Permit •
-i
' -= A {f� CITY OF TIGARD ELECTRICAL PERMIT
`` 2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00561
Date Issued: 10/23/2009
rT1GARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S1 3/2009 600
Jurisdiction: Tigard
Site address: 15980 SW CENTURY OAK CIR
Subdivision: Lot: 0
Project: Beamish
Project Description: 200 amp service and grounding. Double permit fee for work without permit.
Owner: FEES
BEAMISH, ALICE F Quantity Description Date Amount
15980 SW CENTURY OAK CIR 1 ea Services or Feeders - 200 10/23/2009 $100.70
TIGARD, OR 97224 amps or less
PHONE: 503- 684 -8258 1 ea 12% State Surcharge - 10/23/2009 $12.08
Electrical
101 da Investigation Fee (Equals 10/23/2009 $100.70
Contractor: Permit Fee)
METRO'S BEST ELECTRIC 1 ea Investigation 12% 10/23/2009 $12.08
P.O. BOX 30075 Surcharge
PORTLAND, OR 97294
PHONE: 971 - 563 -9418
FAX: 503 - 262 -8251
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $225.56
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 4 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.
Issued By: - t ! - Permittee Signature: DA/ ne/ e,1
,
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.
: 0ct.22 09 01:18p Casey's Plumbing 5032628251 p.2
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Electrical Permit Applicatio w ,,��.� ,, , , , } = .. Fo l e, O F iC,E.rusEtonL t� 910,.'V't145i*. i;
.
' ECEIVE ; 1 '
, Received � .
3 l 2 5 SW Hall l3 d OSA o� r Permit No ��� aoa9 Dos6 f
Sy 2 ° : q 1 Date 312 S W all Blvd.. Tigard, OR 9722_ f T A �1 phr r
,'. Phone: 503.639.4171 lax: 503.598.19 2 2 2Q09 Dale!By: I Other Permit:
T.i1G D', Inspection Line: 503.639.4175 Dale Readw'33 1vr I ell
See Page 2 far
3'_a_- -::∎':G:::._: Intcmct: xeww. Iigard- or.gov CITY OFTIGARI) N /Method: ' 7 7 i SupplementaIInformation
f TYPE 01B Jij1 (IN(i DIVISI PLAN REVIEW
c xv construction ❑ Addition /alteration /replacement
Please check all that apply- (submit 2 sets of plans ta(ilems checked below):
❑ Service or finder 400 amps or more ❑ Building over three stories.
ID Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 1(1,000 amps at 150 volts or ❑ Floating buildings.
Tess to ground, or exceeds 14,000 ❑ Commercial -use agr icalhrrtl
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived sysler
106 SITE INFORMATION r \ND LOCATION
❑ Addition ofncw motor load of
❑ ,. �, , „1,x...1-- .
Job Ito.: lob SIIC addrC55: mom' or more. occupancy.
l � �� C ol��ur O� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Y: �� C �0 :-: ❑ Health -care facilities. ❑ Supply voltage for more than
1 1 ALA t CQ 122 _. ❑ Hazardous locations. G00 volts nominal.
Suiie/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 1 omen rinrr
_ n f vu. 1 ycr. ! anal l-
New residential single- or multi - family dweIliu2 unit.
Includes attached garage.
Subdivision: I,ot no.: 1,000 sq. ft. or less I 145.15 4
Ea. add') 500 sq. ft. or portion 33.40 I
Tax map /parcel no.: Limited energy, residential
75.00
DESCRIPTION OF WORK _ (with abovesq.ft.) _
/ Limited energy, multi- family 75.00 2
L--,---Y-en,,,...., __ `y residential (with above sq. 0.)
Services or (ceders installation, alteration, and/or relocation
I 200 amps or less /60 t JD 00.30 2
OPERTV OWNER f ID TENANT 201 amps to 400 amps 106.85 1 2
{� 401 amps to 600 amps 160.60 1
Name: j 2
t�NC' 'P � �&Y \L yc1 601 amps to 1,000 amps 240.60
f 2
Address: ` I b G Q0 t1-C .- V k C Y�� C_ Over 1,000 amps or volts 454.65 j 2
City/State/ZIP: t• Temporary services or feeders installation, alteration, and /ur
l �c CULC' C _ ��2 Z relocation
Phone: (-j-) ` nA., �� 7s 1 Fax: ( ) 200 amps or less 66.85 I
Owner installation: This installation is being made on property that 1 on which is not 201 amps to 400 amps 100.30 2
intended for salt, (case, rent, or exchange, according to ORS 447, 449, 670, and 70!. 401 amps to 599 amps 133.75 12
Branch circuits- new. alteration, or extension. per panel
Owner signature: Date: A. Fee for branch circuits with 1
,U'PIJC:ANT ❑ CONTACT PERSON above scrvicc or fccdcr fee,
y each branch circuit 6.65 i 2
m
Business nae: t� ' C ' .5 1 Li 1'C - B. Fcc fur branch circuits
without service or feeder FCC, 2
Contact name: U.Q (![ first branch circuit 4 46.85
Address:LX' Each add'I branch circuit 6.65 J 2
r NI isccllaneous (service or feeder not included)
City /State /'LIP: r :-\- , irvi O q 1' _ q _. Each manufactured or modular I
I f / , . r dwelling, service and/or feeder 1 90.40 I 2
Phone: (C1 [ ) S�73 '_C f c� Fax: : { J"7 � !f LS
�� ` Reconnect only 66.85 2
E -mail: C-C31� -} 4 \S (� -I \ 1r [ 7 «'. (. , C� CilTh I'ump or irrigation circle 53.40 2
CO \ RA OR J A I a S ign or outline lighting 53.40 1 2
Business Warne: Signal circuit(s) or limited -
e.,- -:a 1 - �fi P� /� energy pond, alteration, or
Address: ". f' -_ x -;'1 r , ( ° extension. Describe: Page 2 2
� City/State/ZIP: 0 .' � (k i ` (Ai c c c y � l 1 L-4 Each additional inspection over allowable in any of the above
u).-`6 Per inspection 62.50
Phone: C4 SLc � l Fax: () - G ) ,� a S 1 Investigation per hour (1 hr min) 62.50 -}
. CCB Lic.: 1 LI \2_ei Electrical Lic.: CA i/r Suprv. Lic.: L1 ( Industrial plant per hour 73.75 •
ELECTRICAL PERMIT FEES
Suprv. Electrician sign r 0quircd: 2 .L 10 01 10 Subtotal: /00 , 70
�--� flan review (25 %of permit fcc):
Print panne: 7 1 1(.1. ? r U t. . i. ..- Date: 1 .)- 9_2.001
I State surcharge (12 % ofpermitfcc): I / a ,dam
Authorized signature: ' L
`J� TOTAL PERM VI' FEE: 1
e 'this permit application expires if a permit is not obtained within 1811
Print name: D ate: 2 _ 0 days after it has been accepted as complete.
�� f r r X2 �cz �� �►
• Number of inspections allowed per permit. /7 717
I Aiuildins 11'cnn its il.C•PcnnUApp.do: 0Y23/00 4 '10- 46151(11!05 /COMIWEIB /3 67Z /_ A
075 E / S z__4(/'4.6//k/ 6--- - Ails �y� E .-. LfLq / e . Y G
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