Permit
q CITY OF TIGARD ELECTRICAL PERMIT
>z COMMUNITY DEVELOPMENT Permit#: ELC2009-00614
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/17/2009
Parcel: 2S 111 CD03100
Jurisdiction: Tigard
Site address: 9645 SW BRENTWOOD PL
Subdivision: SUMMERFIELD NO.9 Lot: 520
Project: 3e Inz,Q-n
Project Description: Reconnect due to fire.
Owner: FEES
JENSEN Quantity Description Date Amount
9645 SW BRENTWOOD PL
TIGARD, OR 97224 1 ea Reconnect Only 11/13/2009 $67.84
1 ea 12% State Surcharge - 11/13/2009 $8.14
PHONE:
Electrical
Contractor:
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503-252-1609
FAX: 503-253-5831
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Tota 1 $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 accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or f 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 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by calling 50Q3.246.6699 or 1.800.332.2344.
Issued By: ` ru 1 Permittee Signature: v Q _ Its
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 503.539.4175 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 plans are required on the job site at the time of each inspection.
Electrical Permit Application Ht'~' i V
Dxte,'6v: I Permi['.vo.:lf 1
City of Tigard NOV 16 2009 Reeel ed 1301914,
Colo"
13125 SW Hall Blvd., Tigard. OR 07223 kcvicw _ «NV
Phone: 503.639.4171 Fax: 503.59X.19` i)ate": UAier Permit:
Inspection Line: 503.639.4175 1;ITY OF TIGARD Datc Rainy/Sy: Tr E7 Sec Pn~e 2 for
Internet: www.ti,gSrd-0r.n dov BUILDING DIVISION- Notitied/NMhod: Supplementallnfor*naGou
Y t T Q O~ replacen7CnE Ploase c cc.k All That v (submit or of plans ttO throe ntor la Y)
New construction Additi t en "e, be
E] ervico or ce r 400P o g over
es.
❑ Demolition ❑ Other_ whGte the available fault current ❑ Marinas rod boatyards.
exceeds t 0,000 wnp. at 150 volts or ❑ Floating buildings.
Ct??VSt J~iT["Ii~~V
CATEGORY (aiV lass io ground, or exceeds 14,000 ❑ Commercial-use agricultural
l- and 2•family dwelling ❑ Commercial/industrial ❑ Accessory building amp. for all other, inselliation;. buildings.
cl-y dt ed ~
~ ~ ~ ~o~71(~ d ❑ Firc pump ❑ l larger t; on of
❑ Multi-fame ly Master builder y other; r-ccncY system. tar arget a::ion o 7 KVA
C2 o system
i
CXB +a' E '£NF QfI ❑ Addition of new moult tnad of p "A"'E" "I -2•""1 / i 0oHI' or more, cwcupa,lcy
Job no-,- Job site address:
❑ Six pi moi c residential units, ❑ Rc.remmnal vchlett parks.
City/Stale/%IP: 1 ( h.~ ❑l Health-care }::citifies. El supply wltnrc for more than
I u& dou> locations 600 voWs nommat
1~ El Service or feeder 600 amps or more
Suite/bldgJapt, no.: Project name:
:W, L
_ "FEErSCOFWLE
Cross street/directions to job site; j/e5cri tion . v. Fee- Total
New residential single- or multi-family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000,;q. ft. or less ~ 168.54 4
Ea. add'I 500 sq 8- or portion 33.92 1
'l'ax map/parcel no-: Li,nitcd energy, residential 67.84 2
S I1E1 (2'F'r1C)1C m t la above sn ti )
l ,id
• I<-CJY iT,~ E `~t~ ''i" + r residential with above - tt
alteration, and/or relocation
Services or feeders ins n
200 amps or Icss 100.70 12
Q pl«0~ER71r, N (t ~Tk1~T 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2 '
Name: 2
601 amps to 1,000 amps 301.04
Address: Over 1,000 amps or volts 552.26 2 `
Ci /Stale/%ll': Temporary services or feeders installation, alteration, and/or
ty relocation
1 I
Phone: ( ) Fax; ( ) 200 atop, of less 59.36
Owner installation: This installation is being made on property that i own which is not Z01 amps to 400 amps 125.08 2
intended for sale. lease, rent, or exchange, according to ORS 447; 449, 670, and 701, 401 amps to 599 amps 168.54 2
Branch circuits - ncw, alteration, or extension, er anel
Owner stpnaturc Date: - A. Fee for branch circuits tvitlr
O t'(aAFTAC'i' PERSON above serv ice or feeder fcc;
.4Y 2
each branch circuit
Business name: B. Fec for branch circuits
Withow sen, icc or feeder fee, ~6 lg 2
ContWt natne: first branch circuit
'
Address= Each add'1 branch circuit 7.42 27,
_ - 111iscellancons (service or feeder, nut included)
(;ity/State/ZIP: f-:ach nlanufacntrati or modular 67 84 2
dwelling, scrv,cc and/or feeder
['hone: ( ) Fax: t ( ) Reconnect only 67,84 2
E-mail; Pump or irrigation circle 67.84 2 '
C('1itATQrR Sign or outline lightinz 67.84
' Signal circuit(s) or limitcd-
l3usincss name: 6a4 U-i VF S I r i cner-y panel, alteration, or
extension Describe: Paec 2
Address t`` ~X il( ~ rl _
City/State/Z1P~,~.°~ Each additional inspection over allowable in an of the above
r Per inspection 66.2:1
Pltonc: 1J,4 "503 investigation per hour (1 hr min) 66.25
Lic,; g Industrial plant per hour 78.18
CCB Lic.: Electrical LicLS
"ELECTZiICA.? VERIWF k''09S
Suprv. Electrician signature, requi Subtotal:
Punt name Plan teview (25% of permit fee):
State surehar°c (12~° of permit fee):
1Jatc: ~ j~,'ryr7
Authorized signature: TOTAL PFXMiT FEE: 1zs
This permit ;,pplication expires if a permit i8 not obtained within 180
Print name: Date: days after it has bait accepted as complete.
- tvumber of-inspect leas allowed per penult.
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