Permit ;,: a CITY OF TIGARD ELECTRICAL PERMIT
IN
:!'::4 11 : COMMUNITY DEVELOPMENT Permit #: ELC2009-00631
T [ G;ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/24/2009
Parcel: 2S115AA10400
Jurisdiction: Tigard
Site address: 10988 SW BRETTON CT
Subdivision: BRETTON WOODS Lot: 9
Project: Vanderbilt Mortgage
Project Description: Reconnect.
Owner: FEES
VANDERBILT MORTGAGE Quantity Description Date Amount
TIGARD, OR 97224
865-380-3000 1 ea Reconnect Only 11/24/2009 $67.84
PHONE: 865-380-3000 1 ea 12% State Surcharge - 11/24/2009 $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. 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- 0 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: .. hO � S.11� 9.., ( � J "J J Permittee Signature: Q ,A4)
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.
CaII 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.
Nov 24 09 11:08a David K 503 - 465 -4938 p.1
E9+ectrical Permit Application FOR OFFICE USE ONLY
City of Tigard RECEIVED Received
III A3k'By , Permit No. v 0 • . , i /
• 13125 SW Hall Blvd.. Tigard, OR 97223 Pian Review
Phone: 503.639.4171 Fax: 503.598 -7960 Other Permit
`' 2 n D ate 13
TIGARD g g and -or. ov Notifietl/A1et Inspcctionline: 503.639.4175 NOV !r 2.0 p 3 Dme Ready Sy. @Seel'a e3 for
Internet: www-ti g 1
hod: �,� G Supplemental Information
TYPE OF WORliCTT pIVISION • PLAN REVIEW
❑ New construction ❑ Addition/afteniti/BMWItntr Please check all that apply (submit 2 sets of plan; , items checked below):
❑ Service or feeder 400 amps or mute ❑ Building over been stone;.
Demolition ❑ ® Other: re-connect where the available fault cc rent
_ ❑ Marinas and boatyards
CATEGORY OF CONS£RU'('TlON exceeds 10,000 amps at 15n volts or ❑ Floating buildings
t CiaUindustrial Accessory building less to ground, or exceeds 14,0(10 ❑ Commercaal -usc ar,.riculttnal
® 1 - and 2- family dwelling Q Cornme
ry g amps for all other ;nstallations. buildings.
❑ Multi- family ❑ Master build El _ builder I_t Othef: ❑ hue Pump. ❑ install ation of 75 K V A or
3013 SITEINFORi1L#TION AND LOCATION ❑Fmergencysystem Iargerseparatelyderived sgsieln.
1 - ❑ .Addition of new motor load of ❑ "A "E ", "1 - "; - ? ",
Job no.: Job site address_ 10988 SW Bretton Court l00'IP or more. occupancy
0 Six or more residential units. ❑ Recreational velucle pane
City/State/21P: Tigard, OR 97224 ❑ I1ea:th -care facilities ❑ Supply vostage for more than
_ ❑Hara.•dous Iocatiorn. 600 volts nominal.
Suite /bldgJapt. no.: Project name: ❑ Service or feeder 600 amps or more
Cross street/directions to job site: SCREDULE •
Description -- -- - -EQn. 1 Fee. l Total l
Ncw residential single- or multi- faouiy dwelling emit.
Includes attached garage.
Subdivision: Bretton Woods PA L 5 ! Lot no 9 - 1,000 s9. 11. or less 168.54 4
Tax map/parcel Ito.: R2129136 Ea_ add'! 500 sq. ft. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK . _ (with above sq. ft.) 67.84 2
RE - connect Limited energy, multi - family 6784 2
_ r .
residential (with above sq, ft.) III
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
. .. '.. ® PROPERTY OWNER • • 0 TEN ANT 201 amps to 400 amps -
P p I33.56 2
Name: VanderBuilt Mortgage 401 amps to 600 amps 200.34 2
Address:
601 arnp to 1,000 amps 30I.04 2
Over 1,000 amps or votes 552.26 2
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
t I , relocation
Phone: (865)380-3000 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that l own which is not 201 amps to 400 amps 125.08 2
intended for sale, /ease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 168.54 ! 2
Owner signature: Branch circuits — nee., alteration, or extension, per panel
Date:
® APPLICANT A. Fee for branch circuits with ® CONTACT PERSON , • above service or feeder fee,
each branch circuit 7-42 2
Business name: -
B. Fee for branch cir nits
Contact name: David Korniyenko
without service or feeder fee,
first branch circuit 56.18 2
Address: 2406 NE 139 st #387 Each addi branch circuit 7.42 12
City /State/ "LIP: Vancouver, WA 98686 MUiscettaneous (secs ice or feeder not included)
Each manufactured or modular I
dwelling, service and/or feeder 67.84 2
Phone: (360) 521 -1973 Fax: : (503) 465
Reconnact only X 67.84 2
E - mail: daz'idkhomes @gmaiLcom Pomp or irrigation circle 67.84
2
-
CONTRACTOR Sign or outline lighting 67.84 2
-
Business name: none Signal circuit(s) or limited-
energy panel, alteration, or
Address: extension. Describe: P age 2 2
City /Stn elZ1P: Each additional inspection over allowable in any of the above
Phone: ( ) Per inspection 66.25
( Fax: ( )
investigation per hour (I hr ruin) 66.25
CCD Lic.. Electrical Lie.: I Suprv. Lic.: Industrial plant per hour 78
Supra. Electrician signature, required ELECTRICAL PER:tTIF FEES
Subtotal: 67.84
Print name: Date: — Plan review (25% o ofpennit fee): 0
Slate surcharge (12% of permit fee): 8.14
Authorized signature:
TOTAL PERMIT PEE: 75.98
J
Print Warne: I Date: i This permit application expires ifa permit is not obtained within 180
days alter it has been accepted as complete_
I. lmildatg■YennitilELC- 'r'ermrApp dos I0/01:09
• Number of inspection., allowed per p armit
440 -4o 15T(I 1 /05rCOM/WEJO