Permit CITY OF TIGARD ELECTRICAL PERMIT
' a COMMUNITY DEVELOPMENT Permit #: ELC2009-00654
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 12/10/2009
.1 OARL? g Parcel: 2S103BB13200
Jurisdiction: Tigard
Site address: 12270 SW ANN CT
Subdivision: LAKE TERRACE NO. 2 Lot: 25
Project: Chandler
Project Description: Add /alter (2) branch circuits for furnace and a /c.
Owner: FEES
CHANDLER, CHERRYL Quantity Description Date Amount
12270 SW ANN CT
TIGARD, '.Jr 97223 2 crt Branch Circuits 12/10/2009 $63.60
wo /Purchase Service or
PHONE: 503 - 590 -5922 Feeder
1 ea 12% State Surcharge - 12/10/2009 $7.63
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 -266 -1349
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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: c1:5 ✓u 1 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' ,CY n ^ p Date:
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.
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Electrical Permit Applicatio it
_. 1 ;.lOI or ncl.Iu 11 0 1 i•Vz- -
,- ` City of Tigard DEC 10 2009 Received
" ° 13 125 SW Hall Blvd., Ti OR 97 223 Date/B Permit No.: AV ,/`• • ilk !�
41.1 _ i : . t Phone: 503.639.4171 Fax: 503.598. Plan Review Other Permit: 7()R�q n� �(L
? ' t " Inspection Line: 503 -639.4 t 75 MIN OF TIG D a t e/By: `' -r `t JU 1
T lG i1 R'D' Date Ready/By: 10 el Sec Page 2 for
£+ �° Internet: wtvw.tigard or.gov BUILDING DIVISION Not 111 Supplemental Information
TYPE OF WORK
PLAN REVIEW
New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
El Demolition r--r ❑ Service or feeder 409 amps or more 0 Building over three stories.
t _t Other: • where the available fault current ❑ Marinas and boatyards.
•
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 oohs or ❑ Floating buildings.
AL less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived syster
CI Addition of new meter lead of ❑ "A ", "E "I- 2 ","1 -3 ",
Job no.: lob site address: ' 7_1 7i ' } O0HPormore. occupancy.
/ r W\ii _ Cr �� ❑S ix or more residential tmtts- ❑ Recreational vehicle parks.
City/State/ZIP: "r'i 1' i ❑ Health -cart facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 tolls nom inal.
Suite/bldg. /apt. no.: Project name: ❑ Sc vivo or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qtr. 1 Fr<. 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 14
Tax map/parcel no.: Ea. atkl'I 500 sq. fl or portion 33.92 1 i
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
•�, _ MACE/ _ Limited energy, multi - family
�L.0141 .e
.1 r `i i" Y E/ M k CONDI 110 residential (with above sq. 0.) 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
pit_PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 9Ted a C Le 401 amps to 600 amps I 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 1 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
I relocation
Phone:
( ) I Fax: ( ) 200 amps or less 59.36 I -
Owner installation: This installation is being made on property that 1 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
Owner signature: Date: Branch circuits - new, alteration, or extension, r panel
❑ APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder fee, �'J �J'�
Business name: each branch circuit 7.42 (r - 1 `' 2
B. Fee for branch circuits Q
Contact name:
without ranch circuit � feeder fcc, 56.18 ��p�� p 2
Address: Each add'l branch circuit 7.42 ( 2
Miscellaneous (service or feeder not included)
City /State/TIP: Each manufactured or modular
Phone dwelling. service and/or feeder 67.84 2
( ) I F ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 _ 2
Business name: P\ O /� C Ur Signal circuit(s) or limited-
1 �f�l f�'1 I energy panel, alteration, or
Address: T D , q L.( fl extension. Describe: Page 2 2
City /State/ZI (nfi_boi ljtl D o7 0 Each additional inspection over allowable in an of the above
Phone: (fl () 573 sZ ( ' Fax: (5S ,) 2XD Investigati (34 9 Per s tigati ion 66.25
(01-2116-7..... 1 9 on per hour (1 hr min) 66.25
CCI3 Lic.: t I Electrical Lic.: -C,0( Suprv. Lic.: 5'j d7- 5 Industrial plant per hour 78.18
-
Suprv. Electrician signature, required: ELECTRICAL PERMIT FEES
Subtotal: (
Print name: l>�v� a P\ ( k Date: t I 0 , 0 9 Plan review (25% of permitfec):
/ State surcharge (12% of permit fcc):
Authorized signature: TOTAL PERMIT FEE:
Print name: 1 Date This permit application expires ifs permit is not obtained within 180
days after it has been accepted as complete-
' Number of inspections allowed per permit.
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