Permit ' ,,. : , CITY OF TIGARD ELECTRICAL PERMIT
'�; �: ` COMMUNITY DEVELOPMENT Permit #: ELC200900649
.
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/09/2009
Parcel: 2S103BA01002
Jurisdiction: Tigard
Site address: 12370 SW 121ST AVE
Subdivision: Lot: 0
Project: Anderson
Project Description: Replace 400 amp meter base.
Owner: FEES
ANDERSON, EDWARD Quantity Description Date Amount
PO BOX 23593
TIGARD, OR 97281 1 ea Services or Feeders - 201 to 12/09/2009 $133.56
400 amps
PHONE: 1 ea 12% State Surcharge - 12/09/2009 $16.03
Electrical
Contractor:
CHERRY CITY ELECTRIC
1596 22ND ST SE
SALEM, OR 97302
PHONE: 503 - 566 -5600
FAX: 503 - 540 -8147
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $149.59
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 OAR 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.
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Issued By: �_ �14 � �\ .i L , 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' 14— Date:
LICENSE NO.
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.
.. 12/09/2009 09:50 5035408 I CHERRY CITY ELECTRIC PAGE 01
Electrical Permit Application DEC 0 9. 2009 4 '' e } 414- Y ij 4Rii it l it f - y -s «
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6 . , : , City of Tigard / � v ),te �:, �`:� . Q I ?C g _
' " 13125 SW Hall Blvd, Tigard, OR 9722 r
Sr ITY OF TIGARD 1 I[r en :
� �}i. D I NG DIVI then henna
nit
r a Phone: 503- 639.41 ?1 Fax 5°3.59 I,MC H -
inspection Line: 503.639.4175
cute Kca4v P. 1 '' See Pa a far
`' �i'c• ;� No[ifiedR+ I�ap J Supplemental Information
Internet www.tlqard- ttt,gov 1
TYPE OF WORK ,-- rt.AN RLt%•IEW
Please check all that apply (submit b sets of plans w /items checked below)
❑ New construction El Additi011ha onfrepl t ❑ Service or t> eAer 440 amps or more ❑ Building over duet stories.
❑ Demolition ❑ Other where the available fault current Q Marinas and boatyards.
exceeds 10,000 amps at 150 volt or ❑ Floating buildings.
C'.�,TE(,(1__ OF CONSTRUCTION less to ground or exceeds 14,000 [] (.ornmrercial use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings
0 1 builder ❑ Other L3 File pump. El Installation of 75 KVA or
❑ Maki-family Ll ❑ Emergency system. I:usv- rsep.u,td ku- .ed s ceam
_ JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "F•' "1 " I -
10010 or sere. occupancy,
Job no.: S41031-025 Job site address: 12370 Ave p six or more residential units. ❑ Recreational vehicle parks.
❑ Health -taro facilities, ❑ Supply voltage for more than
City /State//"I, P: Tigard OR 97223 a llmardoua locations, 600 volts nominal.
❑ $exvice or feeder 6 W amps or more
Suite/bldg./apt no.: Project name: PGE -AML
F1EE 5CHEDir)LF
Cross street/directions to job site: u° r", =MOM
New residential !gingko- or mull -fQmQy dwelling writ.
Includes attacked Comte.
_ •
no.: 1
] Lot no.
Subdivision: - eck ft- or less 168.54 4
p MM.
add'{ 500 R. or on 33.92
Tax map/parael no.: Limited energy, residential 67.84 MIN
DESCRIPTION OP WORK with above • . ft.)
- Limited energy, multi-family 67.84 a
Replace 400 amp meter base residential t with sIxn m :At tt 1
-
Services or feeders Installation. alteration. and/or relocation
200 amps or less 1111 10. Ell
ID PROPERTY OWNER 1 0 TENANT 201 ads to 400 amps 111 133.56 133.56
401 amps to 600 amps 20.34
Name: 601 amps to 1,000 amps _ 301.04
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders i>mtallation, alteration, and/or
City/Stale/UP: relocation
Phone: ( ) Fax ( ) 200 atups or less 59.36 IN
owner installation: This installation i bring made on propel/\ that 1 ON VII �thiCil iS not 201 amps to400 amps 125.08 mon
intended for sale, lose. rent. or exchange. according to ( MS - 1-17.4 49. (,71). amt 7111. 401 amps to 599 amps IIIII 168.54 MIMQ
Branch Brent: - nen. alteration. or estenrtion _per panel
(,Miter sikllahlfe: Dale: A. Fee fix branch circuity: lent,
0 APPLICANT 1 0 CONTACT PER1SON above service Or feeder fcc, 7.42 2
each branch cim,it
Business mane: B. Fee for branch circuits ..
without service or feeder fee, 56.18 2
Contact name: first branch circuit
Address: Eachaddi blanch circuit 7,42 2
- --- Alirrcellinee ass (Nervier or feeder not included
Ci ty/ State /ZIP: F.acb manufactured or modular 67.84 - dwdlirtg service and/or feeder
Phone: ( ) Fax:: ( ) Reconnect only III 67.84 2
E • , v or irrigation circle 67.84 2
(3NTRACTOR Sign or outline lighting 67.84 2
Business name: Cherry City Electric Signal circuit(s) a or
ration limited-
rgy panel,
Address: 1 596 22"t St SE extension. Describe: Page 2 2
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itv /State /ZIP: Salem OR 973112
(• Eacb additional inspection over allovsablt in an` of the above
_- - w --- ° - Per inspection 66.25
pihile: (FIB) 566 -5600 Fax: t 5113 1 540-8147 Investigation per hour (1 nr min) 66.25
(. Lic.: 91668 Electrical ' - 37-620C Supra. Lie.: 3641PS Industrial plant per hour - 78.18
+ E. I.IZCTItIC'AI. PER1\iIT FEEti
Suprv. [electrician signature, rt q ��1.�
vat. A I` � . Subtotal: 133.56
_
Print name: Douglas Haycock Date: 1219/09 Plan review (25% of permit fee):
l State surcharge (12% of permit fcc): 16.03
Authorized signature: TOTAL PERMIT FEE: l41 .59
Print name: - Date: This permit appllcat1on expires if a permit Is not obtained within 188
days slier it has been accepted as complete_
• Number of inspections allowed per permit.
iMi „iidtnkhvemutlFr.e- Pennitnpp doe l ap U09 440-0615T111/00/COM/Wp,B