Permit . CITY OF TIGARD ELECTRICAL PERMIT
t COMMUNITY DEVELOPMENT Permit #: ELC2010 -00139
Date Issued: 03/26/2010
TIGARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1S136C605800
Jurisdiction: Tigard
Site address: 11140 SW 83RD AVE
Subdivision: STEVE + HUGHIE'S PLACE Lot: 30
Project: Stillwell
Project Description: Replace 200 amp panel
Owner: • FEES
STILLWELL, JEAN Quantity Description Date Amount
11140 SW 83RD AVE 1 ea Services or Feeders - 200 03/26/2010 $100.70
TIGARD, OR 97223 amps or less
PHONE: 1 ea 12% State Surcharge - 03/26/2010 $12.08
Electrical
Contractor:
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
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 B /(91341r-k-rj"°"---- ./\/' f Permittee Signature: D /9P/G L
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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 603.639.4175 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.
Mar 25 2010 4:55PM West Side Electric 503- 736 -0656 p.1
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Electrical Permit Apalication '- r•( )l; ()m( 1: I ,l 1/\1.1
MAR 2 4 2011 Re�i,ed = ��Zoi6 _00 /.3
City of Tigard 5 DatelB : Review ' ...1 026 / �.v� Perm,t 1so.:
11114 .. 131 25 SW Hall Blvd., Tigard, OR 97223 ?Ian
Phone: 503.639.4171 Fax: 503.598.1960 '' ' • r .Clate/B . Other Pennit:
i ,, ,., Inspection Line: 503.639.4175 . , . •t, 'DSfe Ready13y. fill= 21 See Page 2 for
Internet: www.tigard or.gov Notifed:Method: Supplemental !afortnation
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sr r Ci , •I }• e `51 � ,z �; .:. _ ., r::'. , t ., .,:,n.. .. 0 1r 1 '' K 4,0A 7" x;,E.4•;
❑ New construction Addition/alteration/replacement Please check all that apply (submit 1 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.
A {.'
,! t t , e . ,' ,u p . K exceeds 10.000 amps at 150 volts or ❑Floating buildings
tf�71 • - _.` 5 ,. .._i.� .a},[ ,. ;. t*fi..,. r. ,,. Tess to ground, or exceeds 14,000 ❑ Cammemia1 - use agricultural
K and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi family ❑ Master builder ❑ Other: CI Fire pump. ❑ Installation of 75 KVA or
7; :.:..9:;„: ;: -.5:. , .. ❑ Emergency system. larger separately d.erivtd system.
d „ t 's x`* tt . } , ' S! 'a «i lI :.;• r, ❑ Addition of new motor load of ❑ A E l_2 t -3" •
��7y 7 � �y /�/f Six 100HP more rest creation.
Job no.: Jo b site address: /// So i - / ❑ Sax or more residential unit9. ❑ R ecreational vehicle parks
City /State /ZIP: ! !9 ` ,,,( l 02 9 722 3 ❑ Health -care facdimes ❑ Supply voltage fbr more than
❑ Hazardous locations 600 volts nominal
SuiteJbldg.Iapt. no.: Project name: .S' f /, // ill e// tl (, f ❑ SeMCe or feeder 600 amps or more.
/ , , _c ,i tl,rel F 9 , 1 ' y ,�} x .. .ilu, •E 'r<,
Cross street/directions to job site: Description 1 . oty Fee. 1 Total 1 •
New residential single- or multi- family dwelling unit
includes attached garage.
Lot no.: 1,000 sq. ft. or Tess 168.54 4
Subdivision: Ea. add'! 500 sq ft. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
u a i 7-4711;..::,, i. '' a ' r - i „ , „c (with above sq. 11.) 67.84 2 •
r Limited energy, multi - family
P a / ( /Q `t residential (with above sq. ft.) 67.84 2
Services or feeders installation alteration, and/or relocation
200 amps or less / 100.70 /poll": 2
1 8,10g41 vii, ... I i, t :i'... r i ¢ � , ; ; ,r. k 4 . 201 amps to 400 amps 133.56 2
�ELt �C„ Y/-/_ v / 401 amps to 600 amps 200.34 2
Name: S �-77L_ L J 601 amps to 1,000 amps 301.04 2
Address: -F0!-L/ C 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 1 own which is not 201 amps to 400 amps 1x5.08 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
git z.. Jr` � t i - 7 , ii t ! s yr °
.N� i'x a , ... .x'3 ?�4R1l``: above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, 56.78 2
Contact name: first branch circuit _
Each add'l branch circuit 7.42 2
Address: -
Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax. - ( ) Reconnect only 67.84 2
- E Pump or irrigation circle 67.84 2
•;i.,:x ^�" : 7 :i. _ .i, ?' .5�"�. ,.1 t 1:.'.4 '...,. t4>1 +` �.....r:., . :r e.... }, t r' Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: West Side Electric energy panel, alteration, or
Address: 1834 SE 8 Ave. extension. Describe: Page 2 2
City /State/ZIP: Portland, OR 97214 Each additional inspection over allowable in an attic above
_ Per inspection 66.25
Phone: (503) 231 -1548 Fax: (503) 736 Investigation per hour (1 hr min) 66.25 •
CCB Lic.: 13306 j/ Electrical Lic.: 26 - 135C Suprv. Lic.: 4654S Industrial plain per hour 78.18
, „' ;, �t:a E'i!L't� . 1,1i. 7 8 .18 7M i L ...(.... ��
tU � Suprv. Electrician signature, required: Subtotal:
3/2,5176 Plan review (25% of permit fee):
Print name: Randall f Roberts /1
Date: State surcharge ( (25%
of permi fee): 6 :-:- r-
Authorized signature: TOTAL PERMIT FEE: // Z
•
This permit application expires if a permit Is not obtained within 180
Print name: Date. days after it has been accepted as complete.
• Number of inspections allowed per permit. 112.11
1•\ awtdies� Penniis■ELC- PermitApp.doc :0,01/09 440- 46151(1 1.'OS/COM/WEB