Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00237
T [ GRD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/12/2010
A
Parcel: 25111 DB02700
Jurisdiction: Tigard
Site address: 15415 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 486
Project: Burnett
Project Description: (1) 200 amp service and (10) branch circuits.
Owner: FEES
BURNETT, RALPH A/NANCY A Quantity Description Date Amount
15415 SW ALDERBROOK CIR
TIGARD, OR 97224 1 ea Services or Feeders - 200 05/12/2010 $100.70
amps or less
PHONE: 10 crt Branch Circuits w /Purchase 05/12/2010 $74.20
Service or Feeder
1 ea 12% State Surcharge - 05/12/2010 $20.99
Contractor: Electrical
WILLAMETTE ELECTRIC INC
PO BOX 230547
TIGARD, OR 97281
PHONE: 503 - 624 -3631
FAX: 503 - 624 -2938
Type of Use: SF
Class of Work: NEW Type of Const:
Occupancy Grp:
Total $195.89
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 • • he ru es • •opted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0010 through OA 52- 001 -0100. Yo ay •y of the rules • direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued Bye %! Signature:
• •
Perm Si
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 503.639.4175 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.
05/12/2010 WED 8:22 FAX 5036242938 Willamette Electric 0 002/002
n
Electrical Permit l�pp
fl1Ca>�1 � :•:FOR C 5 -0 [;1'
City of Tigard ` L = •J Received Air 7 0 ' ) Permit No.: `'O �V — Viz '
13125 514' Hall Blvd., Tigard, OR 972 v 1 2 2 01 O Dat ly: r
III
3 Phone: 503.639.4171 Fax: 503.598.1' + ti I DalciBy: Other Permit:
T fG A R D inspection Line: 503.639.4175 Date Rcady!E3y: Juris: Q1 See Page 2 for
Internet: www.tigard- or.gov (; OF c yi p ARO Notfied/Method: Supplemental information
' TYPE - o g I J 6 p 7 DivIsio i .. 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 mare ❑ Buildin over three stories.
0 Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGOR OF;; CON S TRIJCTION' exceeds 10.000 amps at 150 volts or ❑bloating huildings
less to ground, or exceeds 14.000 ❑ Commercial use agricultural
-1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ installation of75 KVA or
❑ Emergency system. larger separately derived system.
JOB SIT .INFORMATIO 1 -.. L OC ATI ON Addition of new motor load of ❑ "A". "E', "1.2 ", "1 -3•',
or more.
.fob no.: 6 U r / � 100Ht' occupancy.
Job site address: /�` /�t? 5 v /���Ci /����� YC1 Z ! ❑S ix or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: "` �' ❑ Health -care facilities. ❑ Supply voltage for more than
! tJ'G ❑ Ifaaardous locations. 600 volts nominal.
Sui te/bldg./apt. no.: 1 Project name: /2 0 Service or feeder 600 amps or more.
' F EE ; 5CHEDULE:.
Cross street /directions to job site: Descripti 1 on i Fee. I 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'l 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited energy. residential
DESCR>fPTiO1 OF. ( with above sq.R.) 67.84 2
n fie" energy, multi- family
{ ` e o"',e "e I j j ' p- / . D e" y / residential (with above sq. R.) 67.84 2
Services or feeders installation, alteration, and /or relocation
l / wo
200 amps or ess 100.70 50 2
PROPERT'a O . ❑ TENANT 201 amps to 400 amps 133.56 2
Name: (k r RA "At c r J 40l amps to 600 amps 200.34 2
t 60 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: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on properly 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
�]. APPLIC ' ❑CONTACT- PERSON,: above service or feeder ice, • each branch circuit / O 7 42 � 2
/ 4"...-.—
Business name: B. Fec for branch circuits
without service or feeder fee,
Contact name: 56.18 2
first branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
67.84 2
Phone: ( ) Fax: : ( ) dwelling, service and /or feeder
Reconnect only 67.84 2
E -mail: Pump or in circle 67.84 2
,. CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: Willamette Electric Inc energy panel, alteration, or
Address: P.O. Box 230547 extension. Describe: Page 2 2
City /State /ZIP: Tigard, OR 97281 Each additional inspection over allowable in any of the above
Phone: (503) 624 - 3631 Fax: (503 - 624 - 2938 Per inspection 66.25
/ t Investigation per hour (1 hr nun) 66.25
V
CCB Lic.: 75059 ,./ Electrical Lic.: 34 -283C Suprv. Lic.: 4226. - 5 ✓ Industrial plant per h ou r IGAL PEt MIT 78.18
: FEES
Suprv. Electrician signature, required Subtotal: / 7Y
Print name: David Fife Date: Plan review (25% of pennit fee):
/ 1� • �,�
- Stale surcharge (12 /o of permit fce): 'j O Y ��
Authorized signature: TOTAL PERMIT FEE: /75'
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Number of inspections allowed per permit. Q�
I:: Building •Pcrmial[LC - Penn it App.doc 500 o 440- 461S'r(I t'05 COM WEB q�
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