Permit ip '''',44,,, � ' ���� OF �I���® ELECTRICAL PERMIT
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x F a ,, COMMUNITY DEVELOPMENT Permit #: ELC2010 -00239
T 1 AR O 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/18/2010
4L 11.0.11 : , :4 Parcel: 1S135ACO2400
Jurisdiction: Tigard
Site address: 9425 SW LONGSTAFF ST
Subdivision: Lot: 0
Project: Fannie Mae
Project Description: Electrical reconnect
Owner: FEES
FANNIE MAE Quantity Description • Date Amount
12725 SW MILLIKAN WAY #100
BEAVERTON, OR 97005 1 ea Reconnect Only 05/18/2010 $67.84
PHONE: 503 471 -3542 1 ea 12% State Surcharge - 05/18/2010 $8.14
Electrical
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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. AT , ON: • .. -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 .010 through OAR '5 :: 1 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503 46.6699 or 1.800.332. 44.
Issue By: / / I • � — -• . ' Permittee Signa 1.... f (CJ
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.
05/13/2010 14:25 FAX 5036265137 BEAVERTON 0 001 /002
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Electrical Permit Application { � l�ti til ) fF�. ' ;ti " satt��1' '
)� r� r � yy % � • Received .. Permit No l Q �
„ �1 +ar City of Tigard MPS 1 �. to /B . f e 6 37
• 13125 SW Hall Blvd., Tigard, OR 97223 n Review
` q\ � 1� T Other Permit:
Phone: 503.639.4171 Fax: 503.598.1960 0 ' ` 't �\.' r_ /By.
rT . 1'G A R D N Inspection Line: 503.639.4175 G\ ®\� Date Ready /By: iuris: ® See Page 2 for
. :. , ,ra�3o Internet: www.ligard- or.gov v Notified /Method: Supplemental Information
•
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❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /item.. checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stones.
❑ Demolition ® Other: Reconnect Permi where the available fault current ❑ Marinas and boatyards.
, ,, f rA y J s, - ?:-R a p+ , ° `•-" ' ( h A e�.4- : s'+ . n, exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
g, 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 of 75 KVA or
„ ❑ Emergency system. larger separately derived system.
r . , _ �. ll a ' 1 , t ® ' ::! y f l' ❑ Addition of new motor load of ❑ A E" 1.2 1 _J
1001-IP or more occupancy.
Job no.: Job site address: 9425 SW Longstaff St
ID Six or more residential units. ❑ Recreational vehicle P arks.
City/State /ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: 95 Ave to Longstaff St Dgeription
102. Fn.
New residential single- or multi- family dwelling unit.
Includes attached garage. _
Subdivision: Ashbrook Farm 1 Lot no.: PT 19 1,000 sq. ft. or less 168.54 4
Ea. add' 1 500 sq. ft. or portion 33.92 I
Tax map /parcel no.: R0270664 Limited energy, residential
9" ' ' to" '! "' � ' V` '` f w above 67.84 2
Si > 4 ,:, .4 o ut. e e t . R i '1 9 i ( r31 � ih r „.. ,241lla4'r Vd e + � ort $ i lit a ., (with ( �1. ft. )
"� "" x ` Limited energy, multi family
67.84 2
Reconnect permit to have electricity turned on residential (with above sq. ft.) 7
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
. x . . t" . ; 20 amps to 400 amps 133.56 2
... t� � w
401 amps to 600 amps 200.34 2
Name: Brenda Hereth for Fannie Mae 601 amps to 1,000 amps 301.04 2
Address: 12725 SW Millikan Way #100 Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: Beaverton, OR 97005 relocation
Phone: (503)471 -3542 I Fax: (503)534 -7785 /* 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 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale . rent, or exchang• cording to ORS 447, 449, 670, and 701.
/ Branch circuits- new, alteration, or extension, per panel
Owner signature: A __.a 7/ A te: /t /0 A. Fee for branch circuits with
�, , ,, a v A � 4. , f LL above service or feeder fee, 7 4 . 2
,, ' ki„,--.
A( t ' .;, ? ' .z . _, as ., . ' n i,, ,. ,.s ` 'A ,, 1 [ t;ez each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City /Slate /ZIP: dwelling, service a nd/or feeder
Phone: ( ) 1 Fax: : ( ) Reconnect only I 67.84 67.84 2
Pump or irrigation circle 67 84 2
E - mail: Sign or outline lighting 67.84 2
r 7.,c �+ Si circuit(s) or Iimited-energy
._• . �� ' t1.7.10,'-:10,0E' ' ,.1.'• .. ,.� ; ; :. i µ a ix � ��;�„'�a^r„, „�,��tr..�s'�'`'¢.. -� '�'
Business name: 1 . ianel, alteration, or extension. Page 2 2
Each additional ins r ection over allowable in an of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP: Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) NI Fax: ( ) Inspections for which no fee is 90.00/ hr
s. ificall listed 'A hr min
CCB Lic.: Electrical Lic.: Suprv. Lic.: "" p
Subtotal: 67.84 .
Suprv. Electrician signature, required: Plan review (25% of permit fee): 0
Print name: Date: State surcharge (12% of permit fee): 8.14
TOTAL PERMIT FEE: 75.98
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit
1:\ Building\ Permits \ELC•PermitApp.doc 10/01/09 440 4615T(11/05 /COM/WEB