Permit : � CITY OF TIGARD
PERMIT
a r
n COMMUNITY DEVELOPMENT Permit #: ELC2010 -00251
13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/21/2010
TIGAAL?
,, ,,, Parcel: 2S111CC19800
Jurisdiction: Tigard
Site address: 10275 SW GREENLEAF TER
Subdivision: Lot: 0
Project: Wiley
Project Description: Replacing service.
Owner: FEES
WILEY, DOROTHY E Quantity Description Date Amount
10275 SW GREENLEAF TER
TIGARD, OR 97224 1 ea Services or Feeders - 200 05/21/2010 $100.70
amps or less
PHONE: 503- 620 -3378 1 ea 12% State Surcharge - 05/21/2010 $12.08
Electrical
Contractor:
GARNER ELECTRIC
2920 SE BROOKWOOD AVE A
HILLSBORO, OR 97123
PHONE: 503 - 648 -4552
FAX: 503 - 642 -7925
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 cop o 1- rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By - � _ � �� Perm ittee Signature: ,,%'%:/y11
' 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.
FROM :GARNER ELECTRIC FAX NO. :5036427925 May. 20 2010 02:33PM P1
r � ca f riuct
1 , i 4,,, , b,.> t i�ryM'� 7rLtP " ay1" U N,l ily t'. 9GitIL U""�i if ,prrnlr I st �n,,t a J �ztt ir ,, m .NU t Y Electrical Permit Applica r rv o. «' , + ii:t.0, dr „ l f)12 Olif IC NI • 0 I 1 ' At l • , � w i + � . .4„ r : 1��jx •
'. -- ; p r� • ,.y MAY I 2 - 0 2 0 10 `,J ,, ,J431Wi�Y4 • ' � 4.ir' °. �at,Md,,,.YA'r�G..d^ ,, a 4� i,1,G �n tit war t r 14th ..aX.�l..'1
uIf3' of X IgAt ( Received
1)111.613y, 5—/aL 10_0 i I ... Permit No.:
r- - q 13125 SW Hall Blvd., Tigard, OR 72 3 Plan Review
1 a Phone: 503.639.4171 Fax; 503, TIGARD Date/By: Other Permit:
1' l C,?1'li Li ” '"f" I) P r Y Y lurk. � See Page 2 for
Inc colon la ne: 503.639.4175 BUILDING DIVISION Dat Reuel />3
Oh
, ;41',Vwsram +-tlflt! Internet: www.tigard•or•gov Notified/Method: 71 .63 Supplemental Information
:7: r1, s?gjnnp;! t:4 r{ t,i ,' 1 „p; r tt.±b 1., rp �, r , t.,: ( *m.u, , u „ h ;a s i is 1 •';M1: lr � , . + , •;:i . ,,. pr R n ,..• : , � r ..,
i '' f.. r � , ' y , a r ]'. x pl ' t 'W f 1 i p .,"'rr! `, �M r E ill • 1i � �1�i p , , I 1i ... r ti . 1 ..,1: 2 �I,�tJr),',�. 4 ,.,> t -.4 .' S'�.lill r. i s4i�{ t �l;
!° ,tftt�lh ,��id'.v�. ��`�:4!�;auC:ur�l�ia����. : �;,1°!�' till {��7:8�4I�,`1...;.�r�I;�t. �a, �' d r{, 1t�7llCl! M` li3V�tc��11% k�i' I�e., �If' �J�; �, �P�;; �uiI1P�! �ilPf�ll4 .,11�.,,1
El N ew construct Add / a l tera ti on / rep l acement Pleaac check all that apply (submit j acts of plena whtema checked below);
❑ Service or feeder 400 brims or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
77 1 r t o n r ,r, .. e o ua
4 ' i 1 I f M a1 1 J��• )) �� pp ; ''NN ���� 11 44PP RR��{{l' fif � y iC r:l� - .1; 111 pi t r f �` ��' ( t i i t 1 wtl1 ex(:beds 10,000 amps al 150 yoke or ❑ Pleating buildings.
�t o, Alt _ : .� � i e. it 1114A B asl e V. Ik ! lAt lt. f 'A ' f .: i..p �1H4 I �, ,, �'S, �A, r. n,P lei, to ]_itt1WLLt, or tatted:: 14,000 Commercial-LLR6 BslICn1t11281
E 1- and 2- family dwelling ❑ Commercial /industrial E Accessory building atrrpa for all other installations. buildings.
❑ Multi - family ID Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
5'tIM” v t c 1^.71 [yt 3R rs 1 , u.�a1 +1 t �1 .� q �� r pr�tc r x• w y 1 A S e t;'0 .7 � I ❑ Emergency system larger separately derived >:yxwm.
>,�l�i"tl'l� 'li1 :i�' )', ,0'.1, ,. 1 ii .I, ' �; f f n.,. ,1 w
'm[; ta, 1 +tIfa:a ` e ' ^ L D + O A a v r' ' F 1 . . pi a • C ,,, rip ❑addition of new motor load of ❑ „ r,E..
Job no.: Job site address: I 0 2,.' E S w (1 vcc. r, Liza Six HP or mr occupancy,
e s.
❑ Six or more residential unite. ❑ Recreational vehicle parks.
City /State /ZIP: , 1 CAV U1 0 2 •'4.2 2 1 ❑ Health-care facilities. ❑ Supply voltage for more them
_ 0 Hazardous locations. 600 volts nominal,
Project name: no.: Pro
Suite/bldg. /apt. ..}}..�� �� 0 R � E � � ry
O
job � � , � a Qtr. P. � � 1�rlulala �> l
1 ti . � , ivy 5i ", r t a. n v
Cross street/directions to ob site: ueacrI tlon I Total _
__- .,,... . _.•,... , -- -- - _k_.. -- — ..
N ew res single - or mu lti - f am il y d welling unit.
Inclndes attached garage.
Subdivision: Lot no.: 1,000 sq. ft, or leas 145.15 4
- -° — Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map/parcel no.: 1 Limited energy. residential
M , 'etcX t'Jrl'vS „a►`S fi 3 u' 1 t , . rr � , < re a wl i, P iWit7 l ir A * (with above sq. t. 75.00 2
Limited energy, multi family 75 00 2
De( t/ I c,..g C rAvLce- residential ... 0 . 1/M above sq. ft.) _
Services or feeders installation, alteration, and/ur relocatl
200 amps_ or less / 80.30 , 0 2 ICAO
li r E rAlyi N, T •r r fi t .., ./: �4 ) - �. . PIR f 9 J �' ala > r I Ni , li i i 201 amps to 400 amps
1(16.85 2
t • � �+I. lfni
401 amps to 600 amps 160.60 2
Name: �Ur v( � + ..lep __ ..0
- 601 amps to 1,000 amps 240.60 2
Address; _ Ovor 1,000 amps or volt:: 454.65 2
City /State /ZIP: T Temporary services or feeders installation, alters 'Ion, and /or
__..... ....- �_ -- relocation
Phone: G)0_ 2Z-�r, Fax: ( ) 200 amps or less • 66.85 1
� ... 201 amps to 400 amps 100.30 2
Owner installation: This installation is being made on property that I own which is not .-..,..,.• -,•,•_
intended for sale, lease, rent, or exchange, According to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch clrcults- new, alteration, or extension, per panel
Owncr signature: A. e: A. Fee for branch circuits with
�* i mr I ) r 1 � � "` � �" P r �{ r i(�. 1 � i l � {Wp� Vi
above fie
P ' l `t ; t 4P1 00 t1 +' l" q� { 7 [' 9 o t rvice or feeder fee,
JIC�f G ls: R 1 IIC �ITAZ 4 wt i ! ".,,• !,-.1' leg i 6 ii ,l.:r r4a� . , {; .0 . 1 . » . 1 1 each branc circuit 6,65 2
Business name, • 13. Fee for branch circuits
" " " "' — without service or ::eerier f'ce, 4fi.$5 2
Contact name: first branch circuit
Address: Each add'l branch circuit 6.65 2
- - Miscellaneous (service or fen& not included)
City /State/ZIP: Each manufactured or modular
dwelling, service andlor feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only �__ ._......_.. -_ 66.85 2
E -mail; Pump or irrigation circle 53.40 2
;
�(p� t !l�ir" .r ' rruu o ;'""�'r t, ° ,!' • i ", 8t � ` . l9j ttM�4 + 1 ' "s " l i Sig nr outline lighting 53 40 2
B�. i. �i • i V � ��� �� 4 R vfivj �a 1Pt ,,:V — –
l � � • � , �, r i It.,,4 u3� t ,iwt f
Business name: r - Signal circuit(a) or limited-
Business G� R l .CG I C energy panel, alteration, or
Address: 21f:1 2 e � ri: W 00d _...... extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allow hie in any of the above
• -- J - `• °--' - Yer inspection h2.50
Phone: 3) - Fax (c►3) b 9 2..,;79225-
, 792 m .._._ —
Investigation per hou (I hr mm) 62.50
-�� 5 industrial plant to hour 73.75
CCB Lie -: 12.1 l S'� Electrical Lie.; ��0 C S • • Lie,: p p p
I "r 111M ll;�illlt ',..i,.,,� r90,1, i1r,`„ ' ; is isi ` y;l0.
Suprv. Electrician signature, required: ; Subtotal: .... 5,,,C)-7 - 5 - 0 1Wa7°
J y �� , r rr „ Plan review (25% of p ermit fee):
Print name: p �,,
['! 1
P. / .. _ ... -_.. -- � � V _. State surcharge (l2 °/ ofpern fee): Li i AqC
Authorized signature: TOTAL :PI'.RMiT FEb: - g G/ J 73
Tale permit application cxpirer ' ill permit is not oat cc! witiun 1 so
Print name: P &te: days after II has been accepted as complete.
` • Number of inspectinnu allowed pot permit.