Permit ELECTRICAL PERMIT
CITY OF TIGARD
` s ' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00164
Date Issued: 04/13/2010
TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S111CC15300
Jurisdiction: Tigard
Site address: 10065 SW HIGHLAND DR
Subdivision: SUMMERFIELD NO. 4 Lot: 204
Project: Gottlieb
Project Description: Kitchen remodel - install seven new circuits
Owner: FEES
HENRY, MARSHAL & PAULA Quantity Description Date Amount
10065 SW HIGHLAND DR 7 crt Branch Circuits 04/13/2010 $100.70
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 584 - 747 -8321 Feeder
1 ea 12% State Surcharge - 04/13/2010 $12.08
Electrical
Contractor:
ALL AMERICAN ELECTRICAL CONTRACTORS
PO BOX 1426
GRESHAM, OR 97030
PHONE: 503 - 657 -4351
FAX: 503 - 491 -4473
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 By: .4 , - . Permittee Signature: .4/17 /}`'/ L / C4-77 0" �'
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.
Call 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.
►'' ' CEIVED
Electrical Permit Application ,,. # , d y °, a `< `�� �r
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�' r C� of Tigard Received
+ DnteBY: permit No.;
G
q 13125 SW Hall Blvd., Tigard, OR 9722cITY OF TIGARD men Review
Phone: 503.639.4171 Fax: 503.598 ggg9LDING DIVISIO butu/BY: Other harmiC
a� i`'�'" .. I Inspection Line: 503.639.4175 Date Roady/By: III / I ® Se Pees 2 for ' "
f;Ss134i5; Internet: www.tigurd•or.gov Notified/Method: Supplemental Information
TYPE OF WORIC .. AN R EV I EI V '
0 New construction Addition /alteration /replacement — Please cheek all that apply (submit 1 seta of plane w /itoma checked below):
❑ Service or feeder 400 amps Cr mom 1 ❑1 Building over three stories,
0 Demolition ❑ Other: where the available fault currant l0 Mertnas and boatyards.
. • . CATEGORY OF CONSTRUCTION exceeds 10,000 nmpx at 150 voila or L.7 Floating buildings.
• lees to ground. or exceeds 14,000 ❑ Common:i,,I -use ngrioulluml
0 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all otter installations. buildings.
D Multi- family ❑ Master builder ❑ ether: ❑ Fire pump, ❑ Installation of 75 KVA or
El Emergency system, larger separately derived system
JOB SITE INFORMATION AND LOCATION
r-- -- ❑ Addition of new motor load ut'
Job no.: Job site address: /006s s L) g; 4 N I IooIIP or more. occupancy.
❑Si' m more residential unite. Q Recreational vehicle parka.
City/State/ZIP: alb 9 ty /State/ZIP: 6 p ✓ ❑ Health-care facilities. ❑ Supply voltage for moro than
23 ❑ Hazardous locations, 600 volts nominal,
Suite /bldg. /apt no.: Project name: ❑ Service or feeder 600 amps or morn.
... .,____ _ FEE SCHEDULE
Cross street/directions to job site: Le erotica _ _ 1 Qry T 'tota I •
New residential single- or multi-family dwelling unit.
_____ Includes attached garage.
Subdivision: 7 Lot nu.: 1.000 sq. R, or lase 168,54 4
--- Ea. odd', .500 so. It. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DE$CRiPTION OF WORK (with above sq. 0.) 67.x4 2
7'
1 �p Limited energy, multi - family
K•c.G.tyt nekkmtkt — it p . 4l4 r £eo -VI e ) residential (with above sq. It.) 67.84 2
`+^ Services or feeders installation, alteration, and/or relocation
O e‘ : - X 200 amps or Icsa 100,70 2
ROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 1 2
(r �7Z -S L L �Q 401 amps to 600 amps 20034 _____ 2
Name:
- '! Z l��ti 601 amps to 1.000 umpa 301.04 2
Address: .5/9 Over 1,000 amps or volts 552.26 2
'temporary eervicca or feeders installation, alteration, and /or
City /State /ZIP
relocation
Phone: (SB'/ .0 9 -c 3 A / Fax: ( ) 200 amps or less 59.36 - 1
201 amps to 400 amps 125,08 2
Owner installation: This Installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits •- new, alteration, or extension, per panel
Owner signature: _ Date: A. Fcc for branch circuits with
• C] APPLICANT J. ❑ CONTACT. PERSON above service or feeder fee. 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
- service or feeder fee, first /
Contact name: branch circuit
I 56't8 SG 2
Each udd'l brunch circuit b 7,42 vYS 2 2
Address: Miscellaneous (service or feeder nut included)
City/State/ZIP: Each manuihctured or modular 67,84 2
_ _ .. __ dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
- w-- Pump or irrigation circle 67.84 2
E-mail: ----- - - ----
Sign or outline lighting 67.84 2
CONTRACTOR - Signal circull(s) or limited energy
panel, alteration, or extension. Page 2
Business name: 2
V' t G �- �' ���' COr1��4 Each additional inspection over allowable in any of the above
Address: ?, B 61C / Y2-6. Additionol inspection (1 hr min) 66.25/ hr
City /Slate /ZIP: G r .ts Gi R &VI r 0 . ell 030
Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78,18/ hr
Phone: (561 ) 6,57- y 3 S t Fax. (rb3) 9/- yens v` Inspections for which no fee is 90.00/ hr
specifically listed (55 hr min)
/CCB Lie.: /$21/0 9 Electrical Lie,: 2 ( -ippi Suprv. Lie.: V) 3 /- ELECTRICAL PERMIT; FEES
Suprv. T lectrician signature, required: Subtotal: /00 .7 O
Plan review (25% of permit fee): 9+ •
Print name: VYa - j � �(1 Date: q / /. //p State surcharge (12% of permit fee): 1 2• .0 g
` TOTAL PERMIT FEE: 1 '7
Authorized signature: i / /
` . - This permit application expires' If A permit Is not obtoined within 180
Print name: �/.Q 4-' r Date: �/ �� M day, After It No been accepted AS complete.
r c - ` 7 ` �O 4 Number of inspections allowed per permit.
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