Loading...
Permit CITY OF TIGARD ELECTRICAL PERMIT $ COMMUNITY DEVELOPMENT Permit #: ELC2010 -00440 T I G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010 Parcel: 2S104BB04400 Jurisdiction: Tigard Site address: 14119 SW LIDEN DR Subdivision: Lot: 0 Project: Hoskinson Project Description: Panel replacement. Owner: FEES HOSKINSON, ROBIN L & Quantity Description Date Amount HOSKINSON, DONALD G, 14119 SW LIDEN DR TIGARD, OR 97223 1 ea Services or Feeders - 200 08/26/2010 $100.70 amps or less PHONE: 1 ea 12% State Surcharge - 08/26/2010 $12.08 Electrical Contractor: OAKLEY ELECTRIC INC 11500 SE SUNNYSIDE RD APT N -15 CLACKAMAS, OR 97015 PHONE: 503 - 855 -4712 FAX: 503 - 855 -4723 Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 obt +f1he rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344. Issued B . s. /_AIL Permittee Signature: Ales - asr — 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. CaII 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 ` . , ..: ,, „, If.-•T V' ,f it h .t :.: Electrical Permit A Ilic AUG 2 2010 ` City of Tigard F OFF IC [ SE ONL1 13125 SW Hall Blvd., Ti Ord, Received :� a 1 3 1 25: W 503.639A Blvd. g OR 9722317 ' OF i"1, "� � DareB . i, Permit No. Fax: 5 03.59 &1960 �,, -, �• Pla elg : w � C� t(ll XRD" Inspection Line: 503.639.4175 LI� "L'''' �4 ' ar t i�i ' Date Read 9`tij �ateB : ,• Interact: Www.tigard.or.gov Pamit: TIG Notified/Method: /1111V C4 See Page 2 for TYPE OF WORK w I:9 Supplemental Information PLAN REVIEW ❑ construction New 5 t -Additio n/alteration/replaceme n t 1 D e m olition ❑ Other. P acement Please check all that apply sets a w /items checked be/ow): ❑ Service or feeder 400 amps w more ) CATEGORY OF CONSTRUCTION where the available fault current ❑Building over ]here stories. �. I- and 2 - family dwelling exceeds 10,000 amps at 150 volts or 0 0 Floating Marinas nod boatyards n8 ❑ Commercial/industrial ❑Accessory building less to ground 14,000 Commercial �u or exceeds 14000 e asrieui ❑ Multi - family Master builder mral O ther: Fires Wrailothairtsla0atioas, buildings. INFORMATION L7Ftre pump. JOB MT INFORMATI LOCATION ❑ Emergency system. 0 Installation of 75 K VA or Job n0.: Job Site address: ❑ Addition anew motor toad of larger separately derived system, / �1 // S /tJ L , ' Y� Q 100HP p -A . E -1-2", l 3 • or mare ❑ Six or more resider; occupancy. tal 'm'IS• ❑ Recreational vehicle parks. Suite/bldg./apt. ._ /. _;l ❑111 ❑ Hazardous locations. facilities. ❑ Supply volta no.: Project name: ns. ge for more than Ire • ► 0 Service or feeder 600 600 volts nominal. Cross street/directions to job site: amps or more. FEE SCHEDULE Desert .,ton IIMIN New residential single- or multi - family dwelling uni `311RIENI t. Subdivision: Includes attached garage. Tax map/parcel no.: Lot no.: I,000 se. 11. or less - Ea. add'] 500 sq.11. or portion � DFSCRIP I10N OF Wpm{ Limited energy, residential (with above .. tt. 111 75.00 MEI / It. Limiter energy, multi residential with above . R and J �© Firm Services or feeders installation, alteration and/or relocation ❑ PROPERTY OWNER 200 amps or less in TENANT 201 amps to 400 amps 100,70 /CO '74' Address: 401 an to 600 amps 2 �© 601 amps 101,000 amps City/State/ZIP: Ova amps or volts .6 man s r 5 552 52 26 WINE Temporary services or feeders installation, alteration, and /or Phone: ( relocation IZIIIIIMIIIIIIIIIIIIIIII Owner installation: This installation is bein m 201 amps or less - intended for sale, lease, rent, or exchange, g won property that I own which is not zo l amps to am0 amps ge, accord to ORS 447, 449, 670, and 701_ 401 amps to 599 amps 125.08 � Q Owner signature: 168.54 111111111111E1 Branch circuits new. alteration, or extension, . er and Date , CI APPLICANT - ___ A. Foe for branch circuits rvirh Business name: ❑CONTACT PERSON above service or Feeder fee, 11111111 .L:, ±• .:. each branch circuit Contact name: B. Fee fix branch circuits wUhoar service t feeder er fee, first ���© Address: [ blanch circuit Each add'1 branch circuit 11=11111111MEI City/State/ZIP: Miscellaneous service or feeder not include . Phone: ( ) Each manufactured or modular domino :. service and/or feeder Reconnect only Ma 674 `� Pump or irrigation circle J CONTRACTOR Sign or ratline lighting _ Business name: c+ 67.84 �© �C�tE l -tYC ` Signal ttt(t(s)or extension. energy m �� Addre el, aiteraerai te or limited-energy � ss Q 10. S S' ..,ac. Each additional f . • cairn over alfowabk in an of the above Ad d re ate/ZIP: `` ' k , - 15 0 Additional' MEN G ac k,.., r, • . it C' rupection (t hr min) Phone _ Investigation (1 hr min) r 66.25/ hr ` 3 ) k �” A! i ' [ndastrial plant (1 hr mitt) CCB I. / �. , Inspections for which no fee is ��� �} / J Electrical Lic y5-6 Scall listed %: hr min P 90.00/ hr Suprv. Electrician si Suprv. Lic.: 7/ 7G5 gnature, required: ELECTRICAL PERMIT FEES ,—....— Subtotal: WaSijai Print name: Plan review (25% of permit fee): fit - - Date: Authorized signature: State surcharge on, of permit fee): Print name: r" ------ This TOTAL PERMIT FEE: /rC / f d Date: permit da it has te d perm,t is not obtained within • Namberofids been accepted as complete peetiom allowed per permit, Z'd L60609L909 0!J10812 �Ce i o ab£: L L 0 L bZ 6nb'