Permit ELECTRICAL PERMIT
, CITY OF TIGARD COMMUNITY DEVELOPMENT Permit- #: ELC2010 -00044
13125 SW Hall Blvd., Tigard OR 97223' 503.639.4171 Date'Issued: 01/27/2010
11GAR D Parcel: 2S111CC10100
Jurisdiction: Tigard
Site address: 15790 SW.GREENS WAY
Subdivision: Lot: 0
Project: Davis
Project Description: Add /alter (3) branch circuits.
Owner: FEES
DAVIS, MARSH & HARRIETT T REVOCA Quantity Description Date Amount
TRUST, BY DAVIS, T MARSH & HARRIET T TR,
15790 SW GREENS WAY 3 crt Branch Circuits 01/27/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 01/27/2010 $8.52
Electrical
Contractor:
MITCHELL ELECTRIC INC
1775 NW 3RD
GRESHAM, OR 97030
PHONE: 503 - 307 -9881
FAX: 503- 674 -5855
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 may obtain a+copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
n (�
issued By: I � /. ' � � ■. t rt
Perm ittee Signature:
• 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' Aop 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.
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,A 0:1/26/2010 22:55 5036745855 MITCHELL ELECTRIC PAGE 03/04
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a Received /Cr —�
• " " W , . 13T25 SW 1-lall Blvd. Tigard DatelBy 1 CCZQ • . A. .
•' 5 �+k�� 'Permit No.,
1312 W of Tig gar ;O R'97223 tq f PlanRcvic >+ Oilte[,I?crmit
i x,at" ° v Pllene!' ;503.639,4171 T Fax: 503 : 2 7 Dat e!By. _ ,Av
1.4 >^ 4 Inspect Lmc • 503,6 4175 Pate lteagy/tsy: n s�� pn • r �.o 2 nor
TlUA A R „1 N /Method: PL REV Siipplerncntnllnformatioii -
1i
• � �!�r1 Internet: www Tigard- or.gov ;; OF'T1G
_ , vNISIO JEW
WOE Os I N >. l�I Please check all that apply (submit 2 ..le v plan%w /itcma eheeied'bilo.
• 'D New construction ® Addition /a n %ration /rep lacement ❑Service or feeder 400 amps or ❑ Bi idi s vJr t h ree
1: ' •
Demolition n other-
where the available fault current stories.
e '0,000 amps an174 vuhs ui C7
CATEGORY OF CONSTRUCTION Sess to ground, or exceeds 14,000 bo tlyards.
IN I- and 2- family dwelling ❑ Commercial /industrial Accessory building amps for all other installations, ❑ Floating buildings.
E Multi- family ❑ Master builder El Other: ❑Ftrc pump. ❑ Commerci: - use
agriculhrnl stem
system. y .
JOB SiTE INFORMATION AND LOCATION 0 Emer g - --,. buildings, '
❑Atidition of new motor load of
Jot) no.; Job site address: 1 SW Greens Way 1001 P or-morc- lnsmllatinn ' of:75
KVA err
City /State /ZiP: Tigard, OR 97274 ❑Six or more residontlnl mots. larger separately derived; system,
❑ Health -care facilities, n • ,n. • " -' 1.2''." i-
SJite/bldg. /apt. no.: Project name: Ili
r- r � Hazartintis locations. 3", occupancy
L_I Service or feeder 600 L_,l Recreational vehicle
d street /directions to - job site: amps or +none. parks.
I II Supply voltage for
more than
Silhdivisinn: Lot no.: 600 volts nominal.
Tlix map /parcel no.: FEE SCHEDULE
DESCRIPTION' OF WORK neaed lion t� � �
...
Nov residential single - or mniti4a dwelling oral.
Atld 3 circuits. includes attached garage.
-
i 1,000 sq. ft. or less 168.54 II
Ea. add't.ouu sift. or portion 33.92
El PROPI R1 Y OWNER I TENANT Limitcd energy, residential 67,84
N1nmc: with above s . 0.
Limilca energy, Tnultl-fdmi ly ■ 67,84 MI
Address: residential with above s., fl.
Services,or "feeders installation. alteration, and /or relocation
City /State /Z1F: 200' amps orloss Inn 2
Phone: ( ) , Fax: ( ) 201.am.s to 400 amrs 133.56 2
_ .401 amps to 600 amps ■ 20034 I=
Owirer installation: This installation is borne tl on property t hat 1 own which iA not
601 amts to 1.000 xin 5 301.04
intended for sale, lease, rent, or exchange, according'to ORS 447. 449. 670, and 701. Over 1;000 amps or volts 552.26 2
Owner signature: Date: Temporary services or feeders installation, alteration, and /or
``
r ❑ CONTACT PERSON relocation
APP LICANT 1 200 am.s or less 59.36 1
Business name: • 201 amps to:400 amps 125.08 2
Contact namc: 401 arnpsto 599 amps 160.54 2
Brand] clrcuik §— new, alteration, or extension, per panel
Address: A. Fcc for branch circuit,; with
• above scrviuc feeder. fee. 7 4 Z 2
City /State /ZIP: each branch circuit
13, Fee for branch circuits 1 56.18
Phone: ( ) Fax:: ( ) without sr.rvir nr feeder fee,
E mail:
.- first branch circuit • �' 18 2
2 14.84
CONTRACTOR Each add'I branch circuit 7.42 2
13usinessnamc: Mitchell Electric, Inc.
Miscellaneous, (service or feeder not included)
Address: 1775 NW 3rd Each; or modular
67.84 2
dwcllinQ, service and /or feral
City /State /ZIP; Gresham, 012.97030 Reconncct_only 67.84 2
Phone: (503 )1(179$1R1 I Fax: (503 ) 6745855 Pum. or lrni : ation circle 67.84 2
Si•n. or, outline l Ating 07,84 2
CCB l,ic.: 173822 Electrical Lic.: C244 Suprv. Lic.: 5191$ Signal tircuit(s) or limited-
� t to. —7 . 1 . t t 0. (• w energy panel. alteration, or
Suprv. Llectridiatt slgn��llre, required: • extension. Describe. Page 2 2
Print namc: Tom R. Mitchell ` Date: 01/27/10 Each additional inspectionover allowable In an of the above
I��j / /� / /'� . Per inspection 66.25
Authorized signature: /( /1 // [nvcsti_ation ter hour (1 hrmi,) 66 - 25 ill 11
ll Fr�'C �'C Date: Industrial .lant per hour 78.18 - II
Print name: -.■
. ELECTRICAL PERMIT FEL5
1, 16ullding ∎Permit :\ELC- POrtritApP 10 /0i /09 440.4615T(1l/QS /CONIANED
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