Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC201000482
T i G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/08/2010
Parcel: 2S102AD01800
Jurisdiction: Tigard
Site address: 8965 SW BURNHAM ST
Subdivision: Lot: 0
Project: Armature Coil
Project Description: Feeder installation.
Owner: FEES
CARL H JOHNSON FAMILY L P II Quantity Description Date Amount
BY JOHNSON, CARL H, 8965 SW BURNHAM
TIGARD, OR 97223 1 ea Services or Feeders - 200 09/08/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 09/08/2010 $12.08
Electrical
Contractor:
PRO CIRCUIT ELECTRIC LLC
PO BOX 3948
WILSONVILLE, OR 97070
PHONE: 971 - 563 -8211
FAX: 503 - 266 -1349
Type of Use: COM
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 160
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 Os ' 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.
i
Issued By. - �" Permittee Signature: — /'L. _
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.
Electrical Permit Applicatio
City of Tigard 1 CEIVED I b tt OFFICE Permit o f
13125 SW Hall Blvd,Tigard,OR 97223 t1 «�/ ;jam P�allo.: W- 0,r ; 1 —
Pbone 503.639.4171 Fax: 503.598.1 Q 11 7 MO Plan Review
T I G . 1: D Inspection Line: 503.634.4175 Date/8y Other Punic
Internet: vow .tigard -0r.gow OF TIGARD d ied Ready/13y:
M j °: TTS 1 Sn see P for
ppkm ental Information
TYPE 0 1 t '�ll PLAN REVIEW
❑ New construction ,Addition/ teration/replacement Please check all that apply (submit 2 sets of plans wfitems checked below):
13 Service or feeder 400 amps or more ❑ Building over throe stories.
❑ DemOI ition ❑ • where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- and 2 family d wellingommerciaUmdustrial ❑Accessory building
less to r l of a exceeds ons. b
0 ❑ buildings. tzse agricaltural
❑Multi - famity ❑Masterbuilder Fi r e lsforallotherinsh111atiau. In ma
❑ Other: ❑ Firc pomp. ❑ InstalLuion of 75 KVA or
JOB arm INFORMATION AND LOCATION O Emergency system. larger separately derived system.
Job no.: ❑ Addition of motor load of ❑'•A ", "E","1-2", - 1.3
Job site address: ( Q_ 1t1.._.� l00[e or mom_ mi occupancy.
City/State/ZIP: �ir�+7114T a �rcdeat waits_ ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
Suite/bldg. /apt no.: l /�] ❑ Hazardous locations. 600 volts oominaL
Project name: `�I rineA / r ( O Service or feeder 600 amps ermora
Cross street/directions to job site: ` � 1 L FEE SCHEDULE
aaaiptlaa I MY. 1 Fee. 1 TWO I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. B. or Tess
168.54 4
Tax map/parcel no.: - Ea. add'I 500 sq. ft. or portion 33.92
DESCRIPTION OF WORK Limited energy, residential
r . , (with above sq. ft.) 67.84 2
-+yv�( 74.04- / f�� � L energy, multifamily
residential (with above sq. a) 67.84 2
Services or feeders installation, alteration, and/or relocatio
❑ PROPERTY OWNER ( ❑TENANT 200 amps or less 1 100.70 1 D . 2
201 amps to 400 amps 2
Name: . 401 100.36
� V1� amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts , 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) relocation
Fax: ( ) 200 amps or less
Owner installation: This installation is being m r 201 amps to 400 am 25 03
intended for sal I
I g !3 e on g property that I ow0.which is not amp amps 125.08 2
e, ease rent, or exchange, according to ORS 447, 449 67 and 701. 401 amps to 599 as 168.54 2
Owner signature:
Date: Branch dr'etuts — new, alteration, or extension, per panel
❑ APPLICAN f A For for branch circuits with
❑ CONTACT PERSON above service or feeder fee,
Business name: each branch circuit 7.42 2
B. Fee For branch circuits 111
Context name: without service or feeder fee,
Address:
first branch circuit 56 2
Each add'] branch circuit 7.42 2
CitylSta[t•JZIP: Misedlaneons (service or (ceder not included)
Each nranufactared or modular
Phone: ( ) Fax : ( ) dwelling, service and/or feeder 67.84 2
E -mail Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
/ CONTRACTOR Sign or outline lighting 67.84 2
P �O ark( L E SL � 11 Z
Signal circuit(s) or Iimitod-
Business name: S9 L-18 energy panel, alteration, or
Address: 7. O
extension Describe: Pagc2 2
City/State/ZIP: IJ1Z(JO/alNe- n
cl 07 0 Each additional inspection over allowable in an of the above
Phrle a (�(1") () `)'/ -ti ' I ( ri Fax: (j) 7—(0(0 (� q Per inspection 66.25
CCB Lic,: investigation per hour(' hr min) 66.25
j j ;B-i Electrical Lic.: `(oo( CI Suprv. Lic.: 5 j 07. 5 Irtdttstrial pl antper boar
78.18
Suprv. Electrician signature, required: l ELECTRICAL PERMIT FEES
Print name: e �J� A/A (0 k Date: • Plan review (25 %of Subtotal: ��. "T 0
E O —ZZ —o pemlit fie):
Authorized signature: State surcharge (12% of permit fee):
Print name: TOTAL PERMIT FEE: `1 Z ." p
Date: 'Ileis p it appl icationexpirnd apermitisnotobtainedwittrieli0
days after it bas been accepted as complete.
Lut ioBwer�rsuax- PermitApp.doc 10/01/09 • Number ofimspec
44o•46(ST[I1/osrcOM/waB Pr+Permit.
ti' 617£1.99Z£09 01.119813 11=10 cad 4 69:80 01. LO deS