Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2009 -00633
Date Issued: 11/25/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S103DC00300
Jurisdiction: Tigard
Site address: 13625 SW 110TH AVE
Subdivision: FAIRHAVEN COURT Lot: 2
Project: Garrett
Project Description: Add (1) 200 amp or less service.
Owner: FEES
GARRETT, RULON AND FAY Quantity Description Date Amount
13625 SW 110TH AVE
TIGARD, OR 97223 1 ea Services or Feeders - 200 11/25/2009 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 11/25/2009 $12.08
Electrical
Contractor:
JARMER ELECTRIC INC
5105 SW 45TH AVE #200
PORTLAND, OR 97221
PHONE: 503 - 246 -5381
FAX: 503 -244 -8037
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 - 01100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: C k \ \X, 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' J Q ArP • Date:
LICENSE NO.
Call 503.839.4175 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.
LC- 7•0 o-o Co 33
• ,
• Electrical Permit Application you ()I II( 1: ■ c()N1,1
City of Tigard /0 Received
Date/By: Permit No.:
13125 SW Hall Blvd., Tiga . 4, lkt 1 \ i 'Vj
A Plan Review
Phone: 503.639.4171 Fax: I ! q!t : : . • 60 4 - : ;:. •.;,' 'it ii` DatrJBy: Other Permit:
•
Inspection Line: 503.639.41 .. . ..„...44. 'J_ Date Ready/By: 'uric Ea See Page 2 for
Internet: NuomeiTtigard:orus ‘ ,01 m Notified/Method: Supplemental Information
' '', ', 1 ; a ' .Q• "-: . • , PLA " R EVIE W
t41t
ID New construction { . ' 1 '.:1 teration/replacement Please check all that apply:
['Service over 225 amps, camel ['Hazardous location
0 Demolition '. M • ther:
['Service over 320 snips - rating 0Buildng over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION ., : :-.: .; :?:-'•::;:;-" '-'-:'.:1 of 1- and 2-family dwellings 4 or more new residential
ria 1 and 2 dwelling 0 Commercial/industrial 0 Accessory building °System over 600 volts nominal units in one structure
°Building over three stories °Feeders, 400 amps or more
0 Multi 0 Master builder 0 Other: ['Occupant load over 99 persons °Manufactured structures or
00:sstr.t7.0 iJ"1,90:40:047,;';:4 -:: t. :-::::.4 ['Egress/lighting plan RV park
Job no.: 9 I Job site address: Z36,03T SW /0
776A Ao Ok ql P23 th. ['Health-care facility °Other:
Submit 2 sets of plans with any of the above.
City/State/ZIP:
The above are not applicable to temporary construction service.
'. '''t:AftfS0114)00t4. ''',•3
Suite/bldg./apt. no.: I Project name: 6 frit .,....- & -A--
Deserlpdon I Qty. I Fee. I Total I "
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
-
1,000 sq. ft. or less 145.15 4
. _ _ . _
Subdivision: I Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
, limited energy, non-residential 75.00 2
40.F10144,100 ' :OP, WORK s ';': : ‘:1 --; ::!:j...: - .: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
A sat) ,r/�N ELECT/C / CAL.
Services or feeders Installation, alteration, and/or relocatior
200 amps or less / 80.30 yed1,:e 2
4 : 84:7:00 . 051 # 40 *VOS*0 1 .t s: : , $ ; 1: ;, :: : ::::c '.. ::; . :1,t0 1 *".kkrtalON 2°1 an438 t° 4°i) aniPs 106.85 /06i7o 2
401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Reconnect only 66.85 2
City/State/ZIP:
Temporary services Or feeders Installation, alteration, and/or
Phone: ( ) I Fax: ( ) relocation
200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 s to 400 snips 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
W01:00,0400.iff:I'Rc.Vr:W5V4:':.:::',C;f00.4740,;Iticki.Oki:itAA`ii A. Fee for branch circuits with
service or feeder fee, each
6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name:
without service or feeder fee,
4615 2
Add : each branch circuit
ress
Each add'l branch circuit 6.65 2
City/State/ZIP: Miscellaneous (service or feeder not Included)
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 53.40 2
Sign or outline lighting 53.40 2
E-mail:
Signal circuit(s) or limited-
.:•T.::', :::: :5.:,e;:fsCr.,;:':.--',:-4.:'....'..,::::::-.:.*,_'S,' energy panel, alteration, or
extension. Describe: Page 2 2
Business name: - "A-4 r. Ea- EEeiltir e_ i ik.)C—.•
7*
Address: 5 - / 0 r SW q C - ; Sre. zo 0 Each additional inspection over allowable In any of the above
Per inspection 62.50
1 City/State/ZIP: Po 7 - i. - 4 - "Li 4 0 ,e 49 7 2 2 / Investigation per hour (l hr min) 62.50
4 Phone: (SZ)3 ) 2_ ilb, - (5 fc / I Fax: (j2)3) 2-tiq- e03 7 Industrial pbmt per hciur 73.75
.CAL
CCB Lic.: 42 92 q I Electrical Lic.: 26- 1 q Suprv. Lic.: i-14 qq5
Subtotal
kerrigb
__
Suprv. Electrician signature, required. . .1,/4..c. 4--1--......_ Plan review (25% of permit fee) I •
. AS
State surcharge ($111hfpemit fee) Y Jr
Print name: jr77, 4 a r , de_ I ate: //' /q 0 5
TOTAL PERMIT FEE ft.rjrcre,T
Authorized signature:
This permit application expires if a permit is not obtained within 180
days Print name: Date: • Fee methodology 'l ee n : b Boars! 4
" Number of inspections per permit allowed.
tABuildingWennitABLC-PermitApp.doc 12/03 4404613TOCKWCOM/WEB 12'.4