Permit n CITY OF TIGARD ELECTRICAL PERMIT
• Permit #: ELC2010 -00598
`• a COMMUNITY DEVELOPMENT Date Issued: 10/26/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112AD00900
Jurisdiction: Tigard
Site address: 14800 SW SEQUOIA PKWY
Subdivision: Lot: 0
Project: The Home Depot
Project Description: (3) branch circuits for heating unit change out
FEES
Owner: Date Amount
THE HOME DEPOT Quantity Description
2455 PACES FERRY RD. 3 crt Branch Circuits 10/26/2010 $71.02
ATLANTA, GA 30339 wo /Purchase Service or
PHONE: 770 -438 -8211 Feeder
1 ea 12% State Surcharge - 10/26/2010 $8.52
Electrical
Contractor:
CHRISTENSON ELECTRIC INC
111 SW COLUMBIA ST, STE 480
PORTLAND, OR 97201
PHONE: 503 -419 -3300
FAX: 503 -419 -3695
Type of Use: COM
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 0 952- 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:
Permittee Signature: '" /1-7°/'L/ el-770
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.
OCT -25 -2010 MON 09:11 AM CHRISTENSON ELECTRIC, INC FAX NO 95034193695 P. 01/02
_ - -- --
RECEIVED , :(112 OFFICE li5h: Q�L1
Electrical Permit A lication
C T 2 6 2010 O Received ��11 r� Permit N�' . 0 '/ /
II I Date/13 : tl ,,76) lO 4
City of Tigard •
Plan Review 0thcrPe�iUyEe'.2?Q /o -610y u 13125 SW Ha1I Blvd.,1'igard, 0 A p o
i i r1 a F TIG DateB : m La Set Page 2 for
Phone: 5 Line : . 503 F aX ; 1 DING DIVISION Bate Ready/ By: Supplemental Pa2 Information
Inspec Line 503.41 L blot{tiediMethod:
� ARD
dor. ov ,;
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Internet: www gar : <F..ti; ;` g1, , 1Y
' - �E , - ' Please check all that apply (submit / sets of plane wlitems checked below):
�ddition/alteration/replxcement 0 Service or finder 400 amps or more 0 Building over three aories•
De liti construction where the available fault current 0 Marinas and boatyards.
In Demolition ❑ Other: ,000 amps at 150 volts , , agricultural
exceeds 10 or 0 Marina buildings,
0 Commercial a 'c
L"l'IDr(`,° : %. '• ° . ' �.: � ,'� :' ` �'� `, less to B oun d , or exceeds l4 000
�;:...; �:, .: �:.: • .. . •'' ' building a for all other installations. buildings.
mop 13 installation of 75 KVA or
El 1 - and 2- Calmly dwelling Commercial/industrial ❑ Accessory b []Fire pump,
Other
Multi- family [] Master budder � motor fond of
0 emergency system larger separately derived stem
❑ Addition o f new ❑ "A", "F"'' 1.2" "1.3".
•
JOB.STfE INE0IIMA7lT0N :,AND'.LOGe�,'FIONJ:: occupancy.
`-' Six or or more res idential a rest dantial unit. 0 Rocreytional vehicle parks.
'
Job no'_'I Job site auuress:I 'a' tlV
t II ❑ Hco{th ^tare frcilities. 0 Supply voltage for more than
,(r .1/. • � _ ❑ Six m'
❑ Htuardous locations
600 volts nominal.
❑ send,. or feeder 600 turps or morn. _ '
Project namc'� d' - IL MM nix. 9ore. LE
Suite/bldg./apt. no.: � ,,. ;.� � -:. , �, ��0
Pend 1Mn
Cross street/directions to job site: l► ► New residential single - or multi - family dwelling unit.
illb Includes attached garage.
r _ 54 1 4
1,000 sq, ft or less 111 168 �
Lot no.:
Subdivision: _ Ea. add'I 500 sq. ft. or portion 33 9'?
Limited energy, residential 75.00 Mil Tax map /parcel no.: with above • • . IL MO
DrSC1tA'T[ON Or WORK. Limited enema', mullgamilY 75,00 me
� t�� 1 ... residential (with above R
Ir i... 5e rviva or feeders Installation !Lniocation 2
200 amps or less 100.70 r
+
ll 133.56 2
TENANT 201 amps to 400 amps 2
p 401 amps to 600 amps
200
-: []:, PROPERTY OWNER 2
Name: 601 amps to 1.000 amps II 301.04 552.26 2
Over 1.000 amps or volts
Address: Temporary services or feeders inatnllation, alteration, and/or
relocation
Phone: ( )
City/State /ZIP: 200 amps or less 59,36 II
_
Fax: ( ) 201 amps to 400 amps 125.08 �
165.
401 amps to 599 amps
Owner installation: This installation is being made on property that I own which is not Branch circuits— new alteration ur extension , er a anel
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 • A. Fe fo b circuits with
Date: 7.
Owner signature' — above service or feeder f e e , 2 • ONTACT. P ERSQPL .. each branch circuit
' . APPLICANT.: 1 B. Fee for branch circuit without
��� �,���� service or feeder fee, first 56.15 " - 2
Conceal name: �'• -�/ bpsncncitL7lit 2
Each add'I brunch circuit 7.42
Miscellaneous (service or feeder not included
Address: —� Fitch manufactured or modular El m 2
dwelling. service and/or feeder 67.84 2
City/State/ZIP: Reconnect Only
Phone: ( ) 67.14 Pump or irrigation circle MIMES
Sign or outline lighting
E-mail: Signal circuit(s) or limited -mares 2
C0NT1tAC •noel. alteration, or exteiLsion. Pale 3
BUSIIICSS name I �1k �,'1J al a►' P Each additional ins anon over allowable In an of the above
� _ I Additional insp (1 hr min) 66. hr
Address; 4 , A r1 111 11 911 1 /W • tif+:!5 / hr
City/Stale/ZIP: _ •'O industrial plant (1 hr min)
M �� inspections for which no fee is 90 001 hi
/�,A�� 1� t y s. oific lislod 'h hr min
Phone: ' ^1 ' �vr 3 ^ ,E C1'R1CAI..FERMIT FEES
� uprv. Lie.: Subtotal: � � l d•
�r� Electrical Lic. ID
1 ;� P lan review (35% of permit fee):
Suprv, Electrician signature, required; 1
—
r A nu [. . / 'r 1 , l State surcharge (12 0 i0 of permit fee): �
►• L. V 4m
Print name: li , gy m , �A ,J _ TOTAL PERMIT ► r-
Thie permit applicadon expires If a permit is not obta t • t se
Authorized signature: days attar it boo been accepted w complete.
• Print name: Date; • Number of inspe cti allowed per permit. ,
4 40- 461+T(I1Poicomhv Eft / ,e/ / r
.. naminn �,\ \fit.
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