pa wait.
1 :1 aildiadOcrw4d➢ZGPerwuNpp.ioc 0112306 • • 4aoosts71 was/tom/was
•