Permit ipi ' q CITY OF TIGARD ELECTRICAL PERMIT
- a COMMUNITY DEVELOPMENT Permit #: ELC2009 -00668
.TI'GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 12/18/2009
Parcel: 1S133DD14800
Jurisdiction: Tigard
Site address: 11787 SW 128TH AVE
Subdivision: VILLAGE AT SUMMER LAKE PARK 4 Lot: 185
Project: Tell
Project Description: Add /alter (3) branch circuits for furnace, a/c and gfi.
Owner: FEES
TEEL, DAVID W & MARY C Quantity Description Date Amount
11787 SW 128TH AVE
TIGARD, OR 97223 3 crt Branch Circuits 12/18/2009 $71.02
wo /Purchase Service or
PHONE: 503 - 997 -7028 Feeder
1 ea 12% State Surcharge - 12/18/2009 $8.52
Electrical
Contractor:
SUNSET HEATING & COOLING
0607 SW IDAHO ST
PORTLAND, OR 97239
PHONE: 503 - 234 -0611
FAX: 503- 234 -0439
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 rules are set forth in OAR
952- 001 -0010 through 0 R 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
I /j \
Issued By: -(Y\ C� 1 � \ 1( C-KX n nN Permittee Signature:
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' Q _ /) Date:
LICENSE NO. \` 1
Call 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.
. Pk .
Electrical Permit Application RECEIV FOR OFFICE USE OlNL%
City of Tigard Receiv '' I
b DateB •,.
Other No.' ( poi'/
M 13125 SW Hall Blvd., Tigard OR 97223 DEC 18 I (Clan c;l U/Q
a n Review
l 2 Oth er P erm it :
Phone' 503.639.4171 Fax: 503.598.1960 IDateBy:
Inspection Line: 503.639.4175 11 Ic Rcadyl0y: lurk: ///+++ 0 See Page 2 for
Tic. ARD Internet www tigard of gov CITY OFTIGA'° :lied /Rletho � 4 Supplemental lnforination
. -- � ".� , ./. r . = r `i hF• I �QR�. rr ('�A�rI . is _ .. ��
Please check all that apply (submit 2 sets of plans wlttems checked below)
❑ New construction E Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: • where the available fault current ❑ Marinas and boatyards
' . .---:•-•''' : CATEGORY OF CONSTRUCTION or � f use ulmral
,.; excee 1 0 00 amps at 150 vo o ❑ Floating buildings.
Tess to ground. or exceeds 14,000 ❑ Commercial-use agric
1 1 1 - and 2 family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings
El Multi - family ❑ Master builder 11 Other: ❑ Fire pump. ❑ Installation of 75 KVA or • , motor load of
. , Emergency system. larger separately derived system.
. ,10B SITE',INFOR14 'AND LOCATION'.:
- ; Q Addition of near ❑ "A "E" "I -2" "I -3"
Job no. 7 Job site address: y Cj,'i t l Six or oo a r ❑ occupancy. parks
( ��. L" 'x ❑ Six or more residential units. Recreational vehicle arks
City /State /ZIP: '" \�1t C . t• �7:).: ❑Health -care facilities. ❑ Supply voltage for more than
J
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: T ' ❑ Service or feeder 600 amps or more.
:: ": ..;. FEE: SUU DULE : - . .,
Cross street /directions to job site: Description 10ts"_ [ Fee. t Total i •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. R. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: ___ Limited energy. residential
75.00 1
. ' - _; DESCRIPTION O1 : WORK.: . .. , _ (with above sq. ft.)
Limited energy. multi - family I 75.00 2
5 Gli L�u . t-c -('v( • ^ LC e... (C. f`, residential (sNidt above sq R.) 1
Services or feeders installation. alteration. and /or relocation
200 amps or less 80.30 2
. • PROPERTY OWNER '. ,._:' ❑` • 201 amps to 400 amps 106.85 2
Name: 4 't1{L ,� 1 Z.Lt 401 amps to 600 amps ! 160.60 2
601 amps to LOOU amps 240.60 2
Address: ` \ -1 <51 S'VJ t2 cs Over 1,000 amps or volts 454.65 1 2
City /State /ZIP: _ e ; 3 l ).,3 ti- T services or feeders installation, alteration, and /or
I � relocation
Phone: ( ) {Ci1 - 1(;2 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 l0 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
Branch circuits- new, alteration, or extension, ter panel
Owner signature: Date: A. Fee for branch circuits with
. . ' ' ' . . • 0 APTLICANT , :El CONTAC . above service or feeder fee,
6.65 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name:
without service or feeder fee, 1
first branch circuit 1 46'80 2
ytr '
Address: Each add'I branch circuit _ 6.65 1 3 .3.E 2
1liscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 90.90 2
dwelling. service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 I 2
_., • CONTRACTOR - - '''• - Sign or outline lighting 53.40 2
Signal c a nel ,( al or limited - •
Business name: Sunset Heating and Cooling
energy panel, alteration. or
Address: 0607 SW Idaho Street extension. Describe: Page 2 2
City /State /ZIP: Portland, OR 97239 Each additional inspection over allowable in any of the above
Per inspection i 62.50 i
Phone: (503) 234 - 0611 Fax: (503) 234 - 0439 investigation per hour (I hi min) 62.50
CCB Lic.: 161085 Electrical Lic.: Cl 17 I Suprv. Lie.: 4638S Industrial plant per hour 73.75
1
f - -- -- ' . ELECTRICAL,,-FERMTT FEES . :'
Suprv. Electrician signature. required: .. / C — Subtotal: , C. 1 S
! � - - . - - - -- - -- Plan review (25% of permit ter)
Print name: Randy Ess Date:
t - State surcharge (12% of permit fee): - - 1 , 4,
Authorized signature: - . .- TOTAL PERMIT FEE: =71' - •
* - • Th is per application expires if a permit is not obtained within 180
Print name: Shauna D'Am rosia — 'Date: 0 - 1 f i � � days -after it Ras been accepted a 7
5 Complete. c
111 • Number of inspections allowed per nennit f T
1 '.Buildingtrermiu\ELC-rcrmitApp doe 05/23/06 ' •
440.4615TT11 /05 /C.OM[WED
a•d 6E1?0 t,EZ —EDS 2 ut4eaH gesunS eLOrII 60 BI O fJ