Permit CITY OF TIGARD ELECTRICAL PERMIT
'• • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00631
T I CAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/05/2010
Parcel: 2S102BB00809
Jurisdiction: Tigard
Site address: 10210 SW BROOKSIDE PL
Subdivision: BROOKSIDE PARK Lot: 3
Project: Greenwell
Project Description: Temporary power pole. •
Owner: FEES
FROHNERT, FRITZ E LIVING TRUST Quantity Description Date Amount
BY FRITZ E FROHNERT E TR, 10210 SW
BROOKSIDE PL 1 ea Temp Services or Feeders - 11/05/2010 $59.36
200 amps or less
PHONE: 1 ea 12% State Surcharge - 11/05/2010 $7.12
Electrical
Contractor:
CROWN VOLTAGE
12607 NE 199TH ST
BATTLE GROUND, WA 98604
PHONE: 360 - 666 -0995
FAX: 360 - 666 -4673
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $66.48
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 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: _ 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.
Cali 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 Application "� (t l 1 .'r ' 1, i ` "I , . . .
City of Tigard RE CE IV a . Penult No - = ..6
IIN • 13123 SW I1111 Blvd., Tigard, OR 97223 • tar Review Other Permit;
• Phone: 503.639A171 Pax: 503.598.1960 NOV 4 2.0 t ' Page2Wr
i 1.. , , 7 , u i ., Inspection Lino' 503,639.4175 . ,. $.pplemag 2 t eforatadon
Internet www.tigard -vr.gov
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111101• , , I. I. ■ Please • • hell that apply (submit j sear of Frans w/itema ob )
El New construction Additlonlaltantion/ • , ' ❑ Sprviee err fade 40U amps or more ❑ Huild ns over three stories.
O Demolition ❑ Other: where the available Each curtest ❑ Marinas and boatyards'
! 1-1PP rt1":51 o,anon;gr,7 r t }fit , ■ 'tr, - , f exceeds 10, amps at 150 volts or ❑ Floating buildings.
`. yp ' r • . . My 4 -'g :.•. : -.. ;?' ` ,� I !ir*Pr; L�' 1 i r,,,i • • >l,4ii GikA less to ground, lnual
' .: �it�tm .d! •i' Im±.l ' � r:r�i ,.. .r'i.4 d, or exceeds ❑ Comm Commercial -use agrie
eve 1 - and 2 family dwelling ❑ Commercial/ industrial ' 0 Accessary building amps for eu other tnatallations, buildings.
(] pine pump. 13 Installation of 75 KVA or
ID tinnily Q Master builder El Other Li w syeaa larger separately derived system.
. ""' _ 71 , 71ehlF 7 ; . y YnFir: ri ;i�l nt w F-. I 'r,''1 "ter ",
e a �i <''i ''{ r, a I .1` F , " ... r r, .r3r 1 4,r
" �� 4,cllia� t�rrr .c:el;,.��sr.lLk _t�„tat.nv ti .I lil ! if�r 1�b' „ n :d (] Additiatofne.vmotor loadof ❑ oce
a - t00HP or morn. ocWpancy.
Job no.: Job site Itddress. 0 _ a ea 4 ■ ` e . - • . O Six or more residential unite._ ❑ Recreational vehicle parks.
h 0 Hratth car tea tildes. 0 Supply voltage fbr more than
City /State/Z1P: • -, Ma .2' ❑ /.1mM- c o ra tea tions. 600 volts moiled.
ID Service or feeder 600 amps or mom Suitdbidg /apt no.: Project name: Fe t 'W,' i r : *'" y >. 1: ..t t s r l . t li' ,
Cross street/directions to job site: T .,....
New realdenlyial singk- or multt- ftunity dwelling unit.
• Includes Attached garage.
Lot no.:
1,000 sq. ft. or less 145.15 4
Subdivision 1?a. add'1 500 s• - ft or •rtlon 33.40 1
Tax nap/parcel no.: � y Limited erterpy, residendrtl 75.00 2
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,..d' ' r ','M.;� i4i . -q;' • ilr cF. liY.� il
a 1,;. , a ...... f: ?t � . • . n <eu Limited energy. multi - flintily 2
residential (with oboe ea. tR) 73.00
�, _ . ■ , I 11,.. _ Services or feeders instal edam alteration and/or relocation
' 200 amps or leas 80.30 2 ,
�rr ,e+�l y ,v.t l,5 c 1 ilia r ry , , ..t F,T . r .,' 201 to 40 amps a 106.85 2
+•- ((c .. • •j� r � P � , .� r. y�. S I ...r r , t �r G' ! T , S, OA . t i':.1U! amps p 2
5 ,..w.ItYN1,CR�'/'••• i�r�r�fY:t� ,'i. rvil� lrr.rawhnl'] 160.60
401 amps to 600 amps
' 4 `.. • 601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps arvolts 454.65 - 2
- Temporary .etvkea or feeders Installation, alteration, and /or
City/State/ZTP: . reloeanon
Fats: ( ) 200 em. ' or less 66.85 , A ._-.. - .,,, 1 9/3(
Phone: ( ) 201 amps to 400 amps II 1003 r 2
Owner Installation: This installation is being trade on property that I own which is not = 2
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 70l • 401 599 amps 133.75 Breach circuits - new, alteration, or extension, per panel
Owner signature: _,
Date: A. Fee tit branch 'circuits with
y . ?'o:I, ,roeoe�, s• gt �. F mT:rcin � T." , '`.i`; ' l0 i! ahmro service or feeder fee,
t � l i �' ;•i 1 ,' 1 , ,d,, , y , q ;, ,, li7 ,s 4� I'..T o fd , ,vii 11 ....u,,,,,,i¢. 1 .. ,.,, ,�7iN 6.65
.. �, �,...t;L:,:�"��w,�, - r.a,. -• eachbr®tclt circuit ,
Business name: CROWN VOLTAGE, INC. B. Fee for branch ctrcuita
without arnica or feeder See, 46.85 2
Contact name, STACY first branch circuit
Each add'I branch circuit 6.65 2
Address: Mhtell. ■cou . service or feeder not Included
City/State/ZIP: Each mai ufbetare • tx modular ■ 90.90 2
dwellin.. service and/or feeder
kax:: ( ) Reconnect only 66.85 2
( ) v7� P or irrigation circle 53.40 2 }�' .'.:
E-mail: Ennea ;l n "'der 5 . re 1wµ 4 '' . 7 ' ; o e: , `'t i ' a , . . J.r. r f' t I l i a i t "''!� Sit or outline lighting 53.40 2
"'w9lerl�iVi w� ,,. f � •'{F P SS... M /.` ,�.I. 1 M f K.G:aI -f1. Signal &mitts ) Or l imited-
Business name: CROWN VOLTAGE, INC. energy panel, gustation, or
extension. Describe: Page 2 2
Address: 12601 NE 199 STREET
City/State/ZIP: BATTLE GROUND, WA 98604 Each additional Inspection over allowable in a' of the above
Per inspecdon 62,50
Phone: (360) 666-0995 Fax: ( 360) 666 - 4673 Investigation per has 1 la min) 1.11 62.50 -
c,: 37 -984 7 i I t Su rv. Lie.: 4 116S t 0 I 1 lnduttttial plant per hour Y
Electrical Li P 4dg ?f' ,, .,1,Y - 7,7977: ,__ - . ,. ,,
Suprv. Electrician signature, required: yL • suburiel [5 �
a :..�M_ -1 ► rir _ wan review (25% of permit fee).
Print name: MARGARET HOWES ' bate: ' � _ State surcharge (1296 of permit fee): F --7. 1 ,L
Authorized signature: P TOTAL PERMIT FBE: I G• 10
/ 'lam permit agplkatlao aspires 1f a perm Is eat within too
Print name: DANIEL TUCKER _ Date: 1 / Lf (i O days alter h tw an be accepted as mope%
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