Permit ivz M C y � / q ® ELECTRICAL PERMIT
ili CITY i ®F TIGARD
Y
C COMMUNITY DEVELOPMENT
; Permit #: ELC2009 -00579
°;
:TIGAR 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/03/2009
Y �, V Parcel: 2S102DD00808
Jurisdiction: Tigard
Site address: 13960 SW 87TH CT
Subdivision: FILBERT PARK Lot: 1
Project: Curtis
Project Description: Re- ground electrical system after plumbing work interrupt ground.
Owner: FEES
CURTIS FAMILY TRUST Quantity Description Date Amount
15285 SW ALDERBROOK CT
TIGARD, OR 97224 1 crt Branch Circuits 10/29/2009 $56.18
wo /Purchase Service or
PHONE: 503 - 443 -3925 Feeder
1 ea 12% State Surcharge - 10/29/2009 $6.74
Electrical
Contractor:
MARANATHA ELECTRICAL CONSTRUCTION
PO BOX 1309
CLACKAMAS, OR 97015
PHONE: 503 - 786 -2071
FAX: 503 - 794 -6297
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 1 ccordance 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. A ENTION: Oregon -w 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 1 -■ 100 ' ou may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. `
etc".12_1e4103
//
Issue y: ___—___...4_ t I1. ..1 I Permittee Signatur
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' _. �A :ti• r / Date: // l �j D 9
LICENSE NO. 54/
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.
Electricat Permit Application R td.'-r•' P 1, � : q , ! � � a4 .) j FJ S ij ,w ; l tv
a' C1 O� �I aC(� Re ceive d Permit No.: ; ,� �:
g OCT 2009 Date /B ] t • C3 �. 7 f
l v 13125 SW Hall Blvd., Tigard, OR 97223 P lan Review 8
..i ? C Phone: 503.639.4171 Fax: 503.598.1960 Date /B •: Other Permit: n l. `I •
"� Inspection Line: 503.639.4175 CITY OF - 1 IGARD Date Ready/By: ® See Page 2 for
`+ ?:Al:° Internet: www.tigard- or.gov BUILDING ®N . ISI' Notified/Method: Supplemental Information
TYPE OF WORK u 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 El 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
❑ 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 ", "1 -2 ", "I -3 ",
/ r. (' , ', 1 (' -'1 (.;-;∎ 100HP or more. occupancy.
Job no.: Job site address: .. -> L:�, .a / ,-.0. i � /
r i- ❑Six or more residential units. ❑ Recreational vehicle parks.
f , � facilities. ❑ Supply voltage for more than
City/State/ZIP: r. � i; i `' r3 / i t• it ❑ Health -care facilities
❑ 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 1 Qty. I Fee. 1 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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq. ft)
`) Limited energy, multi - family
1( /t M k Y k∎Rcl( t , ���.IV i ca pos .* residential (with above sq. ft.) 67.84 2
` � LJ 1P; r l Services or feeders installation, alteration, and /or relocation
� � • 200 amps or less 100.70 2
PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
r- H -t- , 401 amps to 600 amps 200.34 2
Name: /1 ; I C k ` ` G� I' l > -. 601 amps to 1,000 amps 301.04 2
Address: Cj $ • h 5 C ` � . I ii- Y Y7 / ' 1 /: X ( , / Over 1,000 amps or volts 552.26 2
/ ' 1 . - Temporary services or feeders installation, alteration, and /or
City/State/ZIP: , )`' j : ; 4 - -., relocation
Phone: ( �) -. U. . 4 '2 - � j '� Fax: ( ) 200 amps or less 59.36 1
Owner installation': This install is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, Ieasnt -or ex hange, accol;ding4o,OR S 447, 449, 670, and 701) 401 amps to 599 amps 168.54 2
; / ' . / c / !! J n Branch circuits - new, alteration, or extension, per panel
Owner signature: : ', ;, 7 "K 3' t � ' t i. u L Date: j ` � l ; ! ` ` L ( A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PEII'SON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, 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
dwelling, service and /or feeder 67.84 2
Phone: ( ) Fax: . ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
�/� l Signal circuit(s) or limited-
Business name:
, `a,1• G... E 'L ._C..�r + La --a.r l._. energy panel, alteration, or
Address: p ` i, n X t -() 9 extension. Describe: Page 2 2
City /State /ZIP: G LU , V c _ L U 9 r 5 Each additional inspection over allowable in any of the above
1 Per inspection 66.25
Phone: (5 ( („z0 6 FM/ ) Investigation per hour (I hr min) 66.25
CCB Lic..,..5 Electrical Lic.: 54-+5 Suprv. Lic.: 5-41/$15 Industrial plant per hour 78.18
n / ELECTRICAL PERMIT FEES
Suprv. Ele �n required: l '° /,0 Subtotal: 5 (4, 18
Print name: ` Date: 9
. Plan review (25% of permit fee):
e) e _ \S � \r-vvA r- At-- /) � 2 v / State surcharge (12% of permit fee): C0.1 -g4
Authorized signature: TOTAL PERMIT FEE: ( 2 •q Z
This permit application expires if a permit is not obt within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit
1\ Building \ Permits \ELC- PermitApp. doc 10 /01/09 440- 4615T(11 /05 /COMAP
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