Permit CITY OF TIGARD ELECTRICAL PERMIT
IIII IL - COMMUNITY DEVELOPMENT Permit#: ELC2013-00523
T WARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/03/2013
Parcel: 2S111AD14500
Jurisdiction: Tigard
Site address: 14827 SW 91ST AVE
Project: HATFIELD Subdivision: MALLARD LAKES Lot: 11
Project Description: (2)branch circuits for A/C unit.
Contractor: BOONES FERRY ELECTRIC INC Owner: HATFIELD, BARRY D AND
PO BOX 628 DEBORAH C
WILSONVILLE, OR 97070 14827 SW 91ST CT
TIGARD,OR 97224
PHONE: 503-682-4936 PHONE:
FAX: 503-682-7946
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 09/03/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/03/2013 $7.63
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 obtain a cn y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800,332.2344.
Issued By. �� =! Permittee 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 503.839.4175 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.
Aug. 29. 2013 2:57PM No. 1223 P. 1
Electrical Permit A lira j . FOR OFFICE USE ONI.i.nr. i
ril City of Tigard I I:,3 AIMIN1 Permit Na': —GL, 0, (1-.)
: - w 13125 SW Hall Blvd.,Tigard,O Plan Review
li ..
Phone: 503439.4171 Pax: 503.598. Data/13y Other Permit
ins ection Line: 503.639.4175 MUG h i7 2013. Darr Rcady/By r,nin sQ 'gc 2 for
TI CAP.D p
Inttattet tvtvw.dgard-or.gov NadStd/Meabod: . 7TJ Supplementall■farmanaa
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4 '
7 • tII..t '1► T I . ' • please�ti J all tLat apply(submit 2 Sets of wfKamr_checked below
p New construction ' Addltio t •i�' �1 1� �� r� i
❑Demolition ❑Other. ❑Scram or feeder 400 amps orators ❑Building over three staoies.
r
where the available salt current ❑Marinas and boatytads.
F-, , 1 exexds 10.000 amps of ISO cults or Q Fleabag beluga .
;. .: ..._:.._1_.�..._.. ......;.:. _,_.. ...._. .mil_ ...,J.:
1-and 2-family dwelling ❑Commercial/industnal ❑Accessory buisps grail of or instals 14,000 ❑t"ommgtial agrianittnal
g �for a0 other installations. buildings.
❑Multi-family ❑Master builder ❑Other DFae pomp. ❑Installation of 75 iZVA or
r ❑EmaBeary system- larger separately clawed system.
.„ t r .,` ';',"2,-;::::!-;,-.1-,1::: :: ❑Addition of new iota-load of ❑"A","B",-1-2""1-3"
Job no.:2 2,t}-36 Job Site address: 1 8 2.7 'i;.J ! s+ 1hi IOOiIP or moos. may
/ ❑Sin or moro residental snits, ❑Recreational vehicle pads
_Ciry/State/ZIP: ^t;a 0,,. t 0 J' O Hwltb�ars facilities. D Supply voltage for more than
j (3 Hazardous location 600-volts=salmi
Suite/bidgJapt no.: 1 Project name: ev J) 111-4 *) ❑Service or feeder 600 amps or more.
Cross street/directions to job site: p w._.. . _'Fee T ':--::'..,..2.•
New residential single-or multi-family dwelling unit.
' Includes attached garage.
Subdivision: _ J Lot no.: 1,000 sq.ft or less 16834 4
artxl no.: Ea add'l 500 sq.8 or portion 33.92 . 1
Tax
map/ F Limited energy,residential 67.84 2
r 1`r i , (with above sq.R.)
_t i Limited energy,multi- y 6784 2
p‹ C^j.A EM co., C3 er S a hs residerrdal(with above sq.
Service;or feeders installation.alteration,and/or relocation
200 amps or lens 100.70 2
,- f < ,.t. 201 amps to 400 amps 133.56 2
;' .,._.,.w,...,.,.. ,_;.,... ., .. ..;_,:..,w..!. ..t.. ',a ..r,
401 amps to 600 amps 200.34
2
Name:
601 amps to 1,000 amps 301.04 2
.ddress: over 1,000 amps or volts 552_26 2
City/Statt:/ZIP' Temporary services or feeders installation,alteration,and/or
_ relocation
Phone:( ) I Fax:( ) 200 amps or leas 59.36 l
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599
M rent,for sale,lease,rt,or exchange,according to ORS 447,449,670,and 701. - 168.54 2
Branch circuits-new,_alte ation,or extension, er panel
. Owner signature: Date: A.Fee for brawn circuits wuh
;: , r as or feeder fee,
7A2 2
Business name: B.Fee for branch t=wits without
service or feeder fee,net t 56.18 2
Contact name: _branch circuit
Each add'1 branch circuit ) 7.42 2
Address: Miscellaneous(Service or feed not ineluded2
er modular
City/State/ZIP: d manufactured
service mallet feeder 67.84 2
Phone:( ) Fax::( ) Reconnect only 67.84 2
Pump or irrigation curie - 67.84 2
ma
84 2& l: ,, 'N' CS V t err oa tgtmg 67.
r J' t -: '
. _ Signal rrWlt(S)or binned-mew.
Business name:Boones)Ferry Electric panel aheratinno rerdmsion Pages 2
Each additional igs�tlon over allowable in any of the above
Address;P.O.Box 628 Additional inspeetion(1 hr Loin) 6625/hr L
Investigation(1 hr ruin) 66251 hr
City/State/ZIP:Wilsonville OR 97070 -Industrial plant(1 br min) 78.18/hr
Phone:(503)682.4936 Fax:(503)682-7946 Inspections for which no foe is 90.00/hr
-, listed K br rain
CCB Lic.: 88482 Electrical Lie.: 3- 3C Suprv.Lie.: g'7'7.O S' �._' _ . ,., . ,, ' ,."� Y...:._ r
Suprv.Electrician signature,required: Subtotal. r a , :6
Plan review(25%of:ptxniit fee):
• r'rint name: 1"61..,t 1 I R•✓yM1 Date:$ .v,3 State surcharge(12%of permittee): ---)c 63-
TOTAL PERMIT FEE: 71.,2.3
Authorized signature: This p it application aspic if a pits not obtained within 180
Print name: Date: days after it has been accepted as complete.
Namber of mspe tioic allowed per mmit.
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