Permit CITY OF TIGARD ELECTRICAL PERMIT
° I COM MUNITY DEVELOPMENT Pe r mittf: ELC2009 -00378
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/28/2009
Parcel: 2S110BA06600
Jurisdiction: Tigard
Site address: 12102 SW WILDWOOD ST
Subdivision: Lot: 0 .
Project: Smith
Project Description: (2) branch circuits for landscaping.
Owner. FEES
SMITH, VISTON & SUSANN Quantity Description Date Amount
12102 SW WILDWOOD ST 2 crt Branch Circuits 07/28/2009 $53.50
TIGARD, OR 97224
wolPurchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/28/2009 $6.42
Electrical
Contractor:
JEROME ELECTRIC
PO BOX 751
HILLSBORO, OR 97123
PHONE: 503 -648 -5144
FAX: 503 -648 -9723
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
95 Issued B O OAR 952 - 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling �3 6.669 �0����
y Permittee Signature: 64/ !ice ,
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.
,• , ' 09:29 5036489723 JERMOE ELECTRIC INC PAGE 01
Electrical Permit A licatio a \V FOR OFFICE USE ONLY G �7 (�
� , Received PerrokNoZ�'� 07 -00.3 /d
C Haal s as Tigard, OR 97223 iUL 2 4 20 - 7 aP 0 9 '�f/! Other Permit o
I ' Phone: 503.639.4171 Fax: 503.598.1960 DateBy, ibr
Inspection Line: 503.639.4175 7 N�iai6 J � I g„p See m�e2laformo6ee
71 G A IL D
Internet: w.tipard- or.gov CI� OF
I I .. eadymy
11 '
❑ New construction Addition/alteration/replacement Ptae cede all that apply (submit Z acts enrolees wilteme checked below)•
❑ Service or feeder 400 amps or more ❑ Building over throe stories.
❑ Demolition ❑ Other: where the available fault cement ❑ Marinas and boatyards
r * 1 ^ r x i " 1 . ,r) 7 , 0+ i i ,r aicceda 10,000 amps at 150 volts or Floating buildings.
J.. leas to ground, or eaceeds 14,000 ❑ Commercial -use agricultural
11 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fi pump Ci installation of 75 KVA or
❑ E„ e ra, larger separately derived system.
,it r , , • 1 + j ii l ,rl r FM +!a l '. 4 �C s+ at• ? i 1 +l .' ❑ Addition of new molar load of ❑"A ,"E", "1.2 ", °1 -r•
9 4f3j. l . V Ali r I 1 1001IPormmm. occupancy.
Job no.: Job site address: I i 1 8 � � ❑ si= or >nor , e res►aatt;at units El Roc Recnaliotioaal vehicle parka,
❑ Healttu care facilities.. ❑Supply vetlage for more thins
City /5tatdZlP: I �� �� ❑ Hazardous locations. 600 volt< nominal.
Suite/bldg./apt no.: Project name:
❑ service or (coder 600 steps or more
;i! i'1n'rpl iii ,N ' .::'
Cross street/directions to job site: Deter,. ion It.ts •Tow
New residential single- or multi - family dwelling unit.
Includes attached garage.
"
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Fa add'l 500 sq. ft or)tortfon 33.40 1
Tax map/paroel no.: Limited energy. residential 75.00 2
- ,' 1 ,t, t ; � i 1 ; +i l'i .. (with above sq. ft.)
Limited energy, multi•Ibmlly
`` j L.. residentialswith above eo. ft, 75.00 2
- Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
',:''` ,.:,151: .:4•10):!:10. I n , t : .- i . , 1\ t ' J . Vr r 1.; 201 amps to 400 amps 106.85 2
Name: .S 7W 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
Temporary services or feeders installation, alteration, and/or
City/Stare/ZIP: relocation
- Phone: ( ) Fox: ( ) 200 amps or less 66.85 i
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps i 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, per panel
Owner signature: Date: A. Fee for branch circuits with
, " - :.: , . sr- .;rl'1 .�t1'n ^ :' J :A1� • tij:j ?.: above o f
r v branch circuit
6.65 2
�. , , ._ .. ... .._... ... _ .... ,(7 each it
Business name: B. Fee far branch circuits 1 Q
without service or feeder fbe, 1 46.85 Q D� 2
Contact name: first branch circuit
Each addl branch circuit 6.65 2
Address: Miscellaneous (service or feeder not included) -
City /State/ZIP: Each manufactured or modular 90.90 2
— dwel ling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 ?_
E -mail: .
� ` Pump or irrigation e
_ e 2
5 3. 0
chute 53.40
? . ' , ' )+ { . , .. � , . .., Sign or outline lighting
ova ei � � Cie/• r ` ' 4 �� ` Signal circuit(s) l to t o, or
sla
Business name: . energy panel, alteration, limited
O i _ extension. Describe: Page 2 2
Address:
City/State/ZIP: - `1 cS �ji�Y� C) � 12 3 E additional inspection over allowable ins!) of the above
Per inspection 62.50
Phone: (503) I . _ 1 jial
Fax: (55 / ♦ ~ P1 7a Investigation per hour (1 hr min) 62.50
. Lie... $ Industrial .;ant • r hour 73.75
CCB Lic.: t � Electrical Lic,:3��([ G Sttpry ��'y ..... .... .... ....:' ! ,ti`'ia ! , _';f.'' .. :,�u� ; : :): : ::∎10i,;:V. ,..,:',.
Suprv. Electrician signature, required::r.,a Subtotal: - Lo
Plan review (25% of . ertnit f :
Print name: 1)Dtvl c A. J-urb mite. Date: State surcharge (12% of permit fee): 4,
TOTAL PERMIT FEE: lI , 1 � r/
Authorized signature: 1
This permit application expires ire permit is not o btained within 181)
Print name: i I Date: Awn aMr it Man h.+n a• a■ rnnentotr.