Permit 1 y r� CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00657
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2010
• Parcel: 2S111DB02900
Jurisdiction: Tigard
Site address: 15375 SW ALDERBROOK CIR
Project: Demarinis Subdivision: • SUMMERFIELD NO.8 Lot: 488
Project Description: Electrical for interior remodel.
Contractor: CONDUIT ELECTRIC Owner: DEMARINIS, DELORES
19461 SW 89TH AVE 15375 SW ALDERBROOK CIRCLE
TUALATIN, OR 97062 TIGARD, OR 97224
PHONE: 503 - 692 -1428
PHONE: 503 - 579 -8465
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/19/2010 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 11/19/2010 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/19/2010 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
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 wit
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 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234
Issued By: �/ /�`f Permittee Signature: - L
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 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:CONDUIT ELECTRIC 5036923652 11/18/2010 16:39 #451 P.002/002
RECEIVED '. .
Electrical Permit Application r OR'OFFICI U$1.ONLY' • '
- City of Tigard NOV 18 2010 DateBea PermitNO.: - "
13125 SW Hall Blvd., Tigard, OR 97223 �� �_ U -
g Plan Review
'� • Phone: 503.639.4171 Fax: 503.598.1 QTY OF TIGARD Date/13 : Per mit: Other Pit • (c)— • 4 I C . . - Inspection Line: 503.639 D Date Ready See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISIO • Notified /Method: • Supplemental information
TYPE OF WORK PT.AN RirV1EW
I
❑ New construction Addition /alteration replacement apply (submit 2 sets of plans w /items checked below). •
P lease check all that a pp
❑ Service or feeder 400 amps or more ❑ Sodding over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF-`CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
�,{ less to ground, or exceeds 14,000 El Commercial-use agricultural
ld 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
', JOB, SITE 1NFOE1 IATION AND ;LOCATION
: ❑ Addition of new motor load of ❑ "A ", "E ", "3 -2 " "1 -3 ",
Job no.: Job site address: S IOOHP ormore. occupancy.
/1S ���� / 3'1 G-i; 415el 6'w�k "fK ❑Recreationalvehicle
_ -_ ❑Six or more residential uni parks.
City /State /ZIP: i t " r t f� f�._ c f 7` Z. 2_ ❑Health -caze facilities. ❑Supply voltage for more than
° Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Qip L. a .--,.,, ,s ❑ Service or feeder 600 amps or more.
FEE =SCHEDULE
Cross street/directions to job site: oetcr'ptioa 1 Qty. 1 Fee. 1 Total i '
New residential single- or multi- family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 168.54 4
Subdivision: Lot no.:
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no. Limited energy, residential
67.84 2
DESCRIPTION ;OF WORK (with above sq. ft.)
Limited energy, multi - family 67.84 2
/ "�< / .C!"'--c 3 e t /PAT-432._ (— residential (with above sq. ft.)
�� Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 f•ICA-,1
`;IWPROPERTY OWNER ❑ , .TENANT:: 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
y 601 amps to 1,000 amps 301.04 2
Address: Sp {�.-L -A 5 / C3�``\i .� Over 1,000 amps or volts 552.26 • 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax:( )
200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that 1 own which is not
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 t above service or f fee, e-'C� 3 b
1 ':. � CONTACT PERSON : :: each branch circu T42 J l --- 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 56,18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City!$tate /ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
- - -- Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
..: CONTRACTOR Signal circuit(s) or limited -energy
name: / t _panel, alteration, or extension. Page 2 2
Business Wa
1} ` t T t _ C Each additional inspection over allowable in any of the abov
c r.
Address: / ? v' / S, W. T t- 4- V -( Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: .. I C1 t'�'c-A=TI IV `, i -_ 7 •� C1 Z„- Industr p t hr mm) 66?5/ hr
industrial plant (1 hr min) 78.18 / hr
Phone: (5 3) (c. ( Z- ( ' L Fax: ( .i C Z - 3 c„.5 Inspections for which no fee is 90.00 / hr
specifically listed (%s hr min)
CCB Lic.:/ C. % Electrical Lic.: 2Q:– `tsL ( Suprv. Lic.: f S :ELECTRICAL PERMIT FEES
c
Suprv. Electrician signature, required: C Subtotal: j -
A __ Plan review (25% of permit fee):
c
Print name: /j- = 2.C---.. Date: /1 / g//1Q State surcharge (12% of permit fee)' - )--•\
TOTAL PERMIT FEE: b /7 9, )-7
Authorized signature: This permit application expires if a permit is not o med within 180
y^— Ay / days after it has been accepted as complete.
Print name: �1 - - -- l-' A. Date: /f %'x1 /`, * Number of inspections allowed per permit,
1: 1Building \Permits/ELC.PermitApp.doe 10/ 01/09 440- 401511(11 /05 /CO.M/WEB