Permit _,,q CITY OF TIGARD ELECTRICAL PERMIT
71
y:.: '.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00664
T [G A RD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/16/2009
Parcel: 2S 102CD00500
Jurisdiction: Tigard
Site address: 9585 SW OMARA ST
Subdivision: Lot: 0
Project: Boydstun
Project Description: Replace 200 amp or less panel.
Owner: FEES
BOYDSTUN, DENNIS GREGORY & Quantity Description Date Amount
BOYDSTUN, SALLY BAUCUS, 9585 SW
O'MARA ST 1 ea Services or Feeders - 200 12/16/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 12/16/2009 $12.08
Electrical
Contractor:
CONDUIT ELECTRIC
19461 SW 89TH AVE
TUALATIN, OR 97062
PHONE: 503- 692 -1428
FAX: 503 - 692 -3652
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
/rff rules oor direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: J -.e S') (i A (\Q t�Q _ IJ ,L .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' Q Q } \pp • 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.
r'
Frog:CONDUIT ELECTRIC 5036923652 12116/2009 11:29 #952 P.001 /002
Electrical Permit Application
c g ,FOR OFFK F 1SF O\ Lld r
t j .- C of Tigard 1 :4 4 1- " J --
Da� ae ' Permit No.: d `' WAY ! ' I
13125 SW Hall Blvd., Tigard, 9
1 d OR 8 009
Plan Review r, i i , Phone: 503.639.4171 Fax: 503.5981 946E 1 6 2 Date /By: Other Permit,
.I A' R 'D. Inspection Line: 503.639.4175 Dare Ready /By: kris ®See Page 2 for
rams' Internet: www.tigard- or.gov nFT Notifi e d/Method: + t Supplemental Information • TYPE OF W 0. D t� C j D�v � s � PLAN REVIEW
171 New construction Addition /alteld on / replacement Please check all that apply (submit 2 sets of plans v./items checked below):
❑ Service or feeder 430 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
4 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of75KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency ne'., system larger separately derived system.
❑ Addition new on of motor load of ❑ "A' "E" "1 2" "L3 ",
, 10011E or more. occupancy.
Job no.: Job site address: Q
� �___�____ � �3� � w�' ` r.. �� I 0 Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: 0(0„4\ be- G`l ❑ Health-care facilities. ❑Supply voltage for more than
L � /� 11Q " — � _ _ _ o _ ❑Hazardous locations 600volsn�minal.
Suite/bldg. /apt. no.: U Project name: it'lay� i J ❑ Service or feeder 600 amps or more.
N C . FEE SCHEDULE
Cross street/directions to job site: - Ue,eription 1 Qrv. I Fa. i Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I.ot no.: 1,000 sq. fi. or less 168.54 J 4
Ea. add'l 500 sq. fi. or portion 33.92 1 1
Tax map /parcel no.: Limited energy, residential
gy '' 67.84 2 l
DESCRIPTION OF WORK (with above sq R.Z_
�r }\ I, \v(�, Limited energy, multi - family
n
1 19 , _ , residential (with above sq. ft) 67.84 2
I Services or feeders installation, alteration, andlor relocation I
200 amps or less I I 100.70 1 1(0 C 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps + 133.56
401 amps to 600 amps 200.34 2 1
Nance: 1 - -,
- - -- — — — — — 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts I I 552.26 j 2 i
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
_ i relocation _
Phone: ( ) _ I Fax: ( ) 200 amps or less 59.36 1 I
Owner installation: This installation is being made on property that i 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 j
Owner signature: —_ Date: _
A. Fee for branch circuits with 1
❑ APPLICANT ❑ CONTACT PERSON above service or fee fee, I 7A2 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee. 56.18 2
Contact name: _ first branch circuit _
Address Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included) i
City /State /ZIP: Each manufactured or modular ( ! i
J — dwelling, service and /or feeder 67.84 I 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle i 67. 2
CONTRACTOR Sign or outline lighting I 67.84 - 2
Business name: Signal circuit(s) or limited -
COZlduit Electric energy panel, alteration, or
Address: extension. Describe: Page 2 i 2
19461 SW 89th Ave
City/State/ZIP: Tua l a t i. n ,_ OR 97062 _ Each additional inspection over allowable in any of the above
°'1� -- � Per inspection 66.25
Phone: (503) 692-1428 j Fax: (5 0 3) 692-3652 Investigation per hour (1 hr mai) 66.25 I --
' CCB Lie.: 109669 _ 1 , Electrical Lie.: 26-905C Suprv_Lie.: 4501 S Industrial plant per hour I 78.18
ELECTRICAL PERMIT FEES
Suprv_F- lectrician signature, required: ' Subtotal: f ( 7Q
Plan review (25% permit fee):
Print name: ff ��J
Date: I � O( � ) State surcharge (12% of permit fee): � a,
-. _ -- }
Charles Parker 4
Authorized signature: I1 t I TOTAL PERMIT FEE: I I
This permit application expires if a permit is not obtained within 180
Print name: Dale: days after it has been accepted as complete.
' Number of inspections allowed per permit.
1.touildai 'fermiu t-/.C-t'errnnApp dor 10 0109 4a0 -40t/ O i l'05'CO\1 w'EH
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