Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00603
T [ GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/12/2009
Parcel: 2S102CB03401
Jurisdiction: Tigard
Site address: 10045 SW GARRETT ST
Subdivision: Lot: 0
Project: Coats
Project Description: Install 200 amp service, and add (2) branch circuits.
Owner: FEES
COATS, ROBERT Quantity Description Date Amount
10045 SW GARRETT ST 1 ea Services or Feeders - 200 11/10/2009 $100.70
TIGARD, OR 97223 amps or less
PHONE: 503 - 708 -7786 2 crt Branch Circuits w /Purchase 11/10/2009 $14.84
Service or Feeder
1 ea 12% State Surcharge - 11/10/2009 $13.86
Contractor: Electrical
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 -313
VANCOUVER, WA 98686
PHONE: 360 - 574 -7200
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FAX: 360 - 546 -2158
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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. AU ' = . ! =ion law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 .010 through OAR • -0' • 00. You may obtain a copy of the rules or direct questions to OUNC by callin r • 246.6699 or 1.800.332.2344.
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Issu =. By: 1 • �r '� Permittee Sign. , /l �� /!Y!
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
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SIGNATURE OF SUPR. ELEC' 'grJr Date:
r r ,
LICENSE NO.
Call 503.839.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plane are required on the Job site at the time of each Inspection.
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('' Nov. 10. 2009 10:01PM No. 1895 P. 1
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Electrical Permit Application RECEIVE FOR OFFICE USE ONLY
City of Tigard Received
fiY d g { Permit No.:
:q 13125 SW Hall Blvd., Tigard, OR 97223 NOV 1 U 2009 DaidaY: � ��� .. , /� 3
g Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/EY: Other Permit:
I I c i :1 R n www Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By; runs: I la Sec Page 2 for
Internet: .tigerd or,gov BUILDING DIVISIO . N01ified/Method: — 11 Supplemental Supplemental Information
• TYPE OF WORK :'PLAN REVIEW
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❑ New construction ❑ Addition /alteration/replacement Please check all that apply (submit 2 sets of plena whims checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current Cl Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings. •
less to ground, or exceeds 14.000 O Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of75KVAor
JOB SITE INFORMATION AND LOCATION D Emergency system. larger separately derived system. • ❑ Addition of new motor load of ❑ "A ", "F ", "1 -2 ", "1 -3 ",
Job no.: Job site address: k)04,5 " S t� G f f 2 �rl s‘ ❑ 100}IP or more. occupancy.
Six or more residential taut. 0 Recreational vehicle parka.
City / State/ZIP: 1: °ad (1? l / 2J r "_ 0 11calth -care facilities. ['Supply voltage for more than
r L ['Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: C6 U ❑ Service or feeder 600 amps or more.
.FEE SCHEDULE
Cross street/directions to job site: 5 u. ) ?
• ir I. L k_'tio ki nrkripdan I Qty. I Fee. -I Total I •
New residential single - or multi- family. dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy. residential
�7 ,�, DESCRIPTION OF WORK -. (with above sq. ft.) 75.00 2
X OrVAR U CQ� cQ_.€C,„/. 0 Ifi�� (
Limited eid ntial(, (with multi-family —
residential with above s ft.) 75.00 2
r. U� Services or feeders installation, alteration, and/or relocation
G
L'� 200 amps or less (, tot
— PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106,85 2
Name: 1 � CA' C's 401 amps to 600 amps 160,60 2
` 601 amps to 1,000 amps 240.60 2
Address: lUUt—ts S C9�� r f i ■k S1* Over 1,000 amps or volts 454.65 2 _
�j �2 Temporary services or feeders installation, alteration, and /or
City /Blatt /ZIP:
���irr ( /'. 2[-3 relocation
Phone: (5155 ) i o ts- "7- Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
A. Fee for branch circuits with
. PPLICANT I ❑ CONTACT PERSON above service or feeder fee, el _
Business name: ` 11 __ (� each branch circuit (r ! 42 I 2
Jc n s 'D A ale d-r, rrx4 CcvN C a, OS 1111r E.i t C, B. Fee for branch Circuits
ivithorrf service or feeder fce,
Contact name: t okts 4 O Q 4r Q V"1 first branch circuit 46.85 2
Address: �t- l %c.Rb ti)E 7A kv, eruct_ �v v 2. -313 Eechadd'I branch circuit 6.65 2
, / c � — Miscellaneous (service or feeder not included)
City /State /21P.V 0.,v1(f ilk V t" (J..) �- �g'1%q "(p Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: (3 ) S7N_'72Jt J Fax: ; (3c ) 5y( -� 5g Reconnect only 66.85 2
E -mail: P 1k din ell er l a_p - L\ Q_ f 4 — y - 1 C. c C- . (__C/Y1/\ Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: J CC ` p_, a / _ Signal circuit(s) or limited -
ra.h f 4 \ G (o �Qvu 0 Nl f t,/ IC.. energy panel, alteration, or
Address: Ng G e Ax Zo - IA VIL 17102 _, )...s extension. Describe: Page 2 2
City /State/ZIP: VCJU/1 coup y qczincivr,,Q Each additional Inspection over allowable in any of the above
Per inspection 62.50
Phone:
(3626 ) a r
7q.. 7 Fax: ( 2--1S investigation per hour (I Iv min) 62.50
CCD Lic.: l t0R z4 Electrical Lic. 1as , 9r,' Suprv. Lie.: LJS"gg 5 Industrial plant per hour 73.75 _
ELECTRICAL, PERMIT FEES
Suprv. Electrician signature, required: ! Subtotal; I ,
Print name Date: 1 1 l 1 1 / O 1 a, plan review (25% of permit fee):
�� lS I State surcharge (12% of permit fee); t 3,
Authorized signature: / TOTAL PERMIT FEE: /2C/ , 40
� I , T� permit application expires If a permit Is not obtained within 150
`, r. l F LK+� Date: I I Ci 0 9 days after It has been accepted as complete.
` ' Number of inspections allowed per permit,
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