Permit CITY OF T C ARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00340
IiGiARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/07/2010
Parcel: 2S103BB09900
Jurisdiction: Tigard
Site address: 12040 SW 122ND CT
Subdivision: YE OLDE WINDMILL Lot: 20
Project: Brummett
Project Description: (2) branch circuits for ceiling fan and can lights.
Owner: FEES
JOSEPH, HENDERSON AND JUDY Quantity Description Date Amount
12040 SW 122ND COURT
TIGARD, OR 97223 2 crt Branch Circuits 07/07/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/07/2010 $7.63
Electrical
Contractor:
MR ELECTRIC OF CLARK COUNTY
14300 NE 20TH AVE. D102 - 313
VANCOUVER, WA 98686
PHONE: 360 -574 -7200
FAX: 360- 546 -2158
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.
Issued By: �'d� 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' 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.
l Jul 7. 2010 1 ' ` L r y N o 4 2 2 9P2 ectrrcal hermit AppYr �� i� , lO Imihlc I ;is E n.'., . � , I w.!.:' ,t .� h AWa n +N ; \,ix4 1 ,43 a1' uV , a6 4kvA , lw., FA,, :, ,,„ n r'„ \, ,,
r ., ` ` City of Tigard `Aeoetved D. T® Pfrrn."° .: J — or t
y, �U 0 6 2010 P
P hone : 639:117I Fax: 503 Plan Re view Other Perinit:
, Terry
/ 1312 +5 Vlr Hall Blvd Tigard, OR 972
.1960 T r, DaielB
;' inS eetipnLme. 5 OF `1 r - DaleReadyBy: AWE 4 Seefege2 -
r fqr -
) ht \ II, ,' p LUNG DIi IO
DIVISION
NoI fiied/Mclhod: 0 Supplemental Ii ormatlon
s,,i Internet wtvw.t tJ V a7
TYPE O 'WORK PLAN REVIEW; .,
•
❑ New construction Addition/alteration/replacement
Please check all that apply (submit g`aete of plans iv /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
El Demolition hi Other.. _ where the available fault current
11 Marinas and boatyards.
' CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
•
Less to ground, or exceeds 14,000 ❑ Commoroial -use agricultural
O L v i - and 2- family dwelling [] Commercial /industrial [] Accessory building amps for :a11 other installations, buildings.
• 'Multi family' ❑ Master builder 11 Other: ❑ Fire pump. ❑ Inatallati(nof or
❑ Emergency System. larger separately derived system,
JOB SITE INFORMATION ANI! LOCATION ❑ Addition of new motor load of ID "A ", "E"'; " 1 - 2", "1-3",
6 Job site address: 12.01-1 , 1 / �.� 100; 1P of e rrs. occupancy:
. Sob.no.;
I ��� V� ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Statc/ZIP: (c'G (', (. 512_, 01 '223 ❑ Health -care facilities. ❑ Supply voltage for Mora than '
❑ Hazardous locations. 600 volts nominal...
SUite/bldg. /apt. no.: Project.name: 6 ( `I V�Q * ❑ Service or fender 600, amps or more.
nE:SCHEOU E . .
Cross_ streetldirections to job site: 5,,A) x ..� (...\,_, Descripti Description .. 1, 1 ' Fee . I row 1 '
New residential single- or multi - family dwelling unit.
Includes attached garage,
—
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54. 4
Tax map /parcel no.: Ea. add'I 500:sq. ft. or portion 33.92 I
Limited energy, residential 67.84 2
DESCRIPTION OF WORK (with above sq, ft,)
Q ( Limited energy, multi - family 2
2 C A..1-1 k .Q, x 6 v .A., Co Ai ( 2CZ�,t�1 residential (with above sq. f1;) 67.84 _
` , �.� (J Services m' feeders instsllation and/or rclotafiol
4— C_ CuV\ 1‘ct `A-'S 200 amps or less 100.70 2
ROPERTY '01VNER ❑ TENANT 201 amps to 900 amps 133.56 2
Name ; vtd� ri A, Q 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: , 7 O 0 ,'7 z D C-4- -• Over 1,000 amps or volts . 552.26 2
City /State /ZIP: Y � Temporary services or teeders Installation, alteration, and/or
i l — relocation
Phone: ( 56j )S w Zvi 73 , . Fax: ( ) 200 amps or less 59.36 1'
Owner installation: This installation' is being made on property that I own which is not
201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature' ,Date: A. Pee for branch circuits with
PLICANT� • 0 CONTACT PEIRSON abov service Or feeder fee, • each branch circuit 7 "42 2
Business name: a 1 R t t__. B. Fee for branch circuits
Contact name: ( Q � wlfhout service or feeder Pee, 56.18 - )S O 2
first branch,pircuit
1 LA) .2 ` (cc y (.3 Each add'l branch circuit 7.42 +- 2
Address: ` �(�
1 ' Q 4 Miscellaneous (service or feeder not Included)
City /State /ZIP; J ovA(Cf3JVeC r ct l 1 G (�f a Each manufactured or modular'
: 67.84 2
Phone: 7q_12. '7 Fax: /RL� 1
dwelling, service and/or:feedcr
�a) 7 f U� S l,2 — Reconnect only 67.84 2
E -mail: on 1 k ` ..•'! w Q,\ e J (, C L , L. ( , (N - v .. Pump ^or irrigation circle 67.84, 2
' CONTRACTOR Sign or outline lighting 67 :84 • : 2
I � Signal circuit(s) or limited -
Business name:
�( f I t_ 1 energy panel, alteration, or
Address: 1'.-V ?.c-'--' 1 — I extension. Describe: Page 2 2
City /State /ZIP: vCA fy\c��) o- • I � Each sdditfonal; inspection over allowable in atiy of the above
) S-7 N .- 'D Pte, ) f r ?-( Per inspection 66.25
Phone: 7 c v v �.P Investigation per hour (1 br min) 66.25
CCU Lic.: Electrical L c.r Su rv. Lie.; Industrial plant per hour _ 78.18
C`3L ELECTRICAL PERMIT FEES
Suprv. Eiectri signature, roquir d: /_ y ._ Subtotal;. (0 . f P_
Print name: Q s j , f .Date: . 71 ) Plan review (25% of permit fee);
�/i 9 ({ State surcharge (12% of permit fee): G'
,
Authorized signature: -- - TOTAL PERMIT FEE: (, 2,3 '
This permit application expires if a permit is not obtained within 180
Print llama: ` / � C DatC: ( days after, 10 has bean accepted as complete.
d I * Number of inspections allowed per permit.
:I:\ Building \PrrmitS\ELC- POrmhApp.doe 10/01/09 440 461 5T(11 /05 /COht/WEF
Val ,e,i s —