Permit n CITY OF TIGARD . ELECTRICAL PERMIT
I
.. COMMUNITY DEVELOPMENT Permit #: ELC2009 -00481
Date Issued: 09/11/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 1 S136DD03800
Jurisdiction: Tigard
Site address: 11675 SW 66TH AVE
Subdivision: WEST PORTLAND HEIGHTS Lot: 7
Project: City County Insurance Services
Project Description: (3) branch circuits for power pole
Owner:
FEES
CITY COUNTY INSURANCE Quantity Description Date Amount
1313 COURT ST 3 crt Branch Circuits 09/11/2009 $60.15
SALEM, OR 97303 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/11/2009 $7.22
Electrical
Contractor:
KEC ELELCTRIC INC
1281 NE 25TH AVE # K
HILLSBORO, OR 97124
PHONE: 503 -439 -0904
FAX: 503 - 640 -3838
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $67.37
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
� 6 6699 or 1.800.332.2344.
Issued By:
/�_ Permittee Signature: g' v .6 ° L ` e `l - 0n
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.
',.. Sep 10 2009 15:53 KECELECTRIC 5036403838 p.1
Electrical Permit Application rol: OFFICE I.SEONLV
City of Tigard alVED RecOved -
DatelEt : Aral _HIT:FT t —Del Ve9
.
4 15125 SW Hall Blvd., Tipnigi/ Plan Revie -
I PitN eoa
I I Phone: 503.639.4171 Fax: 503.598.1960 Date/By: °Me Pami ld4,0WO ( i -De /50
T ) c , \ 1 , i ) Inspection Line: 503,639.4175 t ., Ep I 0 Z009 D a t e R e a d y / B y . : J u r i s . : . • _ l i g See Page 2 for
rn
Inteet: xwew.tigard gov Notified/Method: / /6 llupptemental Information
U:lllilV.: 'i •,'77.::: ;,, ii......-T-----;. .Vi l.; ''.::::'
IC .rtnrvisi:
0 New
construction Additi. El Additi., :., : Ill ,2, TURgif PI- . check all that apply (submit/ sets of plans w/items checked below):
0 Other.' Il . Os ice or feeder 400 amps or more ID Building over three stories.
0 Demolition
w. ere the available fault current 0 Marinas and boatyards
.: ,' ex ds 10.000 ansps at !SO volts Of 13 Floating builchngs.
,d;,,,,fftrelirs,L,_ ,..„:-.=;!;:n1:::.F.E.,z,i141:::,:::::riV;,..,.',. le. to ground, or exceeds 14,000 0 Comercial-use agricultural
0 1 - and 2-family dwelling Isi Commercial/industrial 0 Accessory building a • ps for all other installations. buildings.
Ei Multi-family 0 Master builder 0 Other: 0 Fi pump. 0 Installation of 75 KVA or
DA IMOf larger separately derived system.
to r occupancy.
Job no.: 09-1050 1 Job site address: 11675 66th Ave I or more.
0 Si or more residential units. 0 Recreational vehicle parks.
City/State/ZIP, Tigard, Or OH., tb-care facilities. 0 Supply voltage for more than
1:I .•A. does locations. 600 volts nominal.
Suite/bldg./apt no.: I Project name: City County Insurance OS • cc or feeder 600 amps or more.
.,,.1.R74nSlintlf t40** . ,03:,:il::.:Z
Cross street/directions to job site: Desert .. be I Qty 1 Pee. 1 'nem
New residential single- or inolii-family dwelling unit.
-
Ind 'es attached garage.
-
Subdivision: I Lot no.: •' 14 sq. ft. or less _ 145.15 4
Ea. a , d'l 500 sq. ft or portion 33.40 1 ,
fax rnaptparcel no.:
Limi d energy, residential
75.00 2
..'"'::'.:::::.. A ' '.:: , : , : , ;;T '' Y !':::.T...kr••••, .... ... ,,, l'iliVi1tItTiPTRAVIFF#VjegrEE (w. th ab' s q. ft)
Limi . • energy, multi-family
Add 3 circuits for power pole re' 'dential (with above eq. ft.) 75.00 ; 2
Sery ces or feeders installation, alteration, and/or relocation
200 , :,s or less 80.30 2
!.:.:-,.'..7.".!.T::;.:•:,::W0‘11iirk:::"Wpyirsyti,(,i.tli ..................................................... WI zi 201 , . to 400 amps 106.85 2
Name: 401 : .. to 600 amps 160.60 2
601 :, .. to 1,000 amps 240.60 2
Address:
Over 1,000 amps or volts 454.65 2
City/State/ZIP: Tem t irary servites or feeders installation, alteration, and/or
rel 1 , don
Phone: ( ) Fax: ( ) 200 ,., •• .: or less 66.85 1
Owner Installation: This installation is being made on property that I own which is not 201 , . to 400 amps , 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 . • to 599 amps 133.75 2
Bran h circuit; -. new, alteration, or extension, per panel
Owner signature: Date:
, A. Fe for branch circuits with
tliii*j.TatAittid::::::..:::.i4Fk;ift#0,tgictifstitictew.:,ifti,i : . .ve service or feeder fee,
6.65 2
ei h branch circuit
Business name:
B. Fe . for branch circuits
wi out service or feeder fee, 1 46.85
Contact name: 46.85 2
fi t branch circuit
Address: Each , • . '1 branch _ circuit 2 6.65 13.30 2
Mi Ilaneous (service or feeder not included)
City/State/ZIP: Each . anufactured or modular -
90.90 - 2
dwell ' g, service and/or feeder
Phone: ( ) Fax: : ( )
Reco nett only
66.85 '
2
• -
E-mail: Punt. or irrigation circle 53.40 2
' -. 2'NT:;:iiiiiiii Sign 'r outline lighting 53.40 2
Sign , i circuit(s) or limited-
Business name: KEC Electric, Inc
panel, alteration, or
Address: 761 SW Bailey Ave exten :ion. Describe: Page 2 2
City/State/ZIP: Hillsboro, Or 97123 Each additional inspection over allowable in any of the above
Per i pection 62.50
Phone: (503) 439-0904 Fax: (503) 640-3838 '
/ Lnve igation per hour ti hr min) 62.50
CCB Lic.: 99267 x/ Electrical Lic.: 34-426C Sunrv. Lic.: 44S98 Indus 'al plant per hour 73.75
, 414,7i * . ,_;Arftiggill:F4* - -i': :''
Suprv. Electrician signature, required:
Subtotal: 60.15
Plan review (25% of permit fee):
Print name: Kenneth E. Conway te: 9/10/09
State surcharge (12% of permit fee): 7.22
Authorized signature:
TOTAL PERMIT FEE: 67.37 /
This permit application expires if s permit is not obtained within 180
Print name: Date:
days after it has bemi accepted as complete.
• Number of inspections allowed per pennit.
LVIudaing1Pene1ts1ELC-Pcrmitapp.doe 05/23/06 444-4615TO 1./05/CONYWES