Permit ELECTRICAL PERMIT
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CITY OF TIGARD
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COMMUNITY DEVELOPMENT Permit #: ELC2010 -00299
Tf GA °Rb 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/17/2010
Parcel: 2S104AC08800
Jurisdiction: TIGARD
Site address: 13097 SW BOUNEFF ST
Subdivision: MORNING HILL NO. 9 Lot: 231
Project: Rapp
Project Description: (2) branch circuits for heat pump and GFI.
Owner: FEES
RAPP, RUSSELL E & GEORGIA A Quantity Description Date Amount
13097 SW BOUNEFF ST
TIGARD, OR 97224 2 crt Branch Circuits 06/17/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/17/2010 $7.63
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 r, • rtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
4111110 Issued By: 4101r . Permittee Signature: _ ..rte/ e■Aar■i
4.
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.
rr-" �y '" ° ` � r 1 ^', +,",, :444,1'�r`AtCW4yme.171 1 � ego t c?' p 3
Electrical Permit Application ( . e r ri ol z �o FFIC SFiCIN1 A � 4.
c rs ? , 010 Received Ip I U' l� ow ' P
t'.'�r . '. City Of Tigard L I .: ELF / (1 q
• A\ , DatelE a-vt /� i C v7
�1 13125 SW Hall Blvd., Tigard OR 97223 I t ¶ an Review
Other Permit:
;:: '4 , Phone: 503.639.4171 Fax: 503.598.1960 ..-t(^ te.,'By.
* " "4 Insnection Line: 503.639.
ac" 4175 .nt Ci \I`? aii Read /B y: anis ® See Page 2 for
T.1GA
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t„t.++ Internet: www.t or.gov C �,`C �� otified /M ethod: '� f) Supplemental Information
TYPE OF WORK c3, =yam PLAN REVIEW
❑ New COgStruction Addition/alteration/replacement Please check al hat apply tsubnlit of plans wlitems checked below):
❑ Service or f. ..m 400 amps or more ❑ Building over threc stories.
❑ Demolition ❑ Other: where the a • ilable fault cuncnt ❑ Marinas and boatyards.
•
• CATEGORY OF CONSTRUCTION exceeds 10,t t0 amps at 150 volts or ❑ Floating buildings.
less to grout ., or exceeds 14,000 ❑ Commercial -use agricultural
- q...l- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all I then installat buildings. •
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency Iv stem. larger separately derived system.
JOB SITE INFORMATION AND LOCATION CI Addition of cw motor load of ❑ `A ", "E ", "1 - 2 ", "1 - 3 ",
13 � l 1 St _ ^ �• � I OOHP o m re. occupancy.
6 j Job no.: Sob site address: tS I
Go ❑ Six or more i - i lities l units. ❑ Recreational vehicle parks.
City/State/ZIP: Health-care i aciliti ❑ Supply voltage for more than
Ti l r a / f c ^ ❑ Hazardous I cations 600 voi[s nominal.
Suiterbldg.lapt no.: Project name: Rape ❑ Service or C. s• cr 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 T 1 Ore. I Fee. l Total 1 `
New residen 'al single- or multi- family dwelling unit,
Includes att 1 hed garage.
Subdivision: Lot no.: 1,000 sq. R i less 168.54 ' 4
- Ea. add'l 5++i sq. ft. or portion 33.92 I
Tax map /parcel no.: Limited ener'v, residential
DESCRIPTION OF WORK (with abov. sq.11 .) 67.84 2
Limited ener; y. multi- family 67.84 2
f it 1 tut o) , C FT residenti . I (with above sq. 8.) _
t 1 ∎ Services or + edcrs installation. alteration, and/or relocation
200 amps or I ess 100.70 2
❑ PROPERTY OWNER r ❑ TENANT 201 amps to i 00 amps 133.56 2
4 D. , iy ( �Z 401 amps to 1.00 amps 200.34 2
Name: �°�� F�`�dr "' 17 +" � 601 amps to ,000 amps 301.04 2
Address: Over 1,000. ps or volts 552.26 1 2
City/State /ZIP: Temporary i. erviees or feeders installation, alteration, and /or
relocation
Phone: ( ) i Fax: ( ) 200 amps orl ess 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to l +0 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to1.99 amps 168.54 2
Branch cir I its - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for b 1 ch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above se i ice or feeder fee. 7 42 2
each b • h circuit
Business name: B. Fee for b I. nch circuits
Contact name:
without s. ice or feeder fee, J 56.18 , j¢ 2
firstbran circuit c
Address: Each add'I .1 . ch circuit ^ ( l 7.42 1 7• t{Z 2
Miscellane, s (service or feeder not included)
City/State/ZIP: Each maim .aired or modular 67.84 2
dwelling, se 'ice and /or feeder
Phone: ( ) Fax: : ( ) Reconnect l ly 67.84 2
E -mail: Pump or irr r ation circle 67.84 2
1
CONTRACTOR Sign or outll a lighting 67.84 2
II � C L r L Signal circu' (s) or limited-
Business name S i trtle5 E. iit c_ . c ( Cti." s1 r. C
1 - 1 7 ,,,^ energy pan-I, alteration, or
Address: 'a t �S 0 E iYt (bo. -, a t g /......" Sfe C extension. t l scribe: Paget 2
City/State/ZIP: L fm.Il(ttf i 1 - �,2. 9 -7 t g Each addi ';1na1 inspection over allowable in any of the above
i Per inspecti: 66.25
Phone: (5b3 ) 472,.. 2 5 3 o Fax: (,9 3) 4 '5 j S ....0 , i.57 Investigatio;. per hour (1 hr min) 66.25
CCB Lic.: e33 �(,, ` Electrical 'c. " 6 -S ..0 Suprv. Lic.: )b ci Industrial pl. t per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: l Subtotal: 6. 3, fpo
Print name: Date: ( p t f l Plan review (.25% of permit fce): •---- ke �j! n'?p S� r+ ` V ° tate surcharge (12% of permit fee): 74,3
I
Authorized signature: I TOTAL PERMIT FEE: 1 j. Z 3
This perm' application expires H a permit is not obtained within 180
Print name: Date: 1 days after it has been accepted as complete.
1 * Number e inspections allowed per permit.
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