Permit CITY OF TIGARD ELECTRICAL PERMIT
' °.' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00202
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/06/2009
Parcel: 2S 101 AC00700
Jurisdiction:
Site address: 12700 SW 72ND AVE
' Subdivision: BEVELAND NO. 2 Lot: 13
Project: PAULY & ROGERS
Project Description: Install (1) 200 amp sub panel, and nine branch circuits for HVAC, lights, and outlets.
Owner: FEES
ROGERS, ROY R Quantity Description Date Amount
13690 SW TWELVE OAKS CT 1 ea Services or Feeders - 200 05/06/2009 $80.30
TIGARD, OR 97224 amps or less
PHONE: 9 crt Branch Circuits w /Purchase 05/06/2009 $59.85
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 05/06/2009 $16.82
MOUNTAIN F ENTERPRISES INC Electrical
25973 S MOEHNKE LN
BEAVERCREEK, OR 97004
PHONE: 503 - 313 -0761
FAX: 503 - 632 -5521
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $156.97
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 1 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 obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: �4 \ 1��_ ( Permittee Signature: Rj -% o.pt (7�( `_
OWNER INSTALLATION ONLY 11
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'N 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.
0ei/04/2009 12:14 503 -632 V p ALAN FITCH ELECTRIC PAGE 02/03
' Ilectrical Permit Application y I ( ) ' ()Fry i„
l.l.t 1. l.,
City of Tigard MAY 0 4 ►' s g l 4• 04' PermitNo.:€ lC) pq .03 cc)2
13 125 SW Hall Blvd, Tigard, OR 97223 pten Review ��,,....��oo// 1���
Phone: 503.639.4171 Fax 503.598.1960 CITY OF ' ^•';' Da./Da./By. Other Permit: e r[+. '�•/I.JIJ`•['
• Inspection Line: 503.639.4175 p r . . ?„ �' 'l!, Date lteady/By: sum: ra se. Page 2 for
Internet: www.ci.tigard,or.us BUILDII r _ . . . Noti Ile Supplemental Information
o'SSsc a''v �` ppn}o 4s�f7� ! u u: f�' 1 � . �' � � S � t ; � t '+ m h "tt ia rm� , a ,77 °74•.x7 `msm,',, � s. Yt er r . ' . V Sa :,5e�7C4:, ie.....)1 in •. 'Alt; s{.96?ca ..h.?! / • . ti `. ••1 0. ♦ rr .,:r61 At. - e 1 .r ,,, ,,,z,.�:1 �._, M . ° s4A . .... 4 - -
❑ New construction 14 ddition/alteration/replacement Please check all that apply
❑ Demolition El Other: ['Service over 225 amps, comm'1 ❑Hazardous location
r° nxs Y ❑ Service over 320 amps - rating OBuildng over 10,000 sq. ft.,
h'�y4:,'� M • � y r . . • • R; , k a°`� S'h7 7atTr TiFIR S' .1 1 ., r . , >
i. <.,M,x a��, �: r:. i,.•,v,na; .•�.'� i v. ..; '�� ;: \; ". , � � `y • �, i of 1 and 2 dwellings 4 or more new residential
❑ 1- and 2- family dwelling 1't Commercial/industrial ❑ Accessory building El System over 600 volts nominal units in one structure
❑ Multi - family El Master builder ❑ Other: ['Building over three stories ❑Feeders 400 amps or more
f%a '.'M' ,. a $ P 19 i . " � 111 , ° q � FE `�, s �� e 6,044K? ❑Occupant load over 99 persons ❑Manufactured structures or
�, . , U `" i A S ' =6 ' • =Y=Ser6itt : a , ti . 4 ❑ ess/t m
o.s e.4. , Egr t 8 lan RV park
P
Job no.: Job site address: 1 Z. 1-0o S 1 Z iV ° / ❑ Health -care &ditty ❑ �►�
Submit 1 sets of plans with any of the above.
City/State/ZIP: -1-141 p (2 �j q l- Z z 5 The above are not applicable to tc nporary construction service.
Sui te/bldg /apt no.: ! Project name: `�vtl Q • S M } v, 3 ti i!, ;ei.H''' , ,,...d' , h ;: a. ,,:".� ` 11 1, „ A,,7 4 ' i- ' k i'' �
rksertptlan Qb. Fm .Tad '•
Cross street/directions to job site: New residential single- or mufti- family dwelling unit.
rr Includes attached garage.
v A I F 1..: t Z Co - OC7ID 44 � 1,000 sq. 1 or Tess 145.15 4
Subdivision: -1 Lot no.: Fa ¢dd'I 500 sq. ft or portion 33.40 1 "
Tax map/parcel no.: Limited energy, residential 75.00 2
fig 1 � „� t E , ;,�, h :,
,, : f S V Limited energy, non-residential 75.00 2
7 i \i''li'�i � q al5Y ; `•n� . ..°.. i, ' ,S Lt!1k .'Zt4 +i� '' i;.. • 7 a, .,� EL Each maimfactured or modular
'f�-
dwelling, service and/or feeder - 90.90 2
0IFP1 C 0e0 1 V
P I1 , - l - SUI P/413 Services or feeders installation, alteration, and/or reloeatioo
1 pj t • 1 • sp - v Imo.- l.1 " - • V■ -: - 200 amps or less / .80.30 Ej S O 2
k a { • ^ " r �'' t5� ', N � a � �" �: 20l to 400 ,
.,., {,, .,.i4, i.. , ',,:'t t it � , ,iat: 4A.,0 i; b:,1 °tee cry i , �ns n 1 •A ' t p
40l s to 600 amps 106.8 2
s 160.60 Name: 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /StaffaZlP:
Reconnect only - 66.85 2
Temporary services or feeders installation, alteration, and/or
1 ( ) relocation
Phone: ( ) I Fax: 200 amps or less 66.85 a
Owner installadon: This installation is being made on property that 1 own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease. rent. or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: „_ Branch circuits - new, alteration, or extension, r panel
tier , o
•� y \ •
'
"* w- M77 __
'i A. Fee for branch circuits with
� +',?�t;,,��� . �, rrw � �ir�.'�;�, "' : � . ip.•?�t , pro• K o; '�
'° .. ` service or feeder fee each p
Business name: \ branch circuit ( 6.65 5, 2
Contact name: B. Fee for branch circuits
without service or feeder fee, 46.85 2
Address: - ,
each branch.circult
Each add'1 branch circuit 6.65 2
City /State/ZIP: . Miscellaneous (service or feeder not included)
• Phone: ( ) i Fax: : ( ) Pump or irrigation circle ' 53.40 2
Sign or outline lighting 53.40 2
E -Mail:
Signal circuit(s) or limited- .
% ,' 14 +'." • :: :':, e ".,, '.,, ` ' •r r is e r!' "M w��u I i i � ,.
a• ,fi. em �, ,err. �I,i energy � el, alteration, or
Business name :Mou I to v e f . i tjt :, p A tukti F1 'r - - ( e.,
pension. Describe: Page 2 2
Address: Ci l - S J , .iAA ..1„k t j r tY 1 1 . Each additional inspection over allowable in any of the etwvc
r�J Per inspection 62.50
• City /State/GIP: e C a : • • r Investigation per hour (1 hr min) . 62.50
• Phone: "1j 2 ) ) l 0 i ` Fax: � J) to 2,.. S -- Industrial .Iant hour 73.75 "
CCl31,ic.: tPJ � q � z__ Electrical Lie.: -Zj " Sup c.. �1 ' L,a i , , . ?. ?.,'�`. 2;::az. ?.1n�1.a,��i�;�.a•., s'f'
Suprv. Li 3 S Subtotal /02, /'-
Suprv. lectriclaan signature, required: , A � � � �/ • • Plan review (25% of permit fee) •
' State surcharge a of permit fee) / 4
GC Print name: 1 -. 0 I T G f 4 Date: S"...4_,07 ��
TOTAY *MIT FEE i S1 t q.-
Authorized signature: This permit application expires If a permit is not obtained within is*
days after it has been accepted as complete
Print name: 1 \ L%4V te: • Fee methodology sn by Tri- County Balding Industry Service Board
"" Number of inspections per permit allowed.
ismu lldna\Amnita\stc.Permiu%pp.doc I2POs 440.46 I57(1a'02./COMIWBa