Permit CITY OF TIGARD ELECTRICAL PERMIT
iii III
l: COMMUNITY DEVELOPMENT Permit #: ELC2010 -00452
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/26/2010
Parcel: 2S102BC01400
Jurisdiction: Tigard
Site address: 10250 SW WALNUT ST
Subdivision: Lot: 0
Project: Frazee
Project Description: Grounding.
Owner: FEES
FRAZEE, JOHN & NOREEN Quantity Description Date Amount
10250 SW WALNUT ST
TIGARD, OR 97223 1 ea Reconnect Only 08/26/2010 $67.84
PHONE: 1 ea 12% State Surcharge - 08/26/2010 $8.14
Electrical
Contractor:
A & J ELECTRIC
PO BOX 330
FOREST GROVE, OR 97116
PHONE: 503 - 359 -5891
FAX: 503- 359 -1981
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $75.98
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 9 2- 001 -0100. You ma • • - • • - - • - •, questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
" Issued By � � l� �T 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.
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.
Aug 26 10 08:54a Leeann Greason 503 -359 -1981 p.1
RECEIVED
Electrical Permit Application AUG 2 6' ; ',',0 i ,, I: „ :1 ! „.1
City of ligard CITY OF TIGARD ;,�.. /o f7 PencitNo.: e 1 '(..D 1 (.5�..
. Photo: 501E39.4171 Hall .4171 Tigard.
Fos SOCi.598.
a ,ox
Fbox: 503.b 97 LDING DIVI„ IOI • atberl:'21tht: r+ - O. e X
11 , „ Inspection la 503.639.4175 DoeItady/BY. tact. 6 1 See` Mr
Internet vsww.tigerd4gew Notifredaterboct l emu' Supplemental Imatutettem
TYPE OF WORK PLAN REVIEW .
0 New noun Eil Additionhdtesationhepiacememt Please deck .n tbss apply (.abtaitg sets orpians witans decked betas*
O Stroke or feeder 400 amps or more 13SuBsfing over three eon=
p Demolition ❑ Ott wta:e the avrlebie fsih emus Ol Leine mid boatyards.
CATEGORY OF CONSTRUCTION mmmds 1R4OOampsed1S0voltsar O Fbasin g b di
. katog=otmd,areeooeedsl4000 0 °ommmaahaea g +ia+faxd
12 1 - sad 2-familydwelling ❑ Commereielindustrial ❑ Accessory buikting naps for ail other cntalleims. balding}.
0Multi-femtly ❑ Mester builder 0Other. °Ferepeep. O known= cos INAor
ClEmergeney system. l r .y derived spa=
JOB SITE INFORMATION AND LOCATION OAda k's sinew mota load of D •A'. '8'. •1-r. - 1-3",
. 1001:1P or mom occupancy.
Job no.: I Job site addtese \D c`��O Smell \\ bs\C� O Six or more Merl unib. 0 Itzereatireat vehicle mao.
aBca>m eareiodidea. ❑ Supply voltage for mom tban
----, -,,,C 0 Saudms localism. 600 oohs nominal.
Suitebldglapt.no.: I Project name t e_e_ 0 Semiaearfeeder600 amps oratory.
FEE ALE
Coss street/directions to job Site: a ranter I Q. I fa 1 Teat t •
New eteddeathd single- aa'mnffi -ihully dwelling fit.
Includes attached garage.
Subdivision: 1 LAt no.: 1,000 sq. ft. or less 168.54 4
Ea. add" SOD se,. R or portion 33.92 1
Tax map/parcel no.: Limbed energy, residential
DES( ION OF WORK (with above se, ft.) 67.84 2
limited energy, matti-famly 6724 with above aq. I1)
C--'-5-C2 �'«1 1C� \`t\O\ SO resideatiai
or ( feeders ua, and/or ndordioa 2
200 amps or less 100.70 2
Ci PROPERTY .OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or votes 552.16 2
City/SfEdm': Temporary services or theatre ismta0 arbor, tdteratima, sadlor
aderstiasi
Phone: ( ) ' Fax ( ) 200 amps calm 59.36 1
Owner instilled= This is being made an property that I own which is not 201 amps 10 400 amps 125.08 2
intended for sale, lease, rent, or ett , =aiding to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2
Brandt cicalas -near, alteration, or estension, str panel
Owner signature: Date A Fee for breech caovits with
0. APPLICANT 1 0 CON .4CT PERSON above service or fader fee, 7.42 2
each bun* circuit
Business name B. Fee fir branch circuits I
Camtact name without service or feeder fee, 56.18 2 I
first !Ranch circuit
Address: Each adei broach circuit 7. 42 _ 2
>MilsaBme us(serviceor nded)
City/State/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone ( ) Fax : ( ) Beccsmeotally \ , 67.84 \ s - \ ;%y 2
E-mail: Pump or adgatitm circle 6724 2
• CONTRACTOR .. Sign or outline lighting 67.84 2
Bt>mmess name: `, �� Signal p a il on, or
Ate: \� 10� ��O extension Describe Page 2 2
City/State/ZIP: �O Cam: -. :, Oar��\ \dc. Bach additional over allowable hi oftheabove
‘ Per iaspeCZOn 6635
Peon: ( ) ?- sC S\\ 1 Fax ( ) 37...F3..\- \��\ brown per hoer (1 br min) 66.25
CCB Lie.: C C1 I Electrical Lic.: L1 -1 G I Suprv. Inc.: 92 plant Per hour 78.18
F
ELECTRICAL PERMIT FM �. �nature, required: ..,N� r .._... -�- r- bl f ii' Subtotal:: - ��.��.
hilt nan= y�'�a`t-ilJ -sr :r'' !sicie 1 Data '(aNJ �O Elm review (2596 of permit fee):
State surcharPe (1296 of permit foe):
Authorised signature: TOTAL PERMIT FEE: -- NS . cN�
Print name: I Tab perish application expires lire petatlt is not obtained wattle ISO
days after k has bee. accepted as eoasplete_