Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00644
1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/12/2010
:TIGARD 9 Parcel: 1S134CD07700
Jurisdiction: Tigard
Site address: 11765 SW TIGARD DR
Project: McNinch Subdivision: Lot: 0
Project Description: (3) branch circuits for addition
Contractor: GARNER ELECTRIC Owner: MCNINCH, ALAN
2920 SE BROOKWOOD AVE A 11765 SW TIGARD DR
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503 - 648 -4552 PHONE: 503 - 268 -7735
FAX: 503 -642 -7925
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 11/12/2010 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/12/2010 $8.52
Type of Use: SF Electrical
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 OA 2 -00 - 090. Y u may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: ON T
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.
CaII 603.639.4176 by 7:00 a.m. for the next available inspection date.
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.
FROM :GARNER ELECTRIC FAX NO. :5036427925 Nov. 10 2010 04:50PM P2
Electrical Permit Applicati � V
1� Ii i • ,
City of ,Tigard ° Receives
13125 SW Hall Alvd., Tigard OR 97223 O Dew , // /Z / Permit No•: «/D -tie
' Phone: 503. 639.4171 Fax; 503.598. MO) G� _` Review other Permit, Da rain .
1 ; „ I
Internet: lane: 503.639,4175 �V �1S10 Nodfled/M thud: �� a'.jj eme
V See Pepe 2 fur • ' _ ._ -._ -
Internet: ; www,tigard- or -gnv �W Sappietallntnnuauum
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• a;:',. „N.c1'c'ut d�/.a0tay c.o..�.•.... • . I. ,'•i.': .,, • �.jy� :�t :+ ':.', ��,. �• LV�
tr--tt r Please check al l that a r ' ' :., - . _ .__ .. __ ..
IJ New construction l7� Addition/alt - on/replacement apply (submit & sets of plans w /home checked buluw):
171 service or feeder 400 amps or more 0 Building over Ihrec s brier.
Q De OI1ti0n Other:
'r: r t! - r •r. , J: , i. �'I �+ ,n,,, au,r;= „1r,',. ,� , , ,, where the available huh current 13 marinas and hrMryarda,
�. ;,{ rC v C4. - P a :r Y -'s.7 ,,;,; . f t, :.,. ;' -: "' ex ceeds 10,000 Amps a1 150 V
". n �'u'•;':i lrA!'l+' ?.�i'�'r(;V,�''," r� ,,.:x!�7' - asWaa n.: ��kf;.' �i: i' ": :�1 : ': "l'�'��:�C� � � volts or ❑ floating buildings.
leas to ground, or exceeds 14,000 ❑ COtnmercial•uae aaricnlhlrnl
e 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings-
❑ Multi - family 0 Master builder 0 Other: °Fire pump. Q tnatallatinn of 75 Kt+A or
T ;;r,l �, ��: • ?,� y' , �!' "4 •'.. '. " ,1��, .,t�.... �•�.'• y %rt;:' t ry a 'r: a %('•5 IJ ti ❑ Addition of now ( ❑ Emergency system. larger separaudy derived 9 vino, r
... r ',` ,', ;;;-'' 1...' ai`:01`.lfl �'t. . iy�I ...tl., !t
-iJ4 L�Si :uJ',rr:Ll r� ?'���: 'R] �;:r,• .':,,.,,�°�'S`�`.;p����.�..' �( �1, ;;•;:' + motor load of
1 ...... ri�i. ',3.15 :,:':.:'M %;�,_ .._! < � ' :i
More te l 00HP or more. nOMlpaneV.
Job no.:
Job site address: 1176 5 5'�/ Q R ecreational vehicle
_ �.�.1 -!, �. d � f Q S1R N' Rl dermal units. parkF
City /State/ZIP: � ❑ Health-care facilities. ❑ Supply voltage for mote than
- -. •' ❑ Hazardous bcationa, doU voles nominal.
Suite/bldg. /apt. no.: Project name: 13 stmvice erIbeder600 err more.
{ ,,.,Tip':: i;isCi'd � �. m • l _ - _ .•
Cross street/directions to . job site:
.___.. :i��i ,r,� ' - , .'l ;11'4 -1, . .
.,
E : > : v is h211$D
neeerfettnt
_- _ -_ - _..__.._.•.-._ -_ --- New residential single -or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. it, or leas 145.15 __ _ - 4
,,/,� ce
`� ° e:' N` +,:''rCr l r "'' , Ea add') 500 sq. ft, or portion 33 40 I
Tax map/parcel no
'a 1l• u; f , ; hl;'::': ".l .� ....... _... _ ... ........ _ -. . _- . . • Ignited energy, residential
�
t;ylrlt ',z, `� � u. . ' .:�c�rr� �. �• . '„ . (wldtabove a 75.00 .- . 2
N 1 ? '.. . i1 . j ^l ag multi-family ..� ,...
Limited energy,
residential with above a A 75,00
"3 t_ _l. j ,
Services or feederaIa alteration, and/or relocation
200 ' araps nr toga 80.30 2
S^�i1,f fiit'ii "`:9„'f, • : . : ''.. 6 .', , ;1. • ;it, ' "r:.: ',u;S r r, .,. �;Yi ': `c =G 2 1 to400a s 85 -
�az: 'illas io;f : e.. .'u.,. .. -C'• ' r. .. 4 '` • ' ! ''t:. ^ : !' • ;;-f" I :ar_-;...: cr . "' .'I 201 am rnP - - IQ6.85 2 • Name: fa / 401 a to 600 amps 160.60 2
/I7C.AA,nc. - - -- _ ..__
_ _ .____•__. 6 01 amps to 1,00(1 amps 240.60 2
Address; // / 16 5_- - "� • ��. _ ._... . - . O ven l A 00 atttps or w1u - 454.65 _ _
City /State/71P:
,.+- Temporary services or feeders installation. alteration, and /or {
- -. i „ :iii
Phone: (�-�pp. ) , Fax: ( ) 200 anipa or I09a 66.85 I
Owner installation; This installation is being made on property that I own which is not tot amps co 400 amps 100 ......______ _,
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 _ 2
Brandt circuits new, alteration, or extension, perpunel -
Owner signature: Date: A. Poe for branch circuits wits,
'a'.t 'R ,r' Ir y .A' : �x� 5'.'ra)11ai/1 Nn, A Nr��,y� . . .: Rt� ,
r.itlii+Ay1 i •?:_ ;4 .. i ,j:' :a :'1. ;'r': 'ifh' a' l',' '7: Y °;f:.. '
' shave service or fe fee, .,
q a e :,: P, 6.65 ;
• w1:ari1. ' - '.. .,.... :�::; ,' ., :'i': , �':; ��'x:_ ...: each branch circuit r
Business name: �r ET/04"/ 6 B. Fee for branch circuits �p ^ - I
+ J without service or feeder fee,
Contact name: , -c2A -r 5 c i7,1 r r d c firatbranoh circuit _ 1 , � K ,. ... '
Address: 9e.0 5g- , 1 1, ,,,zf f it Each add'I branch circuit Z e 0 - -
Mheellaneoua ( servke or feeder not included) _I _f ,,,
Ci /State/ZlP: Bach manufactured or modular
/ D e 9 ° - dwelling sarviCO and/or feeder 90.9x1
_
Phone: (�ja j) r l Fax (j(5 6 �,i / �7 Reconnect Z Reenect only -- 66,85 -
53 4x7
E - mail h n r r • t. , , � or imganon circle -.. _.. _
•� Pum io � '
y `�� y ear ll A d:h: rl -.f', ; e '. P T ' 'r. ::, s1 .,:;i Sign or outl light 53.4 2
Signal elrault(s) or limited-
Busineas name: 4f4 ER k // TI tom. _ energy panel, alteration, or
Address_ �Ci'�Q �N/p J�, 44.A_. • - -_ extension. Describe: Page 7.
City/State/ZIP: { I c Each additional Inspection over allowable in any of the allove _
'1 '-ate ••'• -. Per inspection 62.50
1!lone: ( B „� S� Fax: (�S r �j 4 a '",12-5- Investigation per hour (I hr min) 62.50 _ _ ., _�_
e CCB LiC.: 1'L ( 5ot I Electrical Lic.: .i �,. ii S 1' , Lie_:3'� 01--5 ul 1 .lent per hour 73.75
Id-45 `,''T.0^ CAL t'18Rl rr h+,os: / 0. :
Suety. Electrician signature, required: � • Subtotal:
Print oar.- _ _ IV ' . " " s / - - Plan review (25% of permit fee): • �� �.2
f c ( � _- - State surcharge (12% of permit fee): „�r
Authorized signature: TOTAL PERMIT FER: _
-- "' "-- -"" - -' This permit application eeptres If a permit is not ante nett within t 1
Print name: 'T Date: days after 11 h Well on aecepred ox nlmplMr-
Z,. • Number of ii options allowed per permit. n 5
0