Permit N i i CITY OF TIGARD ELECTRICAL PERMIT
'III COMMUNITY DEVELOPMENT Permit #: ELC2009 -00666
TI GA`R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/17/2009
Parcel: 1 S 133AD09800
Jurisdiction: Tigard
Site address: 10729 SW 127TH CT
Subdivision: AMART SUMMER LAKE NO. 3 Lot: 154
Project: Sherwood
Project Description: Reconnect only.
Owner: FEES
SHERWOOD, STEVEN DANIEL & Quantity Description Date Amount
SHERWOOD, CASEY LEA, 10729 SW 127TH
CT 1 ea Reconnect Only 12/17/2009 $67.84
PHONE: 1 ea 12% State Surcharge - 12/17/2009 $8.14
Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT 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 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 les 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 503.246.6699 or 1. 00.3 .2344.
Issued By: JG 9 1.9. ' 1./' Permittee Signature: s
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.
CaII 503.639.4175 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 A lica>tio - `: , > uatvvg aN ... . '
CI of Tigard CEI pg�� Received ��n l Q (Q `� g ��� Date/By: �` / Permit No.: � .
v 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
® Phone: 503 Fax: 503 9 V EC 1 7 2009 Date/By: Other Permit:
1 . liti; I' 1�) Inspection Line: 503.639.4175 w Date Ready/By: Jur s: El See Page 2 for
Internet: ww.tigard or.gov CI Notified/Method: 1 Supplemental Information
CITY O F TICARD
TYPE QICIIPM PLAN REVIEW
N ew construction G DIVISION, P lease check all that apply ❑ ❑ A ddition/alteration/replacemen pp y (submit 2 sets of plans w /items checked below):
�,( ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition I Cher: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 1072_9 S t7 " ' f / or
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: '---(�`�� r �(� �� Z Z ❑ Health -care facilities. ❑ Supply voltage for more than
V ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: S vv� ✓>t r 1 atcP 17 t^ + Description 1 Qty. 1 Eee. 1 Total 1 •
New residential single- or multi- family dwelling unit.
Sp n 4 . u 1 r,e-),-‘ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'i 500 sq. ft. or portion 33.92 I
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family
67.84 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
%PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: l C Q � `, 4 4 �+- � ' 401 amps to 600 amps 200.34 2
( s- J v 601 amps to 1,000 amps 301.04 2
Address: l Z cl 1 to ` 4 Q-,.— CO L Over 1,000 amps or volts 552.26 - 2
City/State/ZIP: -7— Temporary services or feeders installation, alteration, and /or
(c c., r t� �— `� ? Z Z 3 relocation
Phone: ( 5?j S7 7 — 014 y U Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 turps 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
Owner signature: Date: Branch circuits — new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ , APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, . 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State /Z1P: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only ` 67.84 (07: ai 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
•
Business name: Signal circuit(s) or limited -
energy panel, alteration, or
Address: extension. Describe: Page 2 2
City/State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 66.25
Phone: ( ) Fax: ( ) Investigation per hour (1 hr min) 66.25
CCB Lic.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: (pi .re-f
Print name: Date:
Plan review (25% of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: 7J .Ct 8
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 10/01109 44046I5T(11 /05 /COM/WEB