Permit •
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CITY OF TIGARD ELECTRICAL PERMIT
C .... COMMUNITY DEVELOPMENT Permit #: ELC2009 -00284
T! 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 06/11/2009
Parcel: 1 S133DD02800
Jurisdiction: Tigard
Site address: 12910 SW WINTER LAKE DR
Subdivision: Lot: 0
1 Project:
, Project Description: Install /alter (2) branch circuits.
Owner: FEES
MCCARTHY, JUSTIN C & MICHELE M Quantity Description Date Amount
12910 SW WINTERLAKE DR 2 crt Branch Circuits 06/11/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE Feeder
1 ea 12% State Surcharge - 06/11/2009 $6 42
Electrical
Contractor:
FARWELL PERRY ELECTRIC
2536 NE 10TH AVE
PORTLAND, OR 97212
PHONE: 503 - 890 -2352 '
FAX 503 - 760 -8498
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 t• oug •AR 952- 001 -0100 You may ob.'in a •py of the rules or direct questions to OUNC by calling 503 246.6699 or 1.800.332 2344
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Issued By: \,1 _ . _I ��. _ J. 1 Perm ittee Signature:
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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 503.639.4175 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.
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City of Tigard 200 Date/By \... Permit PermitNo.: '\(2OoQ d a'.�aq
JUN 2 9
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
g Phone: 503.639.4171 Fax: 503.598.1960 Dat /B Other Permit
T I G A R D g Inspection Line: 503.639.4175 c, C U �q ,_' i ' ,�� ..: Date Ready/By: Suns. ® See Page 2 for
Internet: www.ti ard -0g „ � r. ov . .. ri1.^., 7t 0^ I Notified/Method: t � � Supplemental Information
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TYPE OF WORK PLAN REVIEW
❑ New construction .. Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
WI- 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 ❑ Emergency system. larger separately derived system.
El A Addition of new motor load of ❑ "A°, "E ", "1 -2 ", "1 -3 ",
Job no.: I Job site address: i 2 9 I b .5.k.). (A) i A*Q,i I0OHP or more. on
� ] Six or more residential units. ❑ Recreational vehicle parks
City /State/ZIP: — 1 - 1 t Oa ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
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Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
A l'�t • C
C . t- 0 l p,4 �.-� residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2 _
❑ PROPERTY OWNER 1 ❑ 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: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 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— new, alteration, or extension, per panel _
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, ( 46.85 2
first branch circuit
Address: Each add'I branch circuit k 6.65 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: r i iz W r Lj T t L L
Signal circuit(s) or limited -
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energy panel, alteration, or
Address: - z 3 ( N i , 67 /1 extension. Describe: Page 2 2
City/ State/ZIP: ¶ o (Z LA N J3 V
e. 1 4 I Z Each additional inspection over allowable in any of the above
I
Per inspection 62.50
Phone:
(5,3 )gy -135 Z I Fa x: (/ ) 28) —/J 13 Investigation per hour (I hr nun) 62.50
CCB Lic.: 11772 I Electrical Lic.: I c, I Suprv. Lic.: 4 O (e7-S Industrial plant per hour 73.75
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /_ Subtotal:
Print name: FA e wtu 'Pg r / [Date: (578/01 Plan review (25 % of permit fee)
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: , q 2
Print name: I Date: This permit application expires if a permit is not obta within 180
days after it has been accepted as complete.
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