Permit � :"/ ` ELECTRICAL PERMIT
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2 •4. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00589
TiGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 11/03/2009
�_.ft ?elm z /,*t Parcel: 1 S 125DB04100
Jurisdiction: Tigard
Site address: 9505 SW 74TH AVE
Subdivision: BOULEVARD HEIGHTS Lot: 24
Project: Scott
Project Description: Install feeder and (8) branch circuits.
Owner: FEES
ALBERTSON, GEORGE R AND Quantity Description Date Amount
ESTHER M, CO- TRUSTEES, PO BOX 1329
SHERWOOD, OR 97140 1 ea Services or Feeders - 200 11/03/2009 $100.70
amps or less
PHONE: 8 crt Branch Circuits w /Purchase 11/03/2009 $59.36
Service or Feeder
1 ea 12% State Surcharge - 11/03/2009 $19.21
Contractor: Electrical
WILSONVILLE ELECTRIC INC
PO BOX 845
WILSONVILLE, OR 97070
PHONE. 503 - 638 -5353
FAX: 503 - 638 -8804
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $179.27
Required Items and Reports (Conditions)
This per is issued subjec o the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicablrfa , . All work will
be do . in accordance with ap ove Tans. This permit will expire if work is not started within 180 days of issua ce, or rf is suspe •ed f• r more the 180
days ATTENTION: Oregon la requir s ou to follow the rules adopted by the Oregon Utility Notification enter. • ose rules are -t forth in OAR
952 001 -0010 th ough OAR 95 01- 10 slou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.•. .r 1.800.332.2344
Is- ued By: / Permittee Signature: �/��i� /��
- 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:
./ /TRACT.. INSTALLAAN ONLY
SIGNATURE OF SUPR. ELEC' (( j A7. Date: // 3,�C}
LICENSE NO. 5 �/ (/ /
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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Application x - 1. OR+OFf ICE, IISE ONL1, r '1 t $
Electrical Permit A ,
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I �' z ' "' C l of Ti an d R ) 2 D / Permit No.: cs.L� Ji-• 665
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n`f t•. ` City g Date/B : /
'' I' ° 13125 SW Hall Blvd., Tigard, OR 97223 at Plan Review
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Phone: 503.639.4171 Fax: 503.598.1960 Date/B : Other Permit:
'l.- "' l'' Inspection Line: 503.639.4175 Date Ready /By: ®® ® See Page 2 fur
1 TIGARD:I Notified/Method: Supplementallnformation
. .'l .el.all.ik -1 Internet: www.tigard or.gov
TYPE OF WORK 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 more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
0 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.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A", "E ", "I - ", "1 - ",
7 0HP or more. occupancy.
Job no.: Job site address: el s ® 5 5.(,J ®
, Lite. L t il ❑ Six or more residential units. ❑ Recreational vehicle parks.
CI /State /ZIP: q ❑ Health-care facilities. ❑ Supply voltage for more than
tY 'Tit 02,. e3 7 e , p ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. 1 Fee. 1 Total 1
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.: Limited energy, residential
sq. 75.00 2
DESCRIPTION OF WORK ( with above q )
fl.
Limited energy, multi - family 75.00 70 2
city ,. _ _ residential (wi th above sq. fl.) /06
tip ..,,,,,,/ ''
Services or feeders installation, alteration, and /or elocation
200 amps or less 1 1 I - 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
Name:
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
Cit 1State /ZIP: Temporary services or feeders installation, alteration, and /or
Y relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 6.65 2
_ each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee, : ,.;= -., _.
Contact name: first branch circuit ..r.'
Address: Each add'I branch circuit 8' — " —
_Miscellaneous (service or feeder not included) Mai �J
City/State /ZIP: Each manufactured or modular ? 2
dwelling, service and /or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
_ _ Signal circuit(s) or limited -
Business name: t • 1 f • L 5 ®rD v 1 ? Q � L �s G 4 is e, energy panel, alteration, or
Address: P n ( ® y. s'4°,3--- ® extension. D escribe: Page 2 2
City /State /ZIP: LL) 11.. -0.�' O l4 1 •7 0 7 ca Each additional inspection over allowable in any of the above
✓� V d L Per inspection 62.50
Phone: (5123) , .. -..3 j? F. • CO g) , '35-- e=-9 v . Investigation per hour (1 hr min) 62.50
CCB Lic.: --45-73-,_ �Electr'cal f 3 1 Sup . Lic.: 3 r ?s Industrial plant per hour 73.75 O
� ELECTRICAL PERMIT FEES J /co
Suprv. Electrician signature •qu' r � " Subtotal:
t e //
�� Plan review (25% of permit fee):
Print name: ( .... 442 .47 0' lNlv 012 Date: it/ • 05 State surcharge (12% of permit fee): / c a t / , v �i
Authorized signature: TOTAL PERMIT FEE: 12
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
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