Permit .
. CITY OF TIGARD ELECTRICAL PERMIT
:- — ' .. a '; COMMUNITY DEVELOPMENT Permit #: ELC2009-00678
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/30/2009
Parcel: 1 S135AD01100
Jurisdiction: Tigard
Site address: 8807 SW SPRUCE ST
Subdivision: Lot: 0
Project: Moon
Project Description: Temporary 200 amp or less service.
Owner: FEES
MOON, BRETT A & SHERRIE A Quantity Description Date Amount
8807 SW SPRUCE
TIGARD, OR 97223 1 ea Temp Services or Feeders - 12/30/2009 $59.36
200 amps or less
PHONE: 1 ea 12% State Surcharge - 12/30/2009 $7.12
Electrical
Contractor:
VAST ELECTRIC
1525 SEATTLE SLEW DR. SE
SALEM, OR 97301
PHONE: 503 - 566 -7274
FAX: 503- 585 -8828
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $66.48
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 t rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: . hO 95
C ` C ` v (� `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' ATU Date:
`e / ` ,,c _ CONTRACTOR INSTALLATION ONLY
SI .ATURE OF SUPR. EL 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.
Electrical Permit Application ) O r l I C 1 l i ti I ONLY
i = r • D aceiv y d I
C of Tigard 4 Date/By: , .) Permit No.: €1 7 g
j . ° 13125 SW Hall Blvd., Tigard, OR 97223 `a 1 Plan Review
I C Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
T I G A R D , Inspection Line: 503.639.4175 Date Ready/By: t ® See Page 2 for
Internet: www.tigard - or.gov Notified/Method: fr� Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® 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.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVAor
JOB SITE INFORMATION AND LOCATION • ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I 2 ", "1 - ",
100HP or more. occupancy.
Job no.: Job site address: 8807 SW Spruce Street •
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgiapt. no.: Project name: ❑ Service or feeder 600 amps or more.
• FEE SCHEDULE
Cross street/directions to job site: Description 1 otr. 1 Fee. 1 Tow 1 •
New residential single- or multi- family dwelling unit.
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 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. 0.) 67.84 2
Pole Limited energy, multi - family
Temp residential (with above sq. ft.) 67.84 2
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: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 1 59.36 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 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 — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
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 /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited- '
Business name: Vast Electric, Inc. energy panel, alteration, or
Address: 1525 Seattle Slew Dr SE extension. Describe: Page 2 2
City/State /ZIP: Salem, OR 97317 Each additional inspection over allowable in any of the above
Phone: (503) 780-8597 Fax: (1503) 585-8828 Per inspection 66.25
Investigation per hour (1 hr min) 66.25
CCB Lic.: 175531 Electrical Lic.: C -280 Suprv. Lic.: 5186S Industrial plant per hour 78.18
• ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 59.36
Print name: Tim Vand St Date: 12/30/09
Plan review (25% of permit fee):
er
State surcharge (12% of permit fee): 7.12
Authorized signatur TOTAL PERMIT FEE: 66.48
c This permit application expires if a permit is not obtained within 180
Print name: I Date: