Permit (11) CITY OF TIGARD ELECTRICAL PERMIT
711E . COMMUNITY DEVELOPMENT Permit#: ELC2016 00574
T[GAR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/21/2016
Parcel: 1 S134CB09100
Jurisdiction: Tigard
Site address: 11145 SW 123RD PL
Project: DEUTSCHE BANK TRUST CO AMERICAS Subdivision: ANTON PARK Lot: 53
Project Description: Electrical reconnect only
Contractor: N/A Owner: DEUTSCHE BANK TRUST CO AMERICAS
BY OCWEN LOAN SERVICING LLC
1661 WORTHINGTON RD
WEST PALM BEACH, FL 33409
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/21/2016 $67.84
Specifics:
1 ea 12%State Surcharge- 07/21/2016 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
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 asgo dance__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` eq ou to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-00 -0010 through OAR 95 -0090. o may obtain a�coppyy offthe rules or direct questions to OUNC y a i 32.1987 or 1. 00.3@22344.
Issu d By: . ,/ �'� �1-'L4—' 4 Permittee : fe..44-4-1.--.--
-
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.
Electrical Permit Application Jul_ 1 4 7n1ii
. Received
City of Tigard ... .y DateiRy: 7,to ac Cth Penult al; ekeovell„...0‘)5 7
II 13125 SW Han blvd.,Tigard,OR 97223 ,' , " -- '' Plan Review
Mated Permit C:
1r 2 Phone: 503.718.2439 Fax' 503,59IyW) . . . . ... ., ... DateDv. ,
...„, _ ,..,,..,, Inspection Line: 503.639.4175 . ,' 5„ .., ' ; s -' t ' ,. . Ready Datet13y. 71944 c..1.4 liirtisi gri See Page 2 for
,,(-'A;N.". Internet: www.tigard-or.gov Notifiedlgo! -i' , Supplemental Information.
...-14i l'• ut.,,td.J.ride--
TYPE OF WORK ' PLAN REVIEW
0 New construction 0 Addition/alteration/replacement Mouse cheek all that apply(submit 2 sots of plans wincros checketft:
0 Demolition 0 Other: 0 Remise or feeder 400 0
CATEGORY OF CONSTRUCTION amps or more Beilding over three
where the available faun current stories,
le 1-and 2-family dwelling 0 Commercial/industrial 0 Accessory building exceeds 10,0(10 amps at 1St volts 0 Marinas
0 Multi-family .
.E1 Master buildor and boatyards
er El Other: lest to ground,or exceeds 14,000
TOR SITIE INFORMATION AND LOCATION atom for ail other instillatio0 ns. Floating
Job it:
Job site address:11145 SW 123rd Pi 0 Fire pmp. buildings.
ti
0
City/State/ZIP:Tigard,OR 97223 D Ertel geney system. Commet cial-use
0 Adtittion of new motor agricultural
Suite/bldg./apt.#: Project name: load of buildiega.
10011P or mars. 0
Cross street/directions to job site:
0 isiv or more residential Installaion of 150
kvA or
units,
larger separately derived
Subdivision: Lot 4: 0 1 letiltheettre facilities,
system,
0 Ilastirdoite locations. 0
Tax map/parcel 4:
0 Service or feeder 600 L."1-2"."1-3",occupancy.
DESCRIPTION OF WORK El
amps or inure.
Electrical Reconnect Recreu annul mind,-
parks.
0 Supply
n PROPERTY OWNER 1 n TENANT voltage for more than
Name: tit ita ,31,,,,a,i
FEE SCHEDULE 600 volts nominal
Address: pt,) /3,5x o?1,,,, 1 p Do_ti_tiition LTLI_Sa_dt_ Totti21Lm,
New residential single-or multi-family dwelling unit.
City/State/ZIP: C
: } , R
i 4 71661 Includes attached garage.
1 e
i000 s.11.11,or less 168.54 4
Phone:9 lie 1.515 ..E .,„:D Fax:( )
Ea.aricli 500 sq.ft.or portion
33.92 1
*".' '7;
Entail: 14..,(...iml\I orro„.ea,,--, Limited energy.residential
75.00 2
(with shove sq.ft.)
Owner installation:thianstallation is being made on property that I own which is not
Limited energy,multi-family
75.00 2
intended for sale,lease, nt,or exchange .':,cording to ORS 447,449,670,and 701, retatiential(with above sq.ft.)
/ '1/f' tilt/A iil
Owner signature' , 1. i,„, , Date: r/ r Renewable Energy 0 See Page
ir P ICANT 0 CONTACT PERSON
/
#th, A 2
Services or feeders installation,alteration,and/or relocation
Business name:Reliable Service ' 200 amps or lees 100.70 2
201 glom to 400 amps 133.36 2
Contact manic:Jessica Shea»
401 amps to 600 amps 200.34 I 2
Address: 601 amps to 1,000 amps 301.04 I 2
City/State/ZIP: - Over 1,000 amps or volts 552.26 2
——
temporary services or feeders Installation,alteration,
Phone:(716)515-8352 Fax::( ') and/or relocation _
1
Email:bbovny.jess200 amps or less 59.36(Ogniail.com
201 amps to 400 amps 125,08 2
CONTRACTOR
401 amps to.50.9 amps 168.54 2
Business name:N/A Branch circuits -new,alteration,or extension,per panel
A.Fee for branch circuits with
Address: above service or feeder fee, 7.42
2
each branch circuit
City/State/ZIP:
B.Fee for branch circuits
without service,or leerier fee,
Phone:( l 56.18 2
Fax:( ) foul branch circuit
Email: Each add)brunch Clallit 742 j 2
Miscellaneous(service or feeder not included)
CCU Lie.: Electrical Lie:,: Suprv.Lie.: Each manufactured or inottinlar
67.114 . 2
dwelling,service and/or feeder
Sumv.Electrician signature,required:
Reconnect only I 67.84 tel,Sti 2
„......
Print name: Date: Pump or irrigation circle 67..84
2
Sign or outline lighting 67.1.4 2
Signal cireuirbil or limited-
Authorized signature: energy panel,alteration,or 0 See Page 2
i . i 2