Permit r,
CITY OF TIGARD ELECTRICAL PERMIT
1 111 1 q
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00190
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2009
T.ICI�R.Z? 9
Parcel: 2S102CA00926
Jurisdiction: Tigard
Site address: 13260 SW VILLAGE GLENN DR
Subdivision: Lot: 0
Project: Freels
Project Description: (4) branch circuits for furnace and heat pump.
Owner: FEES
FREELS, MARK H & KATHLEEN M Quantity Description Date Amount
13260 SW VILLAGE GLENN DR
TIGARD, OR 97223 4 crt Branch Circuits 04/30 /2009 $66.80
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/30/2009 $8.02
Contractor: Electrical
CANBY ELECTRIC INC
790 S IVY ST
CANBY, OR 97013
PHONE: 503 - 266 -7878
FAX: 503 - 266 -5543
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.82
•
. 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 ith 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. TTENTION: Oreg • - re•uires you to follow the rules adopted by the Oregon Utility -lion Center. Those rules are set forth in OAR
952 -001 010 through OAR 9 ' • -0100 You may obtain a c'•py of the rules or direct questions to OUNC • - • 0 • • •699 or 1.800.332.. 344
Issu d By: - T - . .�� Permittee Signature: � Ark WNW
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'N � • ;ode WWI Date:
_ � c
LICENSE NO. &/ i JS
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.
A., . .- ...
. . ' . .
—Electncall Permit Apphca ri
- t' C Pl\fED .
FOR OFFICE USE: ONI,1'
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i • City of Tigard Received. ' 41 g
7 'V-44(
4 100 /VC '
. Ili 13125 SW Hall Blvd_ Tigard. OR 972APR 2 8 2009 Datc/By Pcrrnit No
: ..... . _..__
PlanRevicw
, Phone: 503.639,4171 Fax, 503,598,1960 Datc/By: Other Peill111 .
,
: . .': 1. „...,„ k 0 Inspection Line: 501 69 175 Date Ready/BY: Jutih RI See Pnne 2 kr
Internet: - www.tittard-or.gov _ a 1 CITY OF TIGARD
I "I • .Nu ariidimethod: / . I Supplemental Infarmation .
1 - V ' . , .. . —
..• .. •-., --- . - - ..:. . •.• . -.--...- , • , . - — . .• • .. • TYPE OF WORI .
_.'. ........ . PLAN REVIEW „.. . . .. _
' ''." .• ' ' • ' '
.0,Ncw,construction — KAdditiori/alteration/replacemcnt ' Ple:kie check ariliai apply istihnin 2 ,nt, a ow whiems checked blow), '
. El Service or feeder 400 amp5 lir mem 0 Building over throe stonci.
1=1 Per001illOn _ 0 Other: , . where the available fault current PM:Irina:4 and boatyards ••
• .
• " cATEGORY OF CONST00.10:•, : :,:,,:: .,„,:...i,!. „ •• •., :.;:i; .. :: '!;:•••, • exceeds 10,000 amps rri 150 yplii, in 0 Floating buildinips, ' • . ,
, leas to )sniuntl,tn e‘eeeds i-I,000 0 Cornmeteml•use agnenlldral .
. P ■,,i I and•2 dwelling ID Commercial/industrial 0 Accessory building .
, amps for all who lust:illation,: building.:
, ENtliti-faMily El Master builder El Other: El Fire pump. 1:1 Ingiallation ef75 KvA Or '
, r...-
• , • JOB srtE INFORMATION . ANiiiiibiiiiiik ''.'-' :::'..';'.".',..., , ci Euler g . i larger separatelY derived vYstem. .
,-.... ...... _,...._
Job no,; ,. • 1 Job site address: '2_•4 Vi .. .6 , i ON IP in More. occupancy
' ' . A . O. 0 0 Six or more residennal uniir
n Recreational vehicle parICS
'
CI t:'/State/Z1P 1 r ;15 0 • . I CliitailiKa.; tkiiiti.,s I1 supply voltage for more Man • .'
. . _. .
, . Suite/bldg./apt. no.: V Project name: We_ ‘ ' 0 Hazardous locinion,
0 Scrvii:e in fee & 600 amps or mor FEE SCHEDULE
e 600 veil, nominal : • '
. •
•
— — ,
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,
,.
Cross street/directions to job silc: ,
• • Description _ I Qty. I Ice,... Tow • .
,.
• , . — New residential single or multi-family dwelling unit.
. .
., .. . .
" Ineltldri attached garaEr. . • •
..__ • ,
•SUbdiviSion; Lot no,: 1,000 sq. fl. or les 1 s 145.'5
• - • La. addl 500 so tt or portitni 11 0 =
- 71. - NMI
f a■ map/parer,' n0.. ._ •
. ,
l energy. residential
75.00 II .
.. _
. . • DESCRIPTION OE ''vyq4it : "' .:: .: ::::::,•':!:: ::1:: :•':‘. : ' ' (with above NI/ a.)
...., , -. 1 ' -
. Limited energy, multi-Family 1 ,
751
. , /0 III
rEA' " 4- Iii,e,__:..... . residential (with above so II) .
Services or Feeders installation alteration, undior relocation
. -
••
- . . 200 amps or Icss 80.30 Ell
_ .
. • . • .. . 0 PROPERTY OWNER • ' , .;,...,.,,.:!,., ::: :E:V,:leEI4IANT.: ..:,, -'.;r 201 amps to 400 amps 10(1 85
- , .
. 401 amps to 600 amps
'
N : ' tr)64,K R4,043 160.60
i
- 601 amps to 1,000 amps 240. Ell .
. 60
_...
Address: C N Over 1,000 amps or volts r 454.65
Temporary services or fectte installation, alteration. and/or
• ' ..
City/State/ZIP: relocation .
_., - - -
• Phone: 1 ) , a - 2_ L -.) 1 F a x : ( ) • . 5
_200 amps or les., )
s .3 • • • •
- Owner inStallation: This installation is made ade on property that I own 2�1 amps to 400 amp
which is not 100 0 2
'
' .. intended . for sale, lease, rent, or exchange, according to ORS 447, 449, 670:and I. 401 amps to 599 amps 133.75 • ' 2 • .
• a ra n c h eirCuil5 - new, alteration, or ettensin 'Cr •nnet
,
Owner signature: Date: A. Fee for branch circuit!: wig/
- •••• • , , • . — .
1:3 APPLICANT ' • : ': i' : above service or feeder lee.
each branch circuit
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Business name: f3. Fee for branch circuits - •
., i l'i 2 ail •
with serviu or fader tee. I . 46.85 lip,
" • , Contact, name: . rust branch circuit . I
Address Each addl branch circuit 6.65 • faMMII,,:
: -
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..__ ___ ...— __.. . Miscellaneous (service or feeder .. n i
ol nclude .
- City/StatC/ZI I): Each manufactured or modular 1
90,90 • • • 2 - • ' dwelling, service and/or feeder I
. Phone:.( ) Fax: ; ( ) Reconnect only 66.85 . • 2
'
E Pump of irriga •
tion circle 5140 2 . :
• _ . _
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CONTRAC1'011:::',::;, , ,.' , ,.,. ,:,:^.: ,•,..,;',:;;.::,:;:!..,,•.,., ...,. Sign or outline lighting _ 53 40
. .. .
.- Signal circuit(s) or liinited- -
Business name: C -i - t-- r -- 1 r l_e, - 1--vaA. c..... ' a-fv . - c•-• energy panel. alteration. or . .
(sr■ ..-N Li „ —
extension. Describe. i 'a
Address: 9 b 5 . ge 2 2
' , - ,..,... 1 , 4 ---,--lk-- •
, .. --- ___..... _
--- . - - F,,ach additional inspection net Ailt1W ble in an of the above .
4 City/Stater/11'1 _C,...,6 E).2- ci - 10 k. '71 62 50 NM
--, _ 1...t ..„ • ,— Per inspeclion
\ Phone: Pc0 21, (., .._ 1 (6 7 Si 1 Pm: ( 5 a - 2-C, 6 - 6 44, --.
... •-, ,
0
investigation per hour ( i iv uuni li ,
73.75 al plant per hour 1
CCB Lic.: 2( o n t klettru,, -. C ... Su Industri
prv. Lie.: 2t 7,-3 5 .._ .. .
ELEA TRICA I . PERMIT F 1111 EES '
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1 Suprv. Electricia) sir2.naturc, i equired, 1 ' , 0_,....,.: __ subrti
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- Print name, ‘C-. ' . ,,,._ ( rs-i I 11.4 Stith' ',iLf ■:111112,. I rt", . Ill: /
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--- • ••--- • -- • • • -
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Authorized -Ii _, • ,
— - . ilk p permit ■ etti within 180
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NC mplete.
: I Print name .., ' . L -,-"") ( ) ri,4 , 0-4 1 Dale. .--- ••--- ' Numn g I
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4.411-101
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