Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2015-00977
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 12/15/2015
Parcel: 23112CB07700
Jurisdiction: Tigard
Site address: 15143 SW KENTON DR
Project: CEDENO Subdivision: ASHFORD OAKS NO.2 Lot: 91
Project Description: Adding(1)branch circuit for floor heat.
Contractor: AMP ELECTRIC Owner: CEDENO,JOSE D
8152 SW HALL BLVD#325 BARLOW, MARILYN J
BEAVERTON, OR 97008 15143 SW KENTON DR
TIGARD, OR 97224
PHONE: 360-910-5805 PHONE:
FAX: 503-643-6798
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 12/14/2015 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 12/14/2015 $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 - _ -- - 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. ENTION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0r 1-0010 through OAR 952--: -009 . •u may obtain a copy of the rules or direct questions to O •y ca in• 1987 or 1.800.332.2344...
Is-ued By: /, /LAS` Permittee Sig re: ' . ! f •
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' -� ••• /`.,,4 , i0 , �.. Date:
LICENSE NO. 3s6
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.
07/29/2010 20:18 FAX 5036436798 AMP ELECTRIC INC 001
12/15/2015 09:18 FAX 5032658219 JEFFODELL .a3,Sy p: / 9'6 o Ij 002
electrical Permit 'ea ' P
gl
ty of Tigard .
113125 SSW Hall Blvd,Tigard,OR 97223Defray: / /r,071-- 't#: 1,C.�t?1 s—,c��j 7• 2
Phone: 503.7182439 Fax: 503.598.I61GlJ •,4 7 015
Pisa Revert
UC'' Da,-: - Related Permit*:.Inspection Last: 503.639.4I75 ��t Ready Dste+By. Anis: `/- P.t f I► ,
Internet: www.ligartkr.gov � 17� Notified/Mcfhod: See Pent 2 for
` S . .t �J►` Supplemental Idare adon
I
0 New construction ,Addition/. 11.1.11%.1/t •
❑Demolition t rime cheek all duet apply(submit anis°tp6un wh chocked):
_. - - Q Other: O5crs,oe or feeder 400 craps or more Building over three varies.
where the available fault curtest ❑Marinas and boatyards,
exceeds 10,000
dwelling .' .. ' :._. i..' amps at 150 volts or 13 Floating buildings.
D 1-and 2-family Q Commercial/industrial 0 Accessory building less to around.or exceeds 14.000 ❑CoanneciaLuaa agriroltnral
Q Multi-family ❑Other asps for an other installations" buildings.
0 Master builder ❑Fireptm,p-
,j�. ❑installation of 450 RVa or
. . . ! 17 Emergency system. larger
Job#: Job site address:' ; j'. 0Additionofnewmotorloadof system Kir derived
/� ,�/ter INIM - 100HP or more. ❑A',"E","1-2","1-3v
ityI StateiZ1P: / L a,�Six or more TE41deAtlal units. occupancy.
Suite/bldg./apt# ProjectRecreational mune: ❑Hazardous locations. 13 Supply voltage for more tben
Cross street/direciona to job site: �A,te. a._ ❑sa:vrca feeder 600 or more. boawh><aomimL
:i ._ ..
_Deartwsoa .. .. . .
Qtr. !rad Total •
New residential dstgle-or mufti-tamiiy dwelling unit
Subdivision: Lot#: Includes attached garage.
Tax map/parcel#: 1,000 sq.B.or loss 168.54 4'
••--•• - • � edd'I 500 sq.ft.Orpmtian 33.92 I
I:, Limited metgy,re s4eneni
t - .L Cit az.ii_v I cit FLoo (with above sq.fl.) 75.00 I 2
Limited energy,multifamily 75D0 2
_._..._,. s9 )
.
.�r;:; . ;. Renewable
Energy
0 BeePage2
T .,,
-. . ._.... .. • •-. •>'_.., - --- -.. ...-1. Se lnatallationotiterao°4and/orrelocation
Name: 200 amps or reser 100.70 2
Address: 201 amps to 400 amps 133.56 2
City/State/ZIP: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Phone:( ) I Fax:( ) Over 1,000 amps or volts 552.26 2
Entail: Temporary services or feeders lnstedlatlov,alteration,and/or
relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 5936 1
intended for sale,lease,rent,or exchange,according hi ORS 447,449,670,and 701. 201 snips to 400 amps 125.08 1 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
. ' ., Branch circuits
branch archin alters
r pose!
. -- - - - - :1 A.Fa for with
• ,.v ,, s tl above service or feeder fee,
each branch ctrcuft 7A2 2
Contact name: C13.13.Fee for branch circuits without
Address: //t;"7 — ` r L 'i.! 5 i3 C circuit a fee fust j `r 56 re �f 2
City/StateZIP: . `X I / 7L 13 ! branch Each edd'l branch circuit 7,42 2
(sor feederwt Included)(537) )J^Z 3'UI Fax.:( ) Each manufactured
ormodular
-
dwelling,service and/or feeder 67.84 2
Email: A .63.1.1 ,LL c._. c 0-✓t/-- -
Pump a irrigalimt cis le 667.84 2
7 8 2
Business name: ,gyip -I��'�"`j �f{ C.,' Sign or outline lighting 4
Address: .i \ ^� ci Signal cumnt(s)or limited-energy
L L3 L ) _panel,alteration,or extension.. 0 See Page 2 2
City/State/ZIP: • .A At/ 0 .4 Each additional luspecfioa over allowable to any of the above
Additional inspection(i hr min) 66.25/hr
1 5#) I . �d J
Fax:( ) Investigation(I hr min) 90.00/hr
Email: .:rii:a... e " G _Wagtail plant(I hr min) 71.18/hr
�. N�� Inspections for which no the is
Z /-E1ectr oal ':Lie.: a 7 ' Suprv.Lic.: 6 •..'Sas! Bated A hr min 90.001 hr
• tv EketTician g`r Su
Date: f I ---/ ❑Plan Review Required(2596 of permit ice):
_ ' . 4-0- - State surcharge(12%of permit fee): 1 y
Authorized si :. TOTAL PERMPf FEE:: . i�
Print nam / f/ This u a doe
after
theme x a permit is mot e. within 180
dit)e sdTerftbat been steepled r=vine.
ti�aoid • Number of Inspections allowed per permit
iroPesmie t.c_r.• . Ets_r-.. Rev 06/172015 4404615•f(1145/COWWEIt