Permit •
71 CITY OF TIGARD ELECTRICAL PERMIT
..:..0.17 COMMUNITY DEVELOPMENT Permit #: ELC2010 00432
:TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/20/2010
Parcel: 2S 104AA90322
Jurisdiction: Tigard
Site address: 12646 SW KAREN ST 32
Subdivision: Lot: 0
Project: Bellwood Terrace
Project Description: (2) branch circuits for washer and dryer.
Owner: FEES
BELLWOOD TERRACE LLC Quantity Description Date Amount
PO BOX 189
YAMHILL, OR 97148 2 crt Branch Circuits 08/20/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/20/2010 $7.63
Electrical
Contractor:
FIRST ELECTRIC CO
19093 S BEAVERCREEK RD #305
OREGON CITY, OR 97045
PHONE: 503 - 632 -8373
FAX: 503- 632 -7989
Type of Use: MF
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 ma o•tain a • • • I - • les or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i
Issued By: s��� Permutes Signature: � g2).7Z.r...___"•����
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.
Aug 19 10 01 :09p Mark Lengele 5036327989 p.3
Electrical Permit ri��1CBtl f .' 11 r t. r t I:I s i . r\ l
arty of Tigard nn r 19 2010 ' /� L -
13125 SW Hall Blvd., Tigard, OR 9722 U G I
t -:: ' Phasic 503.639.4171 Fig: 503.5911.1060 , .: Clhee Par*:
Inspection LIM 5034639.4175 a'r' r(- 1 I I i ?�°; ;. % DM Resdyter NM 81 See Page 2 for
+: hornet: aww.tigard- or.gav r • t NotifiediMoh d: v 9ppplem m
emMI raferatiten
0 tti rhlhir „tli , ..:i
0 Newconat=iction Add4tionlalttlation /1110114ernent dicer all d m sooty (sabmtt lass althea w4laaeehetitodbeam):
❑ Service er theder 400 amps Wimps Q Building aver time s wiea
0 Demolition 0 Other whets dm avaaeble WU migrant ' 1:1 Main= cad bvatynrth.
.. t : t [ 'SS)liiR ' er cbaPi3Xxtt7cE101ct • . exceeds 10.000 maps at Igo volts er O Floating toi2dinp.
• Item to around. W exceeds 14.000 ❑ Coro metcid.axo t
- and 2- famatiy dwelling ❑ Commercinirirdustrial 0 Accessory building now fur all outer iaatanaeiom. exdWingv.
g itliti-tamily 0 Mater builder 0 Othet: UFOs nom. ❑ h t gauon of ll KW. er
Mao syatew. terms s�taxecly derived system.
• y 8g6B fi�QRI` '>EA�llr AtND 'b K54TWN ❑ Addition anew moor lead of D 'A S. -1 -2 "1-3",
Job n0.: vol
Job slit a {{� ( i s Of mo risi ocorpsocy
�j rj 1 � � 1 L 1 / ,1 W �" \0.SC S� laSu or tawo,ssidmtial moms. CI Reerent t:MI vehieia patter.
Ci /StOte/ZIp - -- c , (r �a t V ❑?1wUh•enre Facilities. 0 Supply voltage for mete than
tY l -.r. V . ❑Harudwr lacniatm. ticn
Suirelbldg. /apt, no 3 Project name: Re.11ta.) . Tecca.ce. If -s a$etvtaear6aa4er600 mmpeee mete.
Cross strectfd' • tau 10 job sits: • wortopwl 1 tats. L Pte j Teed I •
New residential single- or multi- faln1Iy dwelling wait.
IIadndes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. A. or Ilan 168.54 1 4
Ea, add'1500 sq, fi• or portion 33.92 1
Taos mitp/parcel no.: Limited energy, residential
- : . • : B.$♦::ti 'LION OF :wdllic ' ' .. (Faith above s9. a.) 67.84 2
l Limited etusgy, snutti•family
1 . W G
l,3, •..5 4c i \ e c c..s C,A Cs
c,--A-3- ( J t .. , c l s resided (with above sq. a.) _ b 2
Services or kcdcrs itembtllatton nrtdMr rcloeutia
200 amps or lcu 100.70 ' ' 2
.. :r.2 OP : diVNE it .' .. • • .. L . • . ❑ mom- • . 201 apepo to 400 Imps -
133.56 2
Nu m: 4111 manes to 600 imps 200.34 2
601 amps to 1)000 maps 301.04 2
Address: Ova 1,000 amps or votes 552]46 , 2
City/State/ZIP: Temporary scrvicuor feeder's installation, a 1 krone n, and/or
relocation
MIMIC ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that town which is not 201 mops to 400 mops 125.08 2
intended for sale, tease, rent, or exchange, according bo ORS 447, 449, 670, and 701. 401 snips to 599 arms 168.54 T2
Owners mecum Dale: Braneb circtits - new alteration• or ester ' . •. nc
A. Fax for branch circuits wide 111 •
• ' •13 It ICAN F • • • • ' • I • D`cOM'ACT MASON • above service or feeder fee, 7.42 2 •
- - -- each breach eireoik
Business na mm• B. Re for breach circuits
Contact reams: wirltour service or ftedel Il c r 56.18 t (t SL 1 2
fast branch circuit f
Address: Each pdd`I branch circuit - t 7.42 7, -( - 2
•
- 84oteellaneons (service or 6ader not ;needed)
City/State fZiP: Each manuGeptuoed or modular 67.84 2
- dwcilingoctvka and/or feeeder
Pbonm ( ) Fax:: ( ) Reconnect only 67.84 2
F. Pomp or irrigation shale 67.84 2 1
Sign at outline lighting 67.84 2
~ Business name: (.- ST ELE�tc, C�v�n CD41v'`e signal circuit(s) al e r Pion: o -
,i�� J ( ener panel, alteration or
Addrac: P L) t J�X �� io 1p essrnaion. Describe: Page 2 2
Ci State2IP. n T � S Each additional impeedon over allenritbkin an of ette above
�� w■IN �t �� ` q Per inspection 6625
Rhone ( sue ) t � 3 1 Fax: (5.'3) (.7'. 79' � 1 Investigation per hoar (1 hr anti) 6 625
-
CCB Lie: l e. f-' L4, J Electrical Lie.: [ -• s l l Suprv. j ic.:44. 49' (, j industrial plant per 78.
Suprv. Elcctrician agnaturc, required: c __,„„ (_ Subtotal; •[
Print nsaae: S / Date: Pl an review (25% of peanut fee):
� � � - ' J f 1�( I C� State surcharge (12% of permit Re): io3
Authorized signature: r/� .t9- + TOTAL PERMTr FEE' -11 �3
1.%: 7 rite permit apptia lion mrr
pi ;r a eersoir le vial a blaiaed withta IRO
des, \ ��1� i � � dome voter toles been aeeeptedaeeetapletc.
• Ntuabe r*fin:pealm% Aland per vomit.
Nauilli n Pond .G PernsdAaadot tot0,l09 44a- acISTQ1so lc wain
Of L J ale_