Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT
Permit A: ELC2010 -00566
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/14/2010
Parcel: 1 S125DC00500
Jurisdiction: Tigard
Site address: 9655 SW 74TH AVE
Subdivision: BOULEVARD HEIGHTS Lot: 27
Project: Jeffs
Project Description: Reground water service.
Owner: FEES
JEFFS, JERRY L AND PAUL I Quantity Description Date Amount
9655 SW 74TH
TIGARD, OR 97223 1 crt Branch Circuits 10/14/2010 $56.18
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/14/2010 $6.74
Electrical
Contractor:
ATLAS ELECTRICAL CONTRACTORS
4403 SE ROETHE RD
MILWAUKIE, OR 96267
PHONE: 503 - 659 -2212
FAX: 503 - 659 -4944
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $62.92
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 2- 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.
5
Issued By: %� =� � 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.
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.
Oct, 13. 2010 4:05PM Atlas Electrical Contractors Inc No. 1350 P. 1
Electrical Permit Appli FOR OFFICE ict: use: tl�l,,'
City of Tigard i . ` IE. Received
:1 . 'r 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review 7. Phone: 503.639.4171 Fax: 50 " 9 2 2010 Date/13 : Other Permit; 4 to— ,
T I G Alt 13
Inspection Lino: 503.639.4175 Dale Ready/By: MI fil See pope 2 for
Internet; www,ligardor.gov CITY OF TI(`ARn Notified/Method: Supplementallnformarton _
'' ( t 1ND1VlStOPd ' • • • 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 0 Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps et 150 volts or ❑Floating buildings.
less to gr ound, or exceeds 14,000 ❑ Commercial -use agricultural
g 1- and 2- fancily dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump, 0 lnatallae1on of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load oP ❑'W', "$" "1.2", "1-3",
•
Job no.: 19902 1 Job site address: 9655 SW 74th Avenue 1 OOHP or more. occupancy.
O Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: TIGARD, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑flarardous locations. 600 voles nominal.
Suite/bldg. /apt. no,: I Project name: PAUL JEFFS ❑ Service or feeder 600 amps or more,
FEE SCRED1JLE
Cross street/directions to job site: Derrriation I Qtr. I Fee. 1 Total 1 _
New residential single- or multi- family dwelling unit.
Between Barbara Ln and Shady PI Includes attached garage,
Subdivision: Lot no,: 1,000 sq. R. or less 168.54 4
Ea. add'1500 sq. R. 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
REGROUND WATER SERVICE residential (with above sq. R.) _
Services or feeders installation, attet•atlon, and/or relocation _
_ 200 amps or less 100.70 2
❑ PROPERTY OWNER. I . ❑ TENANT . 201 amps to 400 atnps 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 volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City / Stale/ZIP: relocation _ -
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168,54 2
_ Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
• ❑ APPLICANT 1 • a .CONTACT. PERSON • above service or ft•eder fee, 7 42 2
each branch circuit
—
Business name: ATLAS ELECTRICAL CONTRACTORS INC . D. Fee for branch circuits nirhortr
service or feeder fee, first 1 56.18 56.18 2
Contact name: CATHY MUNSON branch circuit
Each add'I branch Circuit 7.42 2
Address: 4403 SE ROETHE RD Miscellaueousiservice or feeder not included)
City /State /ZIP: MILWAUKIE OR 97267 dwelling, i ng , s e r vice a or r ede 67,84 2
MILWAUKIE, dwe lling service and/or fbeder
Phone: ( 503) 659 -2212 Fax :: (503) 659 -4944 Reconnect only 67.84 2
- - E-mail: cathym @atlaselectrical . c0111 Pump or irrigation circle 67,84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
13usiness ATLAS ELECTRICAL CONTRACTORS, INC. panel, alteration, or extension. Page 2 , 2
Each additional Inspection over allowable in any of the above
Address: 4403 SE ROETHE RD Additional inspection(1 hr min) 66.25/hr
City / State/ZIP: MILWAUKIE, OR 97267 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 659 -2212 I Pax: ( 503) 659 -4944 Inspections for which no fee is 90,00/ hr
specifically listed ('A hr mm)
— CCB Lic.: 1532 Electrical Lie.; 3 - I Suprv, Lic.: 5009S ELECTRICAL PERMIT PEES . •
n 1 ql /1-3 subtotal: 56.18
Sltprv. Electrician signature, required: 44'
Plan review (25% of permit fee):
Print name: 7'Y W. SHEPERSKY Date: 10/13/2010 Slate surcharge (12% of pem» t fee): 0.74
TOTAL PERMIT FEE: 62.92
Authorized signature: _ �� r , �,I� This permit application expires it a permit is not obtained within 180
/ u J �^""�' days aQer i1 has been accepted as complete.
Print name: Ty w. S EPERSKY Date: 10/13/2010 • Number of inspections allowed per permit.
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