Permit CITY OF TIGARD ELECTRICAL PERMIT
11111- Permit #: ELC2013 -00449
C •- COMMUNITY DEVELOPMENT
Date issued: 07/30/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S111DCO5600
Jurisdiction: Tigard
Site address: 9415 SW BRENTWOOD PL
Project: Bank of America Subdivislon:.ST PARK ADDITION TO FOREST GRC Lot: 538
Project Description: Reconnect only.
Contractor: Owner: BANK OF NEW YORK MELLON TR.
BY BANK OF AMERICA
1200 N FRENCH ST
WILMINGTON, DE 19884
PHONE:
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/30/2013 $67.84
Specifics: 1 ea 12% State Surcharge - 07/30/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 OA 2- 1 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: e/ !/ 7o ,L /
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 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.
Ju1.29. 2013 11:O1AM � NW No. 0568 P. 1
Electrical Permit Applica >< FOR 0I+ IC I.', 11SI ON 1.Y
City of Tigard h' Received g 2 9 2 013 //3 f1 ►. i
II bate/By: 7/36 Permit NO.: 67.C.26/3— D 9'
4 13125 SW Hall Blvd., Tigard, OR 9
D Plan Review Other Permit;
Phone: 503,718.2439 Fax: 503. TIGARD Date/By:
TI c ,A R n Inspection line: 503.639.4175 (� l Jr bate Ready/By: runs: See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Method: �� I Supplemental Information
.`TYPE 0P WORK ._ , ° iP><,piN.' RIEVIEw
['New construction 0 Addition/alteratlon/replacemen Please check all that apply (submit 2 sots of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
�' T`
❑ Demolition Other: ,e t. r where the available fault current ❑ Mariana and boatyards.
eonne cA Lo
CATEGORY: "OF CONSTRUCTION . - exceeds 10,000 amps at 150 volts or ❑ Floating buildings,
' leas to ground, or exceeds 14,000 0 Commercial -use agricultural
1- and 2 dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
o Emergency ditioof Systemm or load of larger separately derived system.
• U1V,;AND LOCATIONI' ";.. ❑Adn new ot
_ 'SITE INFORI�iAC! ❑ "A" "H '4 -2" ` °1 -3
Job no.: Job site address: q� 15'e (fl BRIT(' I+U�CL, .P1 1 ixor or errs. Recreational ❑ Six or more residential Mils. (] RTealional vehicle parks.
City /State /ZIP: — i1( m - TD,. c:p 1).D ❑ Health -care facilities. 0 Supply voltage for more than
l ❑Ha¢ardous locations, 600 volta nominal.
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Deatpdoa I Ole. I Pen I Total I •
New residential single- or mulli- fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft, or less 168.54 4
En. edd'l 500 sq. A. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION O1P WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
?NOV fecayNki\e residential (with above sq. ft.)
Renewable Energy 0 See Page 2
Services or feeders installatlonolteration, and/or relocation
' Q PROPERTY. OWNER . I . ' rt TENANT 200 amps or less 100,70 2
201 amps to 400 amps 133.56 2
Name: ok - v \e.lrk CG 401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301.04 2
- Over 1,000 amps or volts 552.26 2
City/State /ZIP: Temporary services or feeders installation, alteration, and /o
Phone: ( ) F ax: ( ) relocation
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,,gr.excha ge, according to ORS 447, 449, 670, and 701. -
�' 401 amps to 599 amps 168.54 2
Owner signature: Date: -2g- /3
� Branch circuits - new, alteration, or extension, per panel • . / 9PPLl;CAivr I 0 CONTAcr PERSON' A. Fee for branch circuits with •
above service or feeder fhe,
7,42 2
Business name: 0..1 VA -'t;` 7( , each branch circuit
��JJ t" f B. Fee for branch circuits wirhottr
Contact name: ,e, f C! service or feeder fee. first
`'�'
branch circuit 56.18 2
Address: q 400 g 1 0 1 S t� e. S4 t 0 tech add'I branch circuit 7,42 2
City/State/ZIP: u.� l , , 1 ` l Miscellaneous (service or feeder not included)
i 7 ci 7005 Each manufactured or modular
r� � dwelling, service and/or feeder 67.84 2
Phone: (. 33 5 (- ° f c l gd Fax:: (b.3) S�7' 7 84�
` Reconnect only l 67.84 4 k9. 2
E- mail:
"�PXeSc. L. %'4 COCAA - b(S 4 < (.t] 11/1 Pump or irrigation circle 67,84 2
CONTRACI'OD i,:; - Sign or outline lighting 67.84 2
Business name: signal circuit(s) or limited-energy See
panel, alteration, or extension. Page 2 2
Address: Each additional ins eetion over allowable In an of the above .
- Additional inspection (1 hr min) 66,25/ hr
City/State/ZIP:
Investigation (I hr min) 66.25/hr MEI
Phone: ( ) Fax: ( ) Industrial plant (1 hr min) 78.18/ hr
inspections for which no fee is
CCB Lic.: Electrical Lic.: Suprv. Lie.: s ' cificall listed h hr min 90.00 / hr
;'; ELECTRICAL P 1Epti11aT FEES
Suprv. Electrician signature, required: subtotal:
Print name: Date; Plan review (25% of permit fee): ' I
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT PEE: •--) q r" V
Print name: Date: permit applicatIon expires it a permit is not obtained within 180
Date: days after it has been Act ep red as complete.
• Number of inspections allowed per permit.
I;V PerminApp ELR ERs.doc Rev OS/rir2Otl 440- 1615T(II /05 /COWWP.5