Permit g ' CITY OF TIGARD ELECTRICAL PERMIT
` ;' COMMUNITY DEVE Permit #: ELC2010 00011
TUGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/08/2010
Parcel: 2S 111 AA04300
Jurisdiction: Tigard
Site address: 14450 SW 86TH AVE
Subdivision: GREENSWARD PARK Lot: 31
Project: Bitney
Project Description: Add /alter (2) branch circuits for heat pump and GFI.
Owner: FEES
BITNEY, ROBERT C & KATHRYN M Quantity 'Description Date Amount
14450 SW 86TH AVE
TIGARD, OR 97224 2 crt Branch Circuits 01/08/2010 $63.60
wo /Purchase. Service or
PHONE: Feeder
1 ea 12% State,Surcharge - 01/08/2010 $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 '52- 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: -! _al, . __ . 1 _ � sr 'ermittee 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' S 9 `� -5I U NT V _ Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This rpermit 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.
• • Electrical Permit Applicati ;t�ECEI � r 7 . a ,,t'S� •flFl"1 LSE , 'O \I } .'_'" ' '' , ' .
t mom -,, :, 4kt-0 e. # ,_ (-1(� [
reirg k Received City of Tigard
A /,, Permst No: 9 ' , _ ®, " 1 l
ut � DatelB4. -�
(" " 13 125 SW Hall Blvd., Tigard, OR 972 0 8 2010 Plan Review
^.- Phone : 503.639.4171 Fax: 503.598. pate
° , By
Other Permit. t r H See Page 2 for
i 2 a a lnsptxtion 503 DatrReadylByt �"`
tT1GARD g CITY OFTIGARD Notificd,Meihod: I 1 C[ Supplemental Information
. �.S a?r'rtrr:, Internet www.li -0r, ov � ��; y��j�
TYPE dir ING DIVISION PLAN REy11 cV
0 New construction 1 Additionlalteration /replacement Please check all t it apply '(submit 2 sets of plans w; items checked b' I9 }•)i
❑ Service or f-- +er400 amps or more ❑ ,Building over three stones.
. ❑ Demolition ❑ Other: where the a l able fault cu rent ❑ Marinas and boatyards.
exceeds 10,0 t'1 amps at'150'volts or ❑ Floating buildings.
CATEGORY OF CONSTRUCTION exceeds
to (gown. or =needs 14,000 ❑ Commercial - use agricultural
(, 1- and 2- family dwelling ❑ Commercial /industrial Q Accessory building amps for all . her installations buildings.
Q Multi- family ❑ Master builder ❑ Other: ['Fire pump. ❑ lnstallationof75 KVA or
❑ Emergency s - - cm. larger separately derived system.
JOB SiTE INFORMATION AND 'LOCATION ['Addition of w motor load of ❑ `A ", °E 1 - 2 ", "t - ",
t 100NP occupancy.
Job no.: lob site address: (qt p Sli) 86 ❑
Six ormore , idential trails. ❑ Recreational vehicleparis.
City /State/ZIP:
1' Healthcare cilities. ❑ Supply voltage for more than
,' 600 yolk nominal.
i ` 7 G' tr , Q�^ ['Hazardous .
Suite/bldg./apt. no.: Project name: ❑ Service or 'f - . er 600 -amps or more. ,
. FEE SCHEDULE
Cross str•eetidirections to job site: DeitrinI.ofl -1 PIT. 1 Fee. I Total 1 •
New resident d single- or multi - family dwelling unit.
Includes atta lied garage
Subdivision: Lot no.: 1,000 sq.,;f. o' ,less 168.54 4
Ea. add'' 500 .q..ft. or portion , 33.92 1
Tax map /parcel no.: -
Limited ener.,. residential
67_84 2
DESCRIPTION OF WORK (with above , .8.1
u
Limited ener ,'. multi- family
�1 nn residential with above sq. R.) 67.84 2 i
4tt�t Services'or f eders installation, alteration, and/or relocation
200 amps or ' s 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 00 amps 133.56 2
40] aurips toil i 00 amps 200.34 2
Name:
60] amps to .,000 amps 301.04 2
Address: Over 1,000: ps or volts 552.26 2
City/State/ZIP: Temporary ;erviccs or feeders installation, alteration. and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or ess 59.36 !
Owner installation: This installation is being made on property that I own which is not 20,1. amps.to 00 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to .99 amps 168.54 2
Branch circ � its— new, alteration. or extension, per panel
Owner signature: Date: A. Fee for b cheh circuits with
❑ APPLICANT ❑ CONTACT PERSON above se ice or feeder fee-
7A2 2
each bran. h circuit ,
Business name: 13. Fee for b inch circuits •
without s-rvice or feeder fee, 56.28 2
Contact name: first bran:, circuit
Address: Each'add't r; . ch circuit r 7,42 '1 - 2
hlrsceifane s (service or feeder not included/ - ,
City /State /ZiP: Each.mann !coned ormodular ;67.84 2
dwellin„ s-; ice and/or feeder -.._
Phone: ( ) Fax: ( ) Reconnect.:; ly 67.84 2
E -mail: Pump or i j_ation circle' '. 67.84 2
• • . CONTRACTOR Sign or:.out1 ne lighting - 67.84 2
Business name: Signal circa: cis! or limited-
•� 1 Si on 1 , J - r IA ii al \\ energy pan , alteration, or
Add ress: at � C _. 6''G P'' (ct L c, � c_ C
extension. I eseribe: Page 2
City/State/ZIP: l ' e rvt .c. 4 + / v i 1 k r q7 Zg Each adds oral inspection over allowable in any of the above
Per,inspect !rn 66 -25 1
Phone: (9)5) 41 2_. 25 30 ( 9 > 3 ) a t S `Z Investigati r per hour (t hr min) 66.25
-
CCB Lic.: r 33 {:, Electrical Lic _ S--,2C Suprv. Lic.: 52) C 3 s - In_ du3tiial .i ant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 1 6 - 0
Plan review (25% of permit fee): t--^
Print name: 99 Date: r 1 5 • ii c�
{ U t .it i . m e -5„.v .tale surcharge (12 %0 of permit fee): '7. & 3
Authorized signature: - TOTAL' PERMIT FEE: ri ( . 23
This per 't application cspire5 if a permit is not obtained oithin 150
Print name: I Date: days after it has accepted as complete.
* Number t f inspections allowed per permit,
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Electrical Permit Applicati t�T CEIVEI� •_ F :ro o �l� 2 'r .. _ •
Ci of Tigard Received a /,, Permit No I , r - ' A . Q 3
Dnk /B
� `
1312 Ha Blvd., Tigard, OR. 972 U 8 2010 Plan Review
wT1G'i . Phan. 503.639.4171 Fax: 503.598. Datc/By: Other Permit:
Inspection Line: 503.639.4175 Date Ready/By: J ' Id See Page 2 for
D Internet: www.tigard -or•gov �CIJIJTYYO�FTIGARD Notified/Method: I ((' Suppkmental Information
TYPE �• 1
�}G DIVISION - PLAN REVIEW
❑ New construction [ Addition/alteration/replacement Please cbev$. all ' 11 apph•_(5nbmit 2 sets of plans w;1tctns checked below):
❑ Service or f -- 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where thew ''1 abk fault current ('Marinas and boatyards.
CATEGORY OF CONSTRUCTION eZeccds 10,041 amps at 150 volts or 0 Floating buildings.
- - !ess to go •• or exceeds 14,000 ❑ Comma•cial -use am icultural
g 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all her installatiot. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑Fircpump. ❑. Installation oF75 KVA or
❑ Emergency s •- cm. larger separately derived systerm.
JOB SITE INFORMATION AND LOCATION 0 Addition df w motor load of
C / j/�� 100HP or m. c- occupancy -
Job rho.: lob site address: f qt.4 S o SW p (.c • ❑Six al more •.idcntial units. ❑ Recreational vehicle parks.
, I I
Health -case clinics. C1 Supply voltage for more than
t f ❑Hazardous l.;- aioas. City /$tateCity/State/ZIP: ) ' 600 volts nominal.
C.,GV�
Suitefbldgiapt no.: 1 Project name: ❑ Scrvit or f • cr 600 amps or more.
FEE SCHEDULE
Cross strcet/directions to job site: oesrrittlioii Lcht. 1 F. l Tai al l •
New' csident d single- or multi- family dwelling unit.
lncludes atta hod garage
Subdivision: • Lot no.: 1,000 sq. fL o less 168.54 4
Ea. add' h500, . q. It or portion 33.92 1
Tax map/parcel no.: Limited cner' .. residential
67 -84 2
• DESCRIPTION OF WORK : , (with above. . ft.) ,
Limited goer b mull(- family CO h residential with above sq. ft.) 67.84 2
t u Services or f viers installation, alteration, and /or relocation
200 amps or: s 100.70 1 1 2
❑ PROPERTY OWNER ❑ TENANT _ 201 amps to '• 00 amps 133.56 2
401 arnps.to i 00 amps 200.34 2 '
Name:
601 amps to , ,000 amps 301.04 2
Address: Over 1,000 • :• ps or volts 552.26 2
City /State /ZIP: Temporary . crvices or feeders installation, alteration. and/or
relocation .
Phone: ( ) Fax: ( ) 200 amps or ess 59.36 I 1
Owner installation: This installation is being made on property that I own which is not 201 arnj,sao 00 am _ 125.08 2
intended for salt, lease, rent, or exchange, according•,to ORS 447, 449, 670, and 701. 40) amps to, .99 apps _ _ 168.54 2
Bninch its— acw, alteration, or extension, Leer panel
Owner signature: Date: A. Fee for h itch circuits with
❑ APPLICANT 1 • • ❑ CONTACT PERSON above se ice or feeder fee, 7 42 2
each bran, h circuit _
Business name: 13. Fee for b inch circuits
without s or feeder fee. J 36.18 ( 8 2
Contact name: first bran: circuit l
Address: Each add''`.: :. hcircuit i ' 7.42 _ '1.42 2 -
Miscellane • s (service or feeder not included) ,
City /State/ZIP: Each menu etured or modular : 67 84 - 2
dwelling, s' , ice and /or feeder- _.
Phone: ( ) Fax :: ( ) Reconnect ., ly 67.84 2
E -mail: Pump or i ;• 1lti°n circle ' 67.84 2
• • . CONTRACTOR . • Sign or outl nc lighting 67.84 2
• Signal circt.1(51 or limited -
Business name: Sr M� S on (e t 1n C c. 1 Ct r tsfr'ur f ov C 0 energy pan , alteration, or
Address: , 64 1 V extension. ti escribe: Page 2 2
•'1a1 A C
City/State/ZIP: G - ; 11 - 12 •`j (Z(> Each addi r onal inspection over allowable in any of the above _
Per inspect .r n 66.25
Phone: (SD) - Fax; (2>3) 0 1ST Invlstigati•• per hour (t hr min) 66.25
CCB Lic.: 1 ( 1 Electrical L i , _ c--2C Suptvv. Lic.: 57) c 3s Industrial .i ant per hour 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: • Subtotal: (�, 3 - 0
(1 0
Plan review (25% of permit fee): .r.-� —••
Print name: / Date: i I ` C � • urge ( a p ): • � • c� 3 �.
1 2U t /1 J i rY1 e''),--1 h ate surcharge l2 of ermit fee
Autho rized signature: - TOTAL PERMIT FEE: , -- 1 (. Z 3
This perm t application expires if n permit is not obtained within 180
Print name: Date: I days after it has been accepted as complete-
• Number ,f inspections allowed per permit.
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