Permit i. "�'P ELECTRICAL PERMIT
Il
"..Z :Le'' CITY OF TIGARD
[1,,, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00159
Date Issued: 04/08/2010
T I G ;..,,,,...4 D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S101AB01602
Jurisdiction: Tigard
Site address: 7310 SW HERMOSO WAY
Subdivision: Lot: 0
Project: Gibson
Project Description: Install (3) branch circuits.
Owner: FEES
GIBSON FAMILY REVOCABLE TRUST Quantity Description Date Amount
BY GIBSON, CORNELIA/KLAUS PETER TRS,
10904 SW PARKWOOD CT 3 crt Branch Circuits 04 /08/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/08/2010 $8.52
Electrical
Contractor:
WINNER ELECTRIC INC
5950 SW PROSPERITY PK
TUALATIN, OR 97062
PHONE: 503 - 638 -5028
FAX: 503 - 638 -4242
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is ued subje —1• the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i accordance with app • ed • - . This permit will expire if work is not started within 180 days • - • - ce, or if work is suspended for more the 180
days. TENTION: Oregon law - • uires o to follow the rules adopted by the Oregon Utilit ...... - ter. Those rules are set forth in OAR
952 -00 - 0010th •ugh OAR 952 -• % -01.0.
Y. obtain a copy of th rules or direct questions to • • , C by calling 503.2 •. • . •9 o 800.332.2344.
Issu d By: � A_ io_di.i.G.. Permittee • -ture: / ! 0 _ a_, e i1i V'lld"..--
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 INST ONLY
SIGNATURE OF SUPR. ELEC' Date: 04)
I
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.
C \cA s
Electrical Permit Applicatio® '`' , 1: } '�' ' ,-',, Y 1 ()R 0! l 10.1:' G) \I ...4.1 Q P�Q � "� h ' 9 I ' •
r"` " _` C of Tigard �� Ca' 1 $ / i 0 Permit No.: Et,.caalt9 — �'t 5,
y a 1 13125 SW Hall Blvd., Tigard, OR 97223 , �'] CJ Plan Review
` : ' ' Phone: 503.639.4171 Fax 503.598.1960 !, . Date/By: Otter Permit
t ;� 0 Inspection Line: 503.639.4175 1 4 4 Date Ready/By: rte: ® See Page 2 for
Internet: ww.tigard- or.gov -Z
•� £' t 1 ds 3 Eed/Method Supplemental Information
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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.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
�
cP 1- and 2- family dwelling ❑ Commercial/ ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 icon or
JOB SITE . INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 7 3 / to S tA$ ileil.n) So L34 100HP or more. occupancy.
/ ❑ Six or more residential units. ❑ Recreational vehicle parks.
Ci ty / State/ZIP: 7 `F)a 06 — 9 7 1)3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: G ,_cu.) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
J l l
Cross street/directions to job site: / F /� , �� 3 L.J 7Z,- Description l Q. 1 Pee. l Total 1"
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. 11. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
DESCRIPTION OF WORK _ (with above sq. ft.) 67.84 2
^ e Zil' r Limited energy, multi- family 67.84 2
2—A45 - 14. 11 4 & &I A tr 4A- Oleej J ..J 6 i residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
A / z() v ; p t.. 2C.✓T` 7 7A 61112pe.. j /! �,,,„ / 44 C
,1I 4 / .20 - ZLvr f 200 amps or less 100.70 2
❑ PROPERTY OWNER 7 all- ❑ 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 59.36 1
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
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits CC
Contact name: without service or feeder fee, 56.18 O ( I O 2
fast branch circuit
Address: Each add'l branch circuit a, 7.42 i ii, 6 y 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
Business name: ; A e-4-- i_J ,. /. /� Signal circuit(s) alteration, or or limited-
(,(} , �c n � 11 energy Panel, alter
Address: 5 9 So S (A) p2as pelt) p)l(K g extension. Describe: Paget 2
City/ State/ZIP: uB LAf'3✓ cy_ q 7d ` L Each additional inspection over allowable in an of the above
0 2 Fax ( &v3) p y) NJ Per inspection ion 66.25
Phone: (663)
6 3� S 8 � O Investigation per hour (1 hr min) 66.25
CCB Lic.: I y 7 94/ I Electrical Lic.: 3c[ f5( c _ Suprv. Lic.: X 5• Industrial plant per hour 78.18
ELECTRICAL PERMIT. FEES
L
Suprv. Electrician signature, required: (A Subtotal: '7/ 0
�` Date:
Print name: b Plan review (25% of permit fee):
� L (_ l2 �' State surcharge (12% of permit fee): 662
Authorized signature: TOTAL PERMIT FEE: This e ��7r Y
Print name: Date:
This permit application expires if a permit is not obta within 180
days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: tiBuildiagTermits \ELC- PermitApp.doc 10/01/09 440- 4615T(11/05 /COM/WEB