Permit CITY OF TIGARD ELECTRICAL PERMIT
-a, COMMUNITY DEVELOPMENT Permit #: ELC2009 -00278
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/08/2009
Parcel: 1 S135CCO3600
Jurisdiction: Tigard
Site address: 10140 SW TIGARD ST
Subdivision: Lot: 0
Project: Webb
Project Description: Install /alter (2) branch circuits.
Owner: FEES
WEBB, ROBERT LEE Quantity Description Date Amount
EDNA M, 10140 SW TIGARD
TIGARD, OR 97223 2 crt Branch Circuits 06/08/2009 $53 50
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/08/2009 $6 42
Electrical
Contractor:
SINGER ELECTRIC CO
2442 NE SANDY BLVD #100
TROUTDALE, OR 97060
PHONE: 503 - 661 -2040
FAX 503 - 667 -0177
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 f• more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notific- • Cen . Those rules are - forth in OAR
952- 001 -0010 through 0 R 952- 001 -0100 You may obtain a copy of the rules or direct questions to OUNC by calla. 03 246 669' or 1 800 332 2344
V�„1�'
Issued By: � ��n �! ,1 kik.6 Permittee Signature: 411111 7.,./...,,_- _
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 503.638.4175 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.
Iectrical Permit Application l.(,R OH I( I% l tin. l I\'I,\ -
lig City of Tigard , Reeved Permit xe.€12Lq12
■ 13125 SW Hall Blvd., Tigard, OR 97223 Plan Ry. eview -- °
tan R
11 . Phone; 503,639.4171 Fax; 503.598.1960 Date/By: other Permit;
TI t .1 t. I Inspection Lino: 503.639.4175 Date Readymy; r s t Ed See Pape Z for
Internet: www.tigard-or.gov NotificdlMcthod 1 ((` Supplemental Information
7
TYPE OF WORK PLAN MEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 nets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: • where the available fault current ['Marinas end boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps al 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION D Emergency of new motor larger separately derived systcrr
• ❑ Addition of new motor Triad of ❑ "A ", "E••, "1-2", "1 -3",
Job no. :p/98"7 S ` ,n /� looHP ormorn occupancy.
I Job site address � / ✓ W I � 1q- c �� 5 f y 0 or more tes; an i ts. ❑ Recreational vehicle parks
City / State/ZIP: ❑ Health.c re facilities. ❑ Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or more.
'FEE SCHEDULE
•Cross street/directions to job site: oeseriptsea I oty. I Fee. I Tetm 1 •
a New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no,: 1,000 sq. ft. or less • - 145.15 4
Tax map/ areal no.: Ea. adds 500 sq. ft. or portion 33.40 1
p Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.)
75.00 2
. Limited energy. multi- family 75.00 2
• residential (with above sit R.)
. Services or feeders installation 'on, and/or relocation
'- 200 amps or les 80.30 2
❑ PROPERTY OWNER ❑ TENANT 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: i Temporary services■or feeders Installation, alteration. and/or
relocation
Phone: ( ) 1 Fax: ( ) 200 amps or less 1 66.85 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 amps 133.75 2
Branch circuits– Owner signature: Date: A. Fee for branch circuits alteration, or extension. per panel
with
❑ APPLICANT I . ❑ CONTACT PERSON above service or feeder fcc, 6.65 2
each branch circuit • ,
Bugitltas name: B. Fee for branch circuits
Contact name: — without service or feeder foe. ` 46.85 2/4,6 2
first branch circuit _
Address; _ Each edd'l branch circuit / 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufachrrod or modular 9090 2
Fax: : dwe1114. service and/or feeder
Phone:
( ) ( ) Reconnect only 66.85 2
E- mail: Pump or irrigation circle 53.40 2
CONTRACTOR .. Sign or outline lighting 53.40 2
Business name: i i IC Signal circuits) or limited-
_ A � energy panel, alteration, or
Address;
a / L .4 ''� '� , $ C. extension. Describe: Page 2 2
City/Statc/Z' ` /� Y : 91 ii. J --J /.6_, /.6_, 0 I. q-706 .) Each additional inspection over allowable in any of the above
/�/� &67 Per inspection 62.50 _
Phone: ( 66 / �D Fax: ,gi.) - ®/ 7 7 Investigation per hour (1 hr min) 62.50
CCB Lic.: L/410 70 1 Elcetrical. 6.9446 4 upry c.: 5/33C. Industrial . lent perhour 73.75
ELEC'XRICAL PERMIT FEES
Suprv. Electrician signature, required _ Subtotal: 63 , . 15-D Print name: --I i / r � ' �` Plan review (25 %ofpetmitfcc):
/ L •fi G� ` / D ate: I S ta te surcharge (12% of permit fee): / • a
Authorized signature: TOTAL PERMIT FEE: oP
Print name: Date: This permit applicelion expires ifa permit is not 011121 wi hin 180
days after it bas been accepted as complete.
- • Number of inepectiona allowed per permit
t:\BuddlnalppmieaLC.Perin App.doe 05/23/06 140.461ST(r t,os/CONrlw¢a