Permit CITY OF TIGARD ELECTRICAL PERMIT
11 COMMUNITY DEVELOPMENT Permit#: ELC201500639
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2015
Parcel: 2S103DD01900
Jurisdiction: Tigard
Site address: 10970 SW GARDEN PARK PL
Project: Wall Subdivision: GAARDE PARK Lot: 4
Project Description: (1)branch circuit for grounding.
Contractor: AMERICAN ELECTRIC SERVICE Owner: WALL, BETTY L
PO BOX 1057 10970 SW GARDEN PARK PLACE
SHERWOOD,OR 97140 TIGARD, OR 97223
PHONE: 503-537-2121 PHONE:
FAX: 503-554-8506
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/12/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/12/2015 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 rul-s are set forth in OAR
952-001-0010 through 9 1- 09 . You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or .801 32.2 44.
Issued By: Permittee Signature: +/ ' /c1
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.
RECEIVED
Electrical Permit Application FOR OFFICE I-SE ( I 1
City of Tigard AUG 12 2015 �'/2 ,: 4 Pe,,,,<<, G�`�i/S-o06,29
74 13125 SW Hap Blvd_,Tigard,OR 9 �n Plan Review
Related Permit t %�vao,s-Don -Phone: 5017182439 Fax: 503.598.L94d Y Of 1 IGARU t _ : .
TIGARD
Inspection w Line: 110;75 BUILDING DIVISION .d�.undm
TYPE OF WORK PLAN RE%7EW
❑New construction N Addition/alteration/replacement Please check all that apply(submit 2 sets of pima w!■ems checked)_
❑Demolition El Other ❑Service or feeder 400 amps or more ❑Bolding over three stoner,
whew t c available fauh current ❑Mtrwas and boatyards_
CATEGORY OF CONSIRUCI1ON ewer&10,000 amps at 150 robs or ❑>lotdg buildings..
N 1-and 2-family dwelling ❑Commercial/mdustrial ❑Accessory building less
to�O°°d or exceeds 14.000 ❑CO®1Ercial use agri`ntmat
❑Multi-family ❑Master builder ❑Other: Fire es_for, other installations_ buildings.
im
❑Fie pimp_ ❑Ia�Ilaooa of 150 KVA or
JOB SIIE INFORMATION AND LOCATION ❑Einemcnc system lunar separately derived
Job#: I Job site address:109711 SW Garden Park PI ❑ of on.motor toga or -7 -1-7,
I001IP or rode- ❑-A-,A-, `°1-2"-`1-3',
City/State/ZIP:97223 ❑Si:or more residential units. �a�-
A7/7-1-4— ❑Hank-cue facilities ❑Remc>doral vehicle perks
Suite/bldgJapt#: I Project name: ❑Hamadan locations- ❑Supply voltage for more than
❑Service er feeder 600 amps or man. 600 volts nomiul..
Cross street/directions to job site: FEE SCHEDULE -
Ds sipsim I O . I Wadi I T. I •
New resdeatial single-or multi-Tamily dwelling tmtt.
Subdivision: I Lot#: Includes attached garage.
1,000 sq.R or less 168.54 4
Tax map/parcel#: a.sun 500 sq.ft.or portion 33.92 1
DESCRIPTION OF N'ORIC
Linked corrrn..nesialeietimil
Drive 2 groaad rods,underground metal water service disconnect from house (with ashore sq.ft) 2
Limited e■tagy,multi-family 75.00 2
residential— (with above sq.R)
❑ PROPERTY OWNER ❑ TENANT Renewable Energy ❑ See Page 2 _
Services or feeders installation,alteration,and/or_ relocation
Nam= 200 amps or less 1 100.70 2
Address: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation,alteration,and/or
Email:
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,lease,rent,or exchange,accozdin llb ORS 447,449 670,and 701_ pmt aous Mr4o®aims 11254 118 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
❑ APPLICANT 1 ❑ CONTACT PERSON Branch circuits—new,alteration,or extension,rm.panel
A Fee for branch circuits with I
Business name: ahem MIMI=m feeder fee. 742 3
each hem&Mimi"
Contact name: B.Fee for branch circuits without
Address service or feeder fee,first 1 56.18 56.18 2
branch circuit
City/State/ZIP: Each add']branch circuit 7.42 2
I Miscellaneous(service or feeder not included)
Phone:( ) Fax::( ) Each omrr,Facaaed or modular 67.84 2
Email: duelling,service and/or feeder
Reconnect only 67.84 2
CONTRACTOR Pump or inigaeon elide 67.84 2
Business name:American Electric Service Sign or cardiac lighting 67.84 2
Address:PO Box 11157 Signal Meta t(s)or limited-energy ❑ See Page 2 2
pared alteration_or extension_ t I
City/State/ZIP:Sherwood,Or 971411
Each ad�donal inspection over in any ti the aho>ne
Phone:(5113)537-2121 I Fax 583 554-85116 Investigation" (I hr®y 9000/hr
( ) (1 hr min) 90.00d hr
davd 8aesstregsn.eem Industrial plant(1 hr min) 78.181 hr
i
Inspections for which no fee is
90.0W hr
CCB Lic.: 11115871/x0 17 I Electrical Lic.: 36-59c Suprv.Lic.: 41ly listed(54 hr min) _
Suprv.Electrician signature,required: 7///17 /0////(O uF_tr"IRICA l_ PERMIT FEES
Subtotal: 56.18
Print name: David Haupt Date: 8/12115 ❑Plan Review Required(25%of permit fee):
State surcharge(12%of permit reek 6.74
Authorized signature: �� c TOTAL PERMIT FEE: 62.92 r/."--
This permit application expires if a permit is not obtained within 180
Print name: David Haupt Date: 8/12/15 days after it has been accepted as complete.