Permit , ,,���` i N�'; (t ;`' ", ELECTRICAL PERMIT
� �� i 1 �,T t CITY OF-TIGARD .
P� �; COMMUNITY DEVELOPMENT Permit #: ELC2010 00041
. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 01/22/2010
1� ( R L g Parcel: 1 S135DB10600
Jurisdiction: Tigard
Site address: •1.1076 SW 95TH AVE
Subdivision: ASHBROOK FARM Lot: 22
Project: Michaelis
Project Description: Add /alter (2) branch circuits to reconnect furnace.
Owner: FEES
MICHAELIS, CLAYTON Quantity Description Date Amount
11076 SW 95TH
TIGARD, OR 97223 2 crt Branch Circuits 01 /22/2010 $63.60
wo /Purchase Service or
PHONE: 503 - 620 -3494 Feeder
1 ea 12% State Surcharge - 01/22/2010 $7.63
Electrical
Contractor:
ALL WAYS ELECTRIC
PO BOX 68456
MILWAUKIE, OR 97267
PHONE: 503 - 652 -5142
FAX:
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 may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
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Issued By: III.. AIL C' g ! _ L I / _ Permittee 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' • i )ret. ' Date:
1 r
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.
'CITY OF TIGARD _ • Ch k#
• '' • :• �� + ll E Perm i t Application PIan.ec
13125 SW HALL BLVD. Recd By
J AN 2 2 Date Recd
TIGARD 97223 2010 Date to;P.E.
Phone (503) 639-4171, x304 CITY OF T GA Print of Type
Date tq DST
e
Inspection (503) 639 -4175 BU 8lie � c ible will not be accepted . Permit # Fiez
. Fax. (503) 5984960 . . Called'
1. Job Address: 4. Complete Fee Schedule. Below:
. Number of Inspections per permitallowed
Name of Development Service included: Items Cost Total
Name (or name of business) .,,tL, : GO� .
/ O 7 - 5' /` 4a. Residential - per unit
Address p �(/ jf , �. �� 1000 sq. ft. or less $147.15 4
City /State /Zip - 1779A `7A 0 L " Each additional 500 sq. ft. or
/ / 97 Z-3 portion thereof • $33A0 1
Commercial ❑ Residential Limited Energy $75:00
Each Manufd Home or Modular
Dwelling Service or Feeder $90.90 2
2a. Contractor installation only: .
4b:'Services or Feeders
(Prior to permit issuance, applicants must provide contractor license Installation, alteration, or relocation
information for COT data b . se) 200 amps or less $80.30 2
Electricalract0 - 4 s -C' ' 201 amps to $100.05 2-
Address V. O •• • Afi.il • _ • 401 amps to 600 amps $160.60 2
City 6 �� •
' r
Ci State f / •- Zip 601 amps to 1000amps $240.60 2 '
Phone No-03 -‘:, S2.--.S7cz---•-- Over 1000 +amps or volts $454.65 2
Reconnect only $66.85 2
Job No.
Exp.Date 4c. Temporary Services or Feeders
Elec. Cont: Lice. No. - p Installation, alteration, or relocation
OR State CCB Reg. No. / 32/ Exp.Date 200 amps or less $66.85 2
COT Business Tax or Metro No. Ext ate 201 amps.to 400 amps $100.30 2
401 amps to 600 amps $133.75 2
Signature of Sup -! -
i Over 600 amps to 1000 volts, •
�� . see "b" above.
License No. /2Zj7 -5 Exp.Date -- / /O 4d. Branch Circuits '
Phone No. New, alterationor'e`'xtension per panel
tno�N
� 1 C sec i IS - 10 G � c , • r(�R A/ ►�c -� a) The fee for branch circuits
e C. L with purchase of service or
2b. For owner installations: feeder fee. •
Each branch circuit $6.65 2
Print Owners Name b) The fee for branch circuits p
Address withoutpurchase of service O� p
or feeder fee. / � 1 6
City State Zlp • First branch circuit /
Phone No. Each additional branch circuit
/ Z 7v.
The installation is being made on property I own which is not 4e• Miscellaneous 7
(Service or feeder not included)
intended for sale, lease or rent. • Each pump or irrigation circle $53.40
Each sign or outline lighting $53.40
Owner's Signature Signal circuits) or a limited energy
panel, alteration or extension $75.00
' 3. Plan Review section (if°required) * \ Miin abets (i 0) $125.00•
1 1 4f. Each,ad inspection over
Please check appropriate item and enter fee in section 5B- _ .- the allowable 'in any of the above
. 4 or more residential units in one structure � $62.50
Service and feeder 225 amps or more 'N Per•hour7 $62.50
System over 600 volts nominal ' In Plant $73.75
py
Classified area or structure containing special occupancy as ,5 Fees: I
described in N.E.C. Chapter 5a. Enter total of above fees $ , 3 - b 3
8 %° Surcharge (:08 X total.fees) " $ ____7_
* Submit 2 sets of plans, with application where any of the above apply. Su $
Not required for temporary construction services. 56. Enter 25 /o of 'tine 5a for
NOTICE Plan Review if required (Sec. 3) $
Subtotal $
PERMITS BECOME VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS'NOT COMMENCED WITHIN 180 DAYS, OR IF CONSTRUCTION OR ❑ Trust Account # �J / Z 3
WORK IS SUSPENDED OR ABANDONED FOR A'PERIOD.OF 180 DAYS Total balance Due / / �•
AT ANY TIME AFTER WORK IS COMMENCED. •
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