Permit CITY OF TIGARD ELECTRICAL PERMIT
e COMMUNITY DEVELOPMENT Permit#: ELC2010 -00524
Date Issued: 09/23/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S105DD00700
Jurisdiction: Tigard
Site address: 15165 SW SUNRISE LN
Subdivision: Lot: 0
Project:
Project Description: Reconnect only.
Owner: FEES
FIELD ASSET SERVICES, INC. Quantity Description Date Amount
101 W. LOUIS HENNA BLVD., STE. 400 1 ea Reconnect Only 09/23/2010 $67.84
AUSTIN, TX 78728 1 ea 12% State Surcharge - 09/23/2010 $8.14
PHONE: 800 - 468 - 1743 Electrical
Contractor:
OWNER
PHONE:
FAX:
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 0 R 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.
Issued � ' /
ued B : '�-Y PermitteeSignature: �/ t PG/ e (��C" ,� "
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 603.639.4176 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.
RECEIVED
SEP 2 2 2010
Electrical Permit Application Ft)li OFFlt� IJSI-: ONLY -
CITY OF TIGARD — — —
City of Tigard BUILDING DIVISIO eceived „40, z3 /d
r' ateBy: �
Permit No.:& CC7D — QD
14 s-,
° 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 Date/By: Other Permit:
- I' I G A R D Inspection Line: 503.639.4175 Date ReadyBy: a luris Cr Supplemental See Page 2 for
Internet: www.tigard - or.gov Notified/Method: � 3 17 6 Supplemental Information
/ 7 - C - -1
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 3 Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
Job no.: Job site address: 15165 SW Sunrise LN. I00HP or more. occupancy.
Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description
1 Qty. 1 Fee. 1 Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or Tess 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Permit for electrical inspection to turn residential (with above sq. ft.)
electricity services On . Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Field Asset Services, Inc 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 101 W. Louis Henna Blvd. Suite 400 Over 1,000 amps or volts 552.26 2
A ustin TX 78728
Temporary services or feeders installation, alteration, and/or
City /State /ZIP: r relocation
I'hdne:( 800)468- 1743 Fax:(512) 275 -0989 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ® CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: Field Asset Services, I n c B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Melissa T a n z e r branch circuit
Each add'I branch circuit 7.42 2
Address: 101 W. Louis Henna Blvd., Suite 400 Miscellaneous (service or feeder not included)
City /State /ZIP: AuS t in, TX 78728 Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ( 512) 609-7349 Fax:: (5171 275-0989 Reconnect onl 1 67.84 1 2 Pump or irrigation circle 67.84 2
E -mail: Melissa.Tanzer@fieldassets.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
Business name: panel, alteration, or extension. Page 2 _ 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (Y2 hr min)
CCB Lic.: Electrical Lic.: Suprv. Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: o Subtotal: 6 - R 4
Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee) 8.14
TOTAL PERMIT FEE: 75
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: . Number of inspections allowed per permit.
9/r 3 //c) it/0 a Fr ( vii IX ( /L6 Q-45 "/L /-f f,,-/LK . ' V ,
2 1 (01(o
Service Request Form FIELD ASSET
A SERVICES
❑ Regular Mail ❑ Two Day 0 Next Business Day Other:
Utility Vendor Information
Vendor Name _ City of Tigard VI D# I i f igi!'7
Ph I Address 13125 SW Hall Blvd. Spoke with: Brandon
Tigard, Oregon 97223 Date 9/16/2010
V erified Service Type ❑ Gas 0 Electric ❑ Water
❑ Sewer ❑ Trash ❑ Propane
❑ Other: I
Phone # 8008221077
Account# Permit
Activation Date: I
Service Address 15165 SW SUNRISE LN Property ID: '545112
TIGARD, OR 97224 REO Date: 9/2/2010
Send With: ❑ Fax/Order ❑ Authorization Letter 0 Application ❑ Deed ❑ POA ❑ Other:
Details:
Billing Details Work Order # I233 02 8 63
RECEIVE'
Deposit Property ID # 545112
* *Past Due Vendor ID # L IZ c iLi 7 SE t 8 16
Application Fee
Permit Fee $ 75.98 *WATER FASTrack Verifications Feld Asseo Sc.
No Leaks Reported (WO /Notes /QC) ❑ I 2 . 40
Plumb Repairs Completed (WO /QC) ❑
— — — — Note: I
Total $ 75.98
* *PAST DUE ❑ Must be paid in order to activate service.
Service Dates: I
Customer I nformation 1
Name Field Asset Services, Inc. Tax ID : 74- 2860973
Mailing Address 101 W. Louis Henna Blvd #400 Phone # 800 - 468 -1743
Austin, TX 78728
FOR FAS EMPLOYEES ONLY
Name Melissa Tanzer extl 11071 Date:I 9/16/2010
Signature: kod.
By signing above you are stating that the above information is true and correct.
1=1 TL Approval Needed TL Name:I 1 Signature
Revised: 7/27/2010
Revised 7/27/2010