Permit 41 CITY OF TIGARD ELECTRICAL PERMIT
IN" e COMMUNITY DEVELOPMENT Permit#: ELC2013-00617
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GA.RD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/15/2013
Parcel: 25111 BA08700
Jurisdiction: Tigard
Site address: 9450 SW ELROSE ST _
Project: PAXMAN Subdivision: BRELYNN WOODS Lot: 4
Project Description: Panel replacement.
Contractor: FALCON ELECTRIC INC Owner: PAXMAN, KAYDI R&JOHN S
2375 SW CEDAR HILLS BLVD 9450 SW ELROSE ST
PORTLAND,OR 97225 PORTLAND,OR 97224
PHONE: 503-208-4709 PHONE:
FAX: 503-646-5565
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/15/2013 $100.70
Specifics:, amps or less
1 ea 12%State Surcharge- 10/15/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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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 obtain a co. of •. • •irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ,
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Issued By: - —�— Permittee Signature: o
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 IC5) 5036465565 p.1
Electrical Permit Applicat•1 4 C��N FOR OFFICE USE ONLY
City of Tigard ,''� ''\. Date/B ,
. era 13125 SW Hall Blvd..Tigard,OR 9722.3 4� Dy� Plan Review
,
Phone: 503.718.2439 Fax: 503.598.196®0 1 1y0 Dare'B Ot`t_r?ermi[.
Inspection Line: 503.639.4175 QQ to Ready/By: RI Ste Page 2 for
TIGARD
Internet: www.tigard-or.gov ���®�����141 tifieeMelhod Supplemental Information
• OF WORKK t01�— PLAN REVIEW
❑New'construction Addition/altuaf acement Please check all that apply(submit 2 sets of plans wliteins checked below):
❑Service or feeder 40C amps or more ❑Building over three stones
❑Demolition ❑Other. J where the available fault cutret:t ❑Marinas and bor.tyards.
CATEGORY OF CONSTRUCTION exceeds I0,000 amps at 150 volts CT ❑Floating buildin s
less to ground.or exceeds 14,000 Cl Coittrnereial-use agt icu'.turai
1-and 2-family dwelling ❑Commercial/industrial E Accessory building as for all other installations. buildings.
❑ Multi-family ❑Master builder E Other: • ❑Fire pmrp El Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION CI Em y system. ugrx separately derived s},stern.
❑Addition of nevv motor load of ❑".A","L' "I-2' "1.3',
Job no.: Job site address: 9450 SIN or i ore res. o:cupancy.
���jj5u) ���SV ✓L• ❑Sipe or mmz residential amts. ❑Recreational vchie'e parks
Cil\'.SI.t[eI I P: O Q ) bg �1 WI ❑Health-care facilities. ❑Supply voltage for mole than
1:[ia�rdous locations. 030 volts nominal
S.titeibldg.apt.no.: Project name: 5 — '") yn 4 ❑Service or feeder 600 amps or more.
C FEE SCHEDULE
Cross street/directions to job site: - nrsrdphion I Qt.. I Fee. I Tout I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000sq.ft.or less I 168.54 4
Ea.add']500 sq.ft.or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq Ili
( xsK Limited energy,mul[-family 75.00 -2
residential(with above Sc.ft.)
� �1 n �" Renewable Lne g ❑ See Page 2 ,
�iaX ( -PP 'Pet4A0 Services or feeders installation,alteration,anafor relocation
�`ROPERTV 0 I ❑ TENANT 200 amps or less i 100.70 100,101 2
Ifdt' E
201 amps to 400 amps 133.56
Name: Sc Q �x14,7Q, 401 amps to 600 amps 203.34
Address: 7(.4 50 5L) t I row 5`�. 601 amps to 1,000 amps 301.04 2
�-} Over 1,000 amps or volts 552.26 2
CityState&ZIP: pc, aYC�' , 0R GO LZt+ Temporary services or feeders installation,alteration,andfit
( ; ���- Li -/ ( relocation
Phone: fax: I
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to400 amps 125.08
intended for sale. lease,rent.or exchange,according to ORS 447.449,670.and 701. 401 amps to 599 amps 168.54
Owner signature: Date: Branch circuits-new,alteration,or extension,per panel
[ PPLLCANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee, 7.42
Business name: -mil Coln 5t ect t c t h C, each branch circuit
B.Fee for branch circuits without
Contact name: At service or feeder Fee,first 2
I I1yZ-ca branch circuit 55.18
Address: 7;;--Is Cb 5 W e ✓ ! 3� v - Foci add'i branch circuit 7.42 ,
Miscellaneous manufactured or modular
or feeder not included)
Cily`S tat e!"LIP: 'eJ Eac'n nanufaaured or modular
67.84
dwelling,service andrnr feeder `
Phone:(501'5) .7,02).- t7 Fax: :( ) Reconnect only 67.84 2
E-mail: $Cb t , ( COh P t eCfriCci> .c dYY1 Pump or irrigation circle 67.84
CONTRACTOR Sign or outline lighting 67.84
l 6 {r�
Signal circuit(s)orlimited-energy See
Business name: Covt G I e t C_ in G panel,alteration,or extension Paco 2
Address: 1-315 5 C as '61u d Each additional inspection over allowable in any of the above
Additional inspection(l hr mini 6625/hr
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City/State/ZIP: r a t D GI-7 I,tg 22 5 investigation(I hr min) 66.25/hr
Phone:(502)) _.O q 70/ Fax:( ) Industrial plant(I hr min) 78.18/Iir
Sb(� Inspections fonehieh no fee is 90.30/hr
CC[3 Lic.: 2490 1 t Electrical Lic.: # Suprv. Lie.: .8 specificallv listed(l I:rmin)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: /MY— D Subtotal: —1 00_ 1 C1
Print name: ccrit- V Date: !d "_` ! Plan review(25%of permit fec1:
State surcharge(12!0 of permit fee): i 2-•0 g
Authorized signature: TOTAL PERMIT FEE: 111,-7 t
This permit application expires if a permit is nut obtained within 180
iPrint]ladle: Date: days after it has been accepted as complete.
` Number of irspeclions allowed per permit.
In,nmld&nt;Wern.1stEt.C_verrmtApp_ELR ERE,do:Rev C52,2013 4,0.16151(11t35iCOM,'w55
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