Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2009 -00375
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/27/2009
TIGARD 13125 2S112BD04300
Jurisdiction: Tigard
Site address: 14827 SW 79TH AVE
Subdivision: RAZE MEADOWS Lot: 25
Project: Bank of America
Project Description: Reconnect.
Owner: FEES
GINIER, ANDREW C Quantity Description Date Amount
14827 SW 79TH AVE
TIGARD, OR 97224 1 ea Reconnect Only 07/27/2009 $66.85
1 ea 12% State Surcharge - 07/27/2009 $8.02
PHONE: Electrical
Contractor:
OWNER
PHONE:
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.87
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 throug. 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.
minA g ao Q A:4)V C C�1'1
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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.
i;u1. 23. 2009 3:15PM No. 1341 P. 2
. .
Electrical Permit Application FOR oFfigyrisE ONLY . .
74
.... „ y SW Hall gar Blvd Cit of Tid
.., ,.. ...-
, ECN ED Received
Vt) Permit No.: 0(
,;, '. ..:,;-''' ' ' 13125 ., Tigard, OR , 2. . .
-: . .- I Phone: 503.639.4171 Fax: 503.5 I.1.
Date/By:
PDiaantetv: Other Permit:
'-, • , - Inspection Line: 503.639.4175 JUL 3 2.°1°9 Date Ready/By 361: ---- fig See Page 2 for
,
garnet: www,figard-orgov Notified/Method: I ,9 supor.... Information
TYPE OF vy017f.c* .6i.;:ski.'..: ,'.:,•.',..::::':.:.':::',:..::':::-..,..,•..':,. PLAN .REVLEYY.
Lj
1 New construction - " - et1111/.. - i\11.,101N • ' Please check ell that apply (submit 2 ots of plans whims cheokcd below):
0 Additionfalternyww. t
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where the available fault current Q Marinas and boatyards.
,■: CATEGORt OF CONSTRUCTION •, :: '": :•.:‘,•'••••';',.. ,:'''':•':',,','I•'.;‘,:''':, exceeds 10,000 amps at 150 volts or El Floating buildings,
km to ground, or exceeds 14,000 0 Commercial-use agricultural
0 1- and 2-family dwelling 0 COrnMercial/industrial 0 Accessory building amps for an other installations. buildings.
0 Multi-family u Master builder p Other: 0 Fire pump. 0 Installation of 75 KVA or
. , . ..,.
..... 0 Emergency system. larger separately derived syStem.
't,' ,f6)13 $irii( irtiFoiti4/mOri :AND. LOCATION .::: :•,'::..'-',.'•',.•'•'...,''':•.:.,:..':,.,I 0 Addition of new motor load of 0 A "1 "1
.'" - ? 4 1001-11) or more. occupancy.
Job no.: Job site address: 14827 -54,3 - 7 ‘ - 0 Six or more residential units. 0 Recreational vehicle parka.
-
City/State/ZIP: Tigard, OR 97224 0 Health-care facilities. 0 Supply voltage for more than
0 flaaardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDIJU
Cross street/directions to job site: Durham to 79th Descesptioa 1 Qr. 1 Fes. 1 Total 1 •
"*------ New residential single- or multi-family dwelling unit.
• Includes attached garage.
Subdivision: Raze Meadows Lot no.: 25 1,000 sq. ft. I
or Icss 145.15 4
Ea. add'I 500 sq, ft, or portion 33.40 ]
Tax map/parcel no 2S112BD-04300 Limited energy, residential
75.00 2
4 i:.'1,g;,':,,!; : X,;; ; '!:,'..:;';;;' : , :',':'',:;'::, , ::‘,.,' , 1)E,StRipTION Or (with above sq. ft.)
Limited energy. multi-family
Reconnect inspection 75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
, . .. 200 amps or less 80.30 I 2
I'iti)i'EBT'ir: 7.7 :1 7 ' . .:'' . .'::', 0 TiisiAitnr 201 amps to 400 amps 106.85 - 2
Name: Bank of America (Judi Hammer) 401 amps to 600 amps 160.60 2
601 amps to 1.000 amps 240.60 2
Address: 224 N. Baker St Over 1,000 amps or volts 454.65 - I - 2 -
City/State/ZIP: McMinnvile, OR 91128 Temporary services or feeders installation, alteration, and/or
relocation
Phone: (503)472-8411 Fax: (503)472-8866 200 amps or less 66.85 I
Owner installation: This installation is being made on property that I own which is n 201 amps to 400 amps ot „ 100.30 2
intended for sale lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Branch circuit; - new, alteration, or esdension, per panel
Owner signature: , Date.
A. Fee for branch circuits with
k,'.i, : .,,,,,: 4 :';':R„': g.'0N7t Act:r• '',Ixtitsiip; above service or feeder fcc,
6.65 2
* each branch rircult
Business name: a Fee for branch circuits
without service or feeder fcc.
Contact namc: Judi Hammer lefiek ./.3'0X 00 DE - . 7° first branch circuit 46,85 2
Address: 224 N. Baker st Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not Included) City/State/ZIP: McMinnville, Or 97128 Each manufactured or modular
90.90 2
dwelling. service and/or feeder
Phone: (503) 472-8411 Fax: : (503) 472-8866 Reconnect only 1 66.85 66.85 2
E-mail: judigiudihammer.com . • 0 *S 1 q G8 Pump or irrigation circle 53,40 2
- ' • •
)%9Mr''':,.','CoNTRAtToR:!:,::V;;;,';.;?Z:i.^ Sign or Outline lighting 53A0 2
Signal circuit(s) or limited-
Business name: ,.. _ A - energy panel, alteration. or
Address:
extension. Describe: Page 2 2
'
. ..
City/State/ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax: ( ) Investigation per hour (i hr min) 62.50
,...- .
CCB Lie.: Electrical Lic.: Suprv. Lic.: Industrial plant per hour 73.75
NR„:,qti'4kt11.0.**i 074
Suprv. Electrician signature, required: Subtotal: 66.85
Print name: Date: Plan review (25% of permit fee);
... State surcharge (12% of permit fee): 8.02
Authorized signature: TOTAL PERMIT FEE: 74.87
i
This permit application empires it a permit Ls not obtained within 180
Print name: JDate: days after it has been accepted as complete.
t: Number of inspections allowed per permit.
latuildingWermits\ELC-PermitApp.d6c 05/23/06 446-4615T(11/05/COMAVE13