Permit Iry
2009 .14:57 FAX L 001
RECEIVE'
Electrical Permit Application 70F, OFFICE USE ONLY
Ci of Tigard JUN 2 2 2009 Received Permit 1\0.: ��.�()
111 tv 131 Hall lvd., Tigard, OR 97223
Ma, Bevis
at y: _ � ! -- ` L C 2l/�`t ' 00.31 ( Z
A Phone: 503.639.4171 Fax: 503.598.1 OF TIGA Other Permit.
T1GAiKD inspection Line: 503.639.4175 BUILDING DIVISION ead D i 1 to s I ® See Page 2 for
f
ormation
Internet: www.ttgnrd or.vov No
d t I � S u /Method: PP
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❑ New construction Addition /alteration /replacement Please check all that apply (subunit 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 ❑ Marinas and boatyards.
"' i_;; a. 0 000 amps 150 volts o r Floating buildings.
- • :a:: - r . � 1 ;i , 3 i ( t''..s;iiii � - exceeds I P S g
a,�::n
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,:�� •• --•- •� • • less to ground, or exceeds 14,000 0 Commercial-use agricultural
❑ I- and 2- family dwelling OCommercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
y ::t,z:,.: „ s „ ;;ii; : eea: _J :;1 - -- _ 0 Emergency system. larger separately derived system..
:0 a' .JOB >'Sl - - '+[i\IEOR J Oi S •'i U, ; - _re = ;y;U 1 _l { :ci h Addition of new motor load of ❑' A ` c' 1_� I.3
100HP or more. occupancy.
Job no.:4 Dc 49 Q Joh site address: ( (o5-0 5,..3 ' D t ai
❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci /State /ZIP: G� 9 (� ❑ Health-care facilities ❑ Supply voltage for more than
h r Q Z ZZ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.. - I Project name: c & V f �N yytQ � r L ❑ Service !`ice or feeder 600 amps or more. t y s ' S ^1'rY
• , Q�idligl::,;;ir;; . i :. ..,.dl�XFg.�l^FI�DiJL - --
Cross street/directions to job site: Peseri ciao F Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax Inap /parcel Limited energy, residential
75.00
1 -s :�,::se,;:;.�r �:R,sA�'yt`:;i' _ <,.s,... ,.r. s...: �. :c•, , ; ! , t!= : (with above s . ft.
5.3 ?;r ;:'i. r;p II; 4.:: :5;:r1 .(7 'fP,'C.f0�1!:OFS:lV.Q, ,. .. ulfiz i ( 9 )
�.;n�:v %V: r. �:�, .J,l��la[Ntr ^+.t; e:.........�r � •�.. ..,,�„j.. ,_..._a..........,�.11�t!�,':. ._.L4':,:.... -..... _.�
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' Limited energy, multi- family 75.00 2
,' i/ Az-06 /Z & Q.DOn1 Vim4- residential (with above sq. ft.) _
Services ` 'lf2Lir'✓� f5 5 1 200 amps or feeders or lesd installation, s Iterattoo.80.30oI eloca 2
n r ti011
'.q,4:.12 i? : • ,til: : i .:i `'giII I " , 201 amps 10 400 amps ";: : tie:, i= �" ���V�fl !JT'�s,:;i�!;:;:.'.:�:i..i':. P s 106.85 2 P
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 I 454.65 2
Cily /State /7_.IP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less I Z_ 66.85 }33.7 l
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, rem, 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
1:! th , f .if"• - .f -- ; ;IF. -r''4e:':roil - - ..x /t:r✓ - t`i :11:x: service or e e
r;�„ •�a� •• % _ ;';' � � _ ..1,1 � � - ' " above sery o feeder fee,
; 14 :• ' .:e:.: ::1P•R1I0' �1. :.r;'ii, ; cc .`,,, ; !.. 4 :. ,., ILC't; R�,�"O !,.... i'r,'tt 7_
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i *s ., „ t { .. :,.,.....,:, 4�Lts1::i�F.:L.:,• j'�'i..L_ .. :, { ....._.......rl. ,r:
each branch circuit -
Business name: B. Fee for branch circuits I
without service or feeder fee,
Contact name: 46.8
first branch circuit
Address: Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City /State /ZIP: Each manut'actured or modular 90.90 2
dwelling, service and /or feeder •
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
? .t - i sir" - Sign or outline Ii honk 2
i � l ' L1 �; ;; _ -r:: rr;�;;i -= _ Gi:i' - - -- - !a: y vti � ' i�:`ila;;;' ?•t� :'':?' 11';��wEil= g g
r� 53.40
S•,..a......._ :.. ai,, 1! f ;...,..... "[.:•EwEre;eallr Far,:: C�l\.TRA.'.`.'.Y..�,�. -•:. _U- _•.r•.,ii � ,. ',.:iAi.i�:.,.::;r,;ca
Business name: STONER ELECTRIC Signal circuit(s) r limited -
energy panel, alteration, or
Address: 1904 SE OCHOCO extension. Describe: Page 2 2
City/State /ZIP: MILWAUKIE, OR 97222 F,aclt additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 462 -6500 Fax: (503) 659 -4968 _ Investigation per hour (1 hr coin) 62.50
CCB Lie.: 44823 Electrical Lie.: 26 -122C Suprv. Lic.: 3496S Industrial plant per hour 73.75 ,
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-• ifr ;:�EEES•E'� ?E;t;, "4I.i;'ri+;T�
Suprv. Electrician signature, required: m ....€ ^ ,_ Subtotal: 133r70
Print name: MICHAEL FALCONER Date: / flan review (25% of pemtit fee): $
(o ZZI State surcharge (12% of permit fee): , (, e b
Authorized signature: TOTAL PERMIT FEE: )TZ• 7
This permit application expires if a permit is not obtained within 180
I Print name: _ Date:
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:t Building /i'cmiits\ELC- Pe.•r.,ilApp doe 05/23/06 44 0- 4615T(t I /05 /COMM'EB