Permit CITY OF TIGARD ELECTRICAL PERMIT
As
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00667
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/18/2009
:TIGARD Parcel: 1 S 135DA00200
Jurisdiction: Tigard
Site address: 11120 SW HALL BLVD
Subdivision: Lot: 0
Project: Peck
Project Description: Replace (1) 200 amp service
Owner: FEES
PECK, CHRIS Quantity Description Date Amount
11120 SW HALL BLVD
TIGARD, OR 97223 1 ea Services or Feeders - 200 12/18/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 12/18/2009 $12.08
Electrical
Contractor:
WILLIES MORE POWER SIGN & ELECTRIC
INC.
1650 HILLILA RD
PHONE: 503 - 738 -5645
FAX: 503 - 717 -4398
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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.
Issued By: ��_ AKA_ Permittee Signature: 4/✓ ,/l�L / ('17
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 503.639.4175 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.
CE�ED
Electrical Permit A lication m< ' 'j N � }
P P fi t 1: 1. Al F .. l axwit+. � t � L I S L }' ' 2 y µ 0• � a . •
ri-7. D EC 1 8 2009 Received
iL q!-� City of Tigard D C!B : f" /tt t '' rmitNo: C� '- 0
rF a 13125 SW Hall Blvd., Tigard, OR 97223 Plan Re 2•_ / I. ' ' OF TIGARD Date/Ely: Other Permit:
ir - Phone: 503.639.417 Fax: 503.598. t
kTfG R Inspection 503.639.4175 BUILDING DIVISION DatcReady/By: to ^ -' 0 See Page 2for
sa:ts is4 Internet: www.tigard or.gov Notified /Method: `� Supplemental Informatio
TYPE OF WORK • PLAN REVIEW
❑ Ncw construction I I Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: 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
0-1- and 2- family dwelling ❑ Commercial/industrial El Accessory building amps for all other installations. buildings.
❑. Multi - family 0 Master builder ❑ Other, ❑ fire pump. ❑ installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition or new motor load of ❑ "A ", "F ". "I -2 "I -3 ",
/' L � f , r f j �� Six o oo more. occupancy.
Job no.: Job site address: ) rn ( ❑ Recreational vehicle arks.
Q Six or more residuttial units. P
City %State/Z.IP: /y d a q 7? 9-3 ❑ Health-care facilities
0 Supply voltage for more than
J� ❑Hazardous locations 600 volts nominal.
S uite/bldg. /apt no.: L Project name: �,`�,r t 5 Ple, ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: oesttiptioe i Qa. I Fee I Total J •
New residential single- or multi-family dwelling unit_
Includes attached garage.
Subdivision: Lot no.:
1,000 sq. R or less 168 - 54 4
Tax map /parcel no.:
DESCRIPTION OF WORK Ea. add'I 500 sq. ft. or portion 33.92 1
atigge eld tad pond ,
Limited energy, residential 67.84 2
(with above sq. ft.) 1
❑ PROPERTY OWNER I ❑TENANT Limited energy, multi -family
67.84 2
Name: 0/X./ S / E-L' . residential ( with a bove sq. ft.)
Address: , 6 - Services or feeders installation, alteration, and/or relocation
City /State/ZIP: 200 amps or less 1 100.70 in.70 2
Phone: ( ) Fax: ( )
Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps 133.56 2
• intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Owner signature: Date: 401 amps to 600 amps , 200.34 2
❑ APPLICANT 1 ❑ CONTACT PERSON
Business name: r 601 amps to 1,000 amps 301.04 2
1.
Contact name:
Over 1,000 amps or volts 552.26 2
Address: 1
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: relocation _
Phone: ( ) Fax:: ( ) 200 amps or less 59.36 1
E -mail: —
CONTRACTOR
/ _� 201 amps to 400 amps 125.08 2
Business name: 4 I e
5 ti P - 5/ s�A < —
t, S�
Address: 14aLi tA �D� ►`� 2'
/ !" �' 401 amps to 599 amps 168.54
City /StateJZlP: 6tea I/ Itai t a l Branch eircaits -new, alteration, or extension, per panel
Phone: ( 563 ) '132 - 4 5 fax: ( 5—b3 ) `21 7 - 4 3 1 p ? A. Fee for branch circuits with
above service or feeder fee, 7 42 2
CCB Lic_: 53 EEe cvical Lic.:� / , S u prv. Lic.: 1 4 bap_ each branch circuit
i V /� B Fee for branch circuits
it
Suprv. Elec ure, requit h`��L(�Y' 4 9 ) 4i244 + f top without service or feeder fee 56.18 2
q first branch circuit
Print name: 1 t i Ilia 44 [ , 1t0 Date: 1; j - 1 tea
Each adds branch circuit 7.42 2
Authorized signature:
Miscellaneous (service or feeder not included)
Print name: Date: ,
e.1
Z'd 86£b IL out ouloeld JeMOd 8.10N B617:20 60 91 oea
Each manufactured or modular
dwelling, service and /or feeder
67.84
rl 1
Reconnect only
67.84
2
Pump or irrigation circle
67.84
2
Sign or outline lighting
67.84
2
Signal circuil(s) or limited -
energy panel, alteration, or
extension. L�)e+cribe:
Page 2
2
Each additional inspection over allowable in and of the above
Per inspection
66.25
Investigation per hour (1 hr ruin)
66.25
Industrial plant per hour
78.18
ELECTRICAL PERMIT FEES
Subtotal:
/ £O, 70
Plan review (25% of permit fee):
State surcharge (129 %o of permit fee):
TOTAL PERMIT FEE:
' . !
•
This permit application expires if a permit is not obtained within 180 days af ter it has been accepted as
Number of inspecticns allowed per permit.
£
complete.
86£17
Clc,F ot)9-ci.60
. out o!Pee .I9MOd eaOV
e617:80 60 8L oea