Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 - COMMUNITY DEVELOPMENT Permit #: ELC2013 -00321
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/10/2013
Parcel: 1 S 135CCO2200
Jurisdiction: Tigard
Site address: 10420 SW MEADOW ST
Project: ALLISON Subdivision: MEADOW, THE Lot: 3
Project Description: Panel replacement.
Contractor: FALCON ELECTRIC Owner: ALLISON, LARRY AND DEBORAH
2375 SW CEDAR HILLS BLVD 10420 SW MEADOW
PORTLAND, OR 97225 TIGARD, OR 97223
PHONE: 503 - 208 -4709 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/10/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/10/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 through OAR 952- 001 -0090. You may obta' . •• • of the rulerect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
I 10
Issued By: t-- e - ermittee Signature:
'' 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 the next available inspection date.
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.
Cedar Hills Legacy Dental 5036465565 p.1
lagEWED
Electrical Permit Applic FOR OFFICE USE ONLY
Elill City of Tigard 1 � � Z013 Re[etyed
i_" 1 ;125 SW Hall Blvd.,'Iigard.OR 97 2 23 : ' a ll �� -
lan R eview
Phone: jl)3.718.2439 Fax: 50 ��yJ D alc , 13 : Other Permit:
TIGARD Inspection Line: 503.639.4175 �� P lISI ON Date Ro x lyiliy. El See Page for
Internet: ■vww'.tigard or.gov BUfD14GD Notitied:Method. Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction [� AdditionJallcratianircplaccmcn[ flutso eheti all dial apply (submit ?sets of plans Niituns checked helot.):
•
❑ Demolition ❑ Ssnie_ a' teedet 400 amps or morn ❑ Building over three stones
❑ other. where the available fault oiincnl
❑ Marinas and 3oatyards.
CATEGORY OF co\s'rlLc escn t s 10,000 amps at 150 volts or ❑ Floating buildings
•
less totuound,orcxnxxls ROW ❑Cutrntcrcial -use agricultural
l - and = family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all othainstallatiuns. Li.ilding,
❑ Mulli- family ❑ Master builder ` � ❑other: 0 f 5re pump ❑Instatlane�n v'150 KVA or
JOB SITE INFORMATION AND LO( AT ION ❑ Emergency system. largta separately deriveu system.
❑ Addition of new motor laud of ❑"!. ".'P "1 -2 'i -3',
.Pub nu.: Job site address: O 1 � � IC011P to man. occupancy.
1 '...„ ,,�d�;w � "' ❑Siyermrn:rUidential ❑Recruaionalvehicleparks.
CityiStatet % T IP: 17 r�y� C,Q
Yci , e'? ?a Oilcan-care ea-care facilities ❑ Supph•w rc
ttagc
-`,!i �-+[� ❑ I lazardous loanioru. 600 wilts nominal.
Suile:bldg.Japl. no.: Project name: ( ._ t/ 1 ❑ Service orfieder000anrpsor .ore
y�(Jf FEE SCHEDULE Cross street/directions to job site: 71,1Y e e `'l or C� s 1 h "f-l' _ byy urwnprion f Vrv. I rz I Iuial
'�j'� t,, New residential single- or multi - fancily dwelling unit.
1 1 e MG J { �Ve . Includes utlached garage.
Subdivision: Lot no.: I,000sq. It. or less 168.54 t
La. add': 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited tmerly, residential 75 OU 2
DESCRIPTION OF WORK . (with above sq. ll.)
• l ( G honied energy. muhi-latnlly 75 Olt
(C r b� CZ Vt5 maid vtti:rl (with alwve s .. 1t. l
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and /or relocation
❑ PROPERTY OWNER I ❑ TENANT- 200 amp, or less r I 100.70 . xj 2
Name:
201 amp-; to 400 amps 133.36 2
401 limps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
CiIvJSialc ? %IP: Over 1.000 amps or volts 552.26 2
• Temporary services or feeders installation, alteration, and /or
Phone: ( ) I Fax: ( ) relocation
' 2c0 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 2C1 amp ID 400 amps 125.08 2
intended for sale. lease, rent. or exchange. according to ORS 447. 449. 670, and 701.
401 tarps is S99 amps (OS 54 2
Owner signature: _ _ Dale: Branch circuits - arty, alteration, or extension. per panel
alciPLICANT l ❑ CONTACT PERSON A. l•ee for bratcL circuits with r
above service or feeder lix,
Business name: etch branch circuit 7.42 2
11 Pee fur branch cirty :ts i idxnrr
Contact name: serice or feeder fee, gird
Address: Mulch circuit 56.1 8 2
l:uch aJd'I blanch circuit ( 7.42 2
City./State/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( i I Irax :: ( ) dwelling. service and/or feeder 67.84 2
E-mail:
Ile onnectonly 67.84 2
Pump or irrigation circle 57 34 2
CON'I'RACI'OR Sign or outline lighting 67.84 ' 2
Business name: F- Co n �1 eCyt C. Si circu lt(s)or limucda;ncrsy S
[/ � `
t 4 panel, alteration, or extension. P: s c 2 i 2
Address: "?..:--7 5 5 �; c- )
✓ /-1-1 1 is lid Each additional inspection over allowable in any of the abov
City /Slate/ %IP: 'j �- -t't 1 , c � nve v r 1'7 I 2 � Inve s[igati on (1 h � l ti (I hr min) mmn) ) 66.25; hr
hrminj 66.25; hr
'`
ca.
Phone: (56.??) �z) T -7 0 GI Fax: (�ij ) - • n - -r'— Industr,al plant (1 hr mu) 78.18: hr
I cly71, Z J � F ` , g 3 for which no lee is
13 Lie.: Electrical Lie.: Suprv. Lie. : 5 J (�'(p specifically hsnxl pl: hnnir. j 90001 hr
/
ELECTRICAL PERJ11'F FEE
Suprv. Electrician signature. required: _- 1 ,. t ��
Subtotal:
Print name: ��1 ���LLL + I Scott (f p(-I Date: -51.--..----/ 3 Plan review ( % or purmit l'ce)_
Scott Slate surcharge (1 Yo ol'permit Ice): 1 2 , Oa
Authorircxl signature: J 1/ 2, 7 T
1�U'I'AL IrIiRMI'I� 1
Print name: Date:
permit application expires ifa permit is nut obtained within ISO
Uate: days afer it has been accepted as complete.
" Number of inspections allowed per permit.
I IIluitdir"jd' nnii$5tC pernu■A,p til.R hi[h.d,w ILr 03171,"2013 - i40 15'I'l l I.Uj,CUerJWt:l1