Permit V
CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00067
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/10/2010
Parcel: 1 S 134CA04100
Jurisdiction: Tigard
Site address: 11650 SW NORTH DAKOTA ST
Subdivision: Lot: 0
Project: Walker
Project Description: (2) branch circuits for bathroom addition.
Owner: FEES
WALKER, THOMAS A JR & JENA A Quantity Description Date Amount
11650 SW NORTH DAKOTA ST 2 crt Branch Circuits 02/10/2010 $63.60
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 02/10/2010 $7.63
Electrical
Contractor:
NORTHSIDE ELECTRIC
PO BOX 12323
SALEM, OR 97309
PHONE: 503 - 585 -4879
FAX: 503 - 364 -0248
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is • o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i ccordance with app ed • This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. A ENTION: Oregon law - • • urea • • follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952 -00 0010 th • gh OAR 952 -001 •10'. V. • ay •btain a copy of the j les or direct questions to OUNC • ••: rmet: 46.6699 or 1.800.332.2 .
• Issu d By: ' ‘ 0 1 Permittee Signa mi• i 1!
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 I fSTALLATI N ONLY
SIGNATURE OF SUPR. ELEC' � Date:
LICENSE NO.
Call 503.039.4176 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.
f . FEB /09/2009/MON 04:30 PM NORT IIZ FAX No,503- 364 -0248 P. 001
. Electrical Permit Appl D . ... • . r'ori`or -r. usr ONLY ,
6
•
City of Tigard �[ 9 q Received
: � t,e,gezo - eme 2} 8 v L 01O Plate/8 : /7 � permit No,: p
4 13125 SW Hall Blvd., Tigard, OR 977
Plan Review
Phone: 503:639.4171 Fax: 503,598 Date/3 : • Other Permir.
• T.1 GARD inspection Line: 503.639.4175 Cr 1 OF 7 IGARD bate Ready/fly:' • . kris; See Page 2 for
.tigerd- of Notifed/Method:
/ 1 Internet; www
t ; l '1 ( ' Supplemental Information jd".i :, S:t g r'! tt ., �. • '
D . t x`Tj 4 's .: n Is"� xai! vs,• ^F.
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. ❑ New construction ddition/alteration /replacement • Please check all that apply (submit 2 sets of plans wide= checked below);
• ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards. '
.. =�.a. :,•� r,�,• , uc��clj�Cy ` ^�isl3ffai;..F,s„�_ rr- c����V.rr;� .,v _ =•-�1 ,.a??S�J..A_:. vnln .EI
,i ;s1;. ff : •- 7,2N,,i".t:c r.� -- `.1t... �..• 7.c. =. z= D 00 r 50
�«. f•„ �;_•.::. .r'C -: ...:7- u a; a ta��, x)., v-::�na��__.p���!giw�!r
. t4,000• )]�tnmiida(:ifse agnoultntiil' -e
- and 2 -family dwelling ❑ Commercial/industrial
❑ Accessory building amps for all other installations. buildings.
Cl Multi- family • ❑ Master builder ❑ Other: ❑Fire lip. • • 0Installation of75 KVA or
y or4 ,, ,q� � ', rit>V.�t fx r r� ❑E mer eneY sYStem.
larger ate! deriveds stem,
r . `! , - ` ,e.�._ e 6 �: � �y g separately r. .
. ❑ Addition of new motor load of ❑ "A" "E ", "1 -2" "1
• Job no. • -� Job site address: 10 t00E1P or more. occupancy.
- • w, 11. - . ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: \� ' 0 facilities. ❑Supply voltage for more then
l 1. '1 • P - ❑ Hazardous locations. 600 volts nominal.
•
Suite/bldg. /apt no.: '*' Project name: • ❑ Service or feeder 600 amps or more.
Cross street/directions to job'srtc: � �+' �'�." �� -' +•'
Dem i Ilan • e I . Fee. Tole! '
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: . .
• . . Lot no.: 1,000 sq. ft or less . . 168.54 4 •
Tax map /parcel no.: • • ' • - Ea add'I 500 sq. fl or portion 33.92 • 1
r_ 7- , . gt , } -rr Limited energy, residential
• ' ° d.�i aitols ¢��C ' ti c � ' ;,.4,•'' t ! -.{: r r „yM, " (whh atxive sq. R.) 67.84' 2
Ci
• Limited energy, multi -family
. -v. t � NI 1�1],s
I. 'h) ►� _ _ • residential (with abovesq, R.) 67 2
1 111111 A
Services or feeders installation, alteration relocation
• • _ • : ��,,,� 200 amps or less . . 100.70 2
. iii' Y -,_ . ='N
.. \ 7"mrrv.`e 4. ,dis3:1���,G „ Y .., .4 201 amps to 400 amps ]33.56 2
• Name: . •• . 401 amps to 600 amps 200.34. 2
' 601 amps to 1,000 amps 4
' 301.04 . 2
Actress: Over 1,000 amps or volts 552.26 2
ity/State/Z�: Temporary services or feeders installation, alteration, and /or
relocation
. Phone: ( . ) Fax: ( ')' • 200 amps or less . 59.36 ' 1
• Owner installation:. This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
• intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 , • . 2
Owner signature:. Date; Branch circuits -- new, alteration, or extension, per panel
�; e "� -, , T . '� A. Fee for branch circuits with ,
.. : ' r ig4 F' ' ht r. `4 4 4: ` t' . I` ®.'1Z',oi,•. ,.,9 P a ,,;. r ":l above service or feeder fee,
each branch circuit • 7'42 2
Business name: B. Fee for branch circuits
•
Contact name: t vifhout service or f eeder tee, R.
fast branch circuit 56.18 �` Q 2
Address: Each add'I branch circuit ` 7,42 '),` - 2 • 'Miscellaneous (service or feeder not Included) •
City/State/ZIP: . . Each manufactured or modular
dwelling, service and /or feeder 67,84 2
Phone: ( ) I Fax:: ( ) Reconnect only 67.84 2
E -mail:
'Wr is �'; " o : �r �r ,.. s Y_. L • Pump or irrigation circle 67.84 2
:: ::c A +:; it ' .. 61 � . �0 6T0ii §: .:1;.':' • 'l� % ;' r s, 'R ,•S- • Si or outline lighting ,f: � s .,:�.r•S''k a�4.. , •:s Sign Sh ng 67.84 2
Signal circuit(s) or limited -
,to. aili II L ‘A energy panel, alteration, or • .
Address: extension. Describe: Page 2 2
4,6 . rr . .
City/State/ZIP: r * , j k $., • +�� - • Each additional inspection over allowable in any of the above
r . r , . • Per inspection 66.25
�saj 1a v Fax: (515) 3 ! I ME 0. per hour (1 hr min) 6625
CCB Lic.: Electrical Lic.: 991 7C Suprv, Lic.: 2b I'S S Industrial plant per hour . 78.18 •
11 , ; ii f ;(• Irr z '•r i"rri _.1: ;
Suprv. Electrician signature, required: Subtotal: kn uOC�
,tint name: - 0 • . . Date: Plan review (23a% of permit fee): •
r� ,tJ �1 r ' r ; _ ,
State surcharge (12% of permit fee): \0
Authorized signatu /.�_ � .. —•
i � /. - °O • TOTAL PERMIT FEE:
Print name: ` Date: This permit application expires if a permit l9 not obtained within 180
- days after it has been accepted as complete.
Number of inspections allowed per permit.
INsudolnau'amiW6t.C.Permilm 10/01 /D9 44 0. 4 6 , sr(1 1/05/COMIWga •