Permit a CITY OF TIGARD ELECTRICAL PERMIT
" - . . 111 ,:-;;..- COMMUNITY DEVELOPMENT Permit #: ELC2010 00085
GARS) 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 02/19/2010
-� I
Parcel: 2S111 DC01700
Jurisdiction: Tigard
Site address: 15945 SW ALDERBROOK CIR
Subdivision: SUMMERFIELD NO.8 Lot: 464
Project: Denney
Project Description: Install (1) 200 amp or less service and add /alter (3) branch circuits.
Owner: FEES
DENNEY Quantity Description Date Amount
15945 SW ALDERBROOK CIR
TIGARD, OR 97224 1 ea Services or Feeders - 200 02/19/2010 $100.70
amps or less
PHONE: 3 crt Branch Circuits w /Purchase 02/19/2010 $22.26
Service or Feeder
1 ea 12% State Surcharge - 02/19/2010 $14.76
Contractor: Electrical
T ELECTRIC
18300 NW ODELL CT
PORTLAND, OR 97229
PHONE: 503 -629 -8664
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $137.72
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.
CS1 A 1 �l A
Issued By: 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' 111 4 p 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.
t 1 1. i 1 Pt { r s
Electrical Permit Application - FOR OFFiCF: (.'Sl 0iNlX
City of Tigard FEB 19 2010 Received Permit No.:
Date/By: £I C20 t G ' CCU' _
1 Phone: SW Hall BlvdTigard,
1 Ti 03 97223 'fi ry M2.0IO 0
q Plan Ltrt
Phone: 503.639.4171 Fax: 503.598 i Date.`By: Other Pu mil
Inspection Line: 503.639.4175 Date Ready /6y htrb: H Sec Page 2 for
TLGARA 'I it ' , •. •:.x��s�t
Internet: www.tigard-or.gov ; Notified/Method: c Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ®Addition /alteration /replacement
Please check all that apply isubmit 2 sets of plans whims checked below'):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps 01 150 volts or ❑ Floating buildings.
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 K VA or
lOB SITE INFORMATION AND 1.00A'['iON
El Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E' "1 -2" "1 3"
Job no.: Job site address: 15945 SW Alderbrook Cir 10011P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZiP: Tigard, OR, 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: Denney ❑ Service or feeder G00 amps or more.
FEE SCHEDULE
Cross street/directions to job site: nmeription 1 Qtv. 1 Fee. 1 "rota' l ^
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'! 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
Limited energy, multi - family
67.84 2
Replace existing panel. Relocate water heater, washer and dryer circuits residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 I 100.70 12
❑ PROPERTY OWNER ❑ 'TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State /ZiP: relocation
Phone: ( ) 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 1 own which is not - - - --
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, er panel
Owner signature: Date: A. Fee for branch circuits with
F.2 APPLICANT above service or feeder fee, 3 22.20
❑ CONTACT PERSON each branch circuit 7.42 2
Business name: T. Electric B. Fee ibr brunch circuits without
service or feeder fee, first
Contact name: Bruce Turner branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and /or feeder 67.84 2
Phone: (503 -) 307 -9436 Fax: : ( ) Reconnect only 6784 2
E - mail: bat4nat@yahoo.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: T. Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 18300 NW Odell Ct Additional inspection (1 hi min) 66.25/ hr
City /State /ZIP: Portland, OR 97229 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 629 -8664 Fax: ( ) Inspections for which no fee is 90,00/ hr
specifically listed (Vi hr min)
CCB Lic.: 52552 Electrical Lie.: 34 Suprv. Lic.: 3342S ELECTRICAL PERMIT FEES
Subtotal: 122.96
Suprv. Electrician signature, required: C4 Plan review (25% of permit fee):
Print name: Bruce Tumer Date: 2 -18 -10 State surcharge (12 %ofpermit fee): 14.76
TOTAL PERMIT FEE: 137.72
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.
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