Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00208
TIGARDI 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/30/2010
Parcel: 2S102DB02000
Jurisdiction: Tigard
Site address: 13255 SW BURNHAM CT
Subdivision: BURNHAM PARK Lot: 14
Project: Gardner
Project Description: (5) branch circuits for kitchen remodel
Owner: FEES
GARDNER, GLORIA A Quantity Description Date Amount
13255 SW BURNHAM CT
TIGARD, OR 97223 5 crt Branch Circuits 04/30/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/30/2010 $10.30
Electrical
Contractor:
BOONES FERRY ELECTRIC INC
PO BOX 628
WILSONVILLE, OR 97070
PHONE: 503 - 682 -4936
FAX: 503 - 682 -7946
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 S 503.246.6699 or 1 / .
Issued By: � �� Permittee Signature: 0A 7a / - -,G K7 �/6
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.
CaII 503.639.4176 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.
Apr, 28. 2010 1.08PM .,(EC 1 bi- No 3759 159 P. 1 4'4f
Electrical Permit Application i � ' ° ', `t I ; v
1 " 1. . , ., . ti (E t'.i5 II.Y. . s < ,.
�� t Received { � -- / 2d ► :. ,
y r City of n Date/13 . 3d / „Ai. Permit No eo2(7,0 ._ 0Il /
'f ,° 13125 SW Hall Blvd,, Tigard, OR 97223 �'APR`'2 U''.2O�O!'
! ) , , Phone: 503.639.4171 Fax: 503.598.1960 ' ' ' Date/By. Other Permit.
r � G Inspection Line: 503.639 tin( OF TI) ° • Date Ready/By: rods El See Page 2 for
iart is3i Internet: www.tigard ° 4 otifiedIMethod: , Supplemental Information
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C3 New construction ddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below);
['service or feeder 4.00 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: where the available fault current ❑ Marinas and boatyards.
1 ' " ` t r t 3 r g g 'r, Nn.F.' ' 1 .47 r t� 7 -.. r_ E I , 4 s'E . es coeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑Commercial -use agricultural
-R 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations buildings.
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 7 5 KVA or
VLTZ Lr �{ _ - ❑ Emergency system. larger separately derived system
a' L t `"itw c ..., J� vas: to 19 j '1 ;1 ivi r t f t
'i , s ac ....es;.. c . a.� .....: a } - ..` c. ra tr.:s w t i _ 7 s vli ❑ Addltio0 of new motor load of ❑ "A" ` se rate) . ` derived
Job no.:) 6 `1- ) v Job site address: f 3 25 S St.,/ t u rh ) out CA 100HP or more. occupancy,
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: ' ' kr d 0 ❑ Health -care facilities. ❑ Supply voltage for more than
/ ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: ( Project name: ' r ,., ❑Service or feeder 600 amps or mote, p �
. I♦ I,L S , 77 - .t !�4 ''xY Z 1_ ` y ) i , 1 r `" Tt $,; , 1 '' - a �,�' 5.
G ill leit~t. GN ,.i.: 1,.. i i it.' fi l ii f .::.J lYfSiL .4 ,'
Cross street/directions to job site: o44ceiptioa Oh. Fee. Total
New residential single- or multi- family dwelling unit.
Includes attached garage. _ _
Subdivision. ( Lot no.: 1 sq. R. or less 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential
""47th, " y - ; t i a ?�` �"' p n l �, a 3 gpf7' ; i,� a r . '5 with above ft. 67.84 2
r„ r m ,, , 7, :Tt. . - - y �. Vie ,, . 7�l11s _s.. i• "I:
Limited energy, multi - family 67.84 2
lc; 1, 1 en rt r,r\ 0 aR- 4 residential (with above sq. ft.)
Services or feeders jzstallatj0n, alteration, and/or relocation
200 amps or Tess 100.70 2
F a 'fl+i '1" R i T!l { L f f ^{ e n., r { " ,
� 533R, �^. ij?.15: a1i s r i to 3i i4 t 'ltl.1 ' r 3v6a - ,� , - 201 amps to 400 amps 133.56 2
,NN. s.]iLiY -Y� IJL3 iF Y.ii:41U.CiCS.t;i3..G �.1. -.� ;I:S�.. ...F116 �...Y -. �...II
Name:6 9 i6 �� / / Q 401 amps to 600 amps 100.34 2
Ul? / ` r/ 601 amps w 1,000 amps 301 04 2 -
idress: _S'l�- � Over 1,000 amps or volts 552.26 12
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
_ relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 4 0 1 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
'' r" g 3.t r L'" '7. :TS = above service or feeder fee,
r , ga cira . ' r9 .• . -- il ". ; ,- . r i 'e nl t h, k i 7.42 2
r..
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first I
56.18 2
Contact name: branch circuit
- - Each add'l branch circuit +). 7.42 29 , 6 P 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty : dwelling, service and/or feeder
Phone ( ) Fax' ( ) Reconnect only 67.84 2
Pump or irrigation circle 67. 2
E-mail: Sign or outline lighting 67.84 2
rr, c i u .f r r s 1? i d Sri }4 s. it',,'-
caitrr:e�. s;,ss tl. a,)1rg_.t,s],;c?��. ..,_i 4 , �ax ,r.r S ignal circuit(s) or limited-energy
Business name. Boones Ferry Electric panel, alteration, or extension. Page 2 ( 2
Each additional inspection over allowable in any of the abov
Address; P.O. Box 628 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Wilsonville OR 97070 Investigation (1 hr min) 66.25/ hr
_ Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 682 - 4936 Fax: (503) 682 - 7946 Inspections for which no fee is 90.00 / hr
s■ lfically listed Yi hr min
B Lic.: 88482 electrical Lic.: 3- 23C ✓Suprv. Lic.: !19 1 6 s*1 3 ' J F rrEjs, '' ,a„ ij ?
1 _
I - , uprv - Electrician signature, required : - {� Subtotal: S. 6 6
if plan review (25% of permit fee): ------ Print name: 5 / 4C..-pi. VVV Date: 4� � State surcharge (12% of permit fee): 10 ,, O
�aCC� TOTAL PERNIIT FEE: 76,1 4
/
Authorized signature: This permit application expires if a permit is not obtained within 18
Print name: Date: • days after it bas been accepted as complete. ✓ ✓✓
Number of inspections allowed per permit.
-
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