Permit CITY OF TIGARD ELECTRICAL PERMIT
! _ I COMM DEVELOPMENT Permit #: ELC2009 -00405
Date issued: 08/06/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S112BCO3000
Jurisdiction: Tigard
Site address: 14725 SW 83RD AVE
Subdivision: HAMBACH PARK Lot: 14
Project: House
Project Description: Service and (3) branch circuits for workshop.
Owner: FEES
HOUSE, EDWARD Quantity Description Date Amount
14725 SW 83RD 1 ea Services or Feeders - 200 08/06/2009 $80.30
TIGARD, OR 97224 amps or less
PHONE: 503 526 - 3705 3 crt Branch Circuits w /Purchase 08/06/2009 $19.95
Service or Feeder
1 ea 12% State Surcharge - 08/06/2009 $12.03
Contractor: Electrical
JD MILLER CONSTRUCTION CO
11070 SW ALLEN BLVD
BEAVERTON, OR 97005
PHONE: 503 - 649 -6991
FAX: 503 -641 -1902
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.28
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 503.248.6699 or 1.800.332.2344.
Issued B Permittee Signature: ( 'V'/( 97 70,-i
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.
Sefrt By: MIKE'S ELECTRIC; 591 7847; Aug-5-09 10:38; Page 1
To : TIGARD At: 50359
Electrical Permit Applica -
tion CUEIVED
ri..)1‹ u•vici: (;q: ()Ni,\
City uf Tigard Received ea i
Dateffiy: 4 0 0 0 . 0 " 0 4 . 1 2 Permit NoaC,2009 -ere yes
--- " 13125 SW Hall 14 lvd., Tigard, OR 9722J A UG U G 0 5 2 0 09
11, I
Plan Review
• Ph°": 501639.4171 Pax: 503,598. MY OF TIGARD N Ec ta y' , _ Other Permit
TIGAR :
Inspection Line; 503 639 4175 Date Ready/By:
D ' . —
Rd's: * fil See Paga 2 for
Internet: www.tigard.or.gov BUILDING DIVISION Natifw
ied,hod: 7 7 C— _ st.ppl,..0,1 Information
' . . mit puyiiORA .. : • .!., • ,: .:, , • . ' , ' :'. :.•:•..:': '.'. -,•.":.''.' tip1440.*Vii..•'•::: '; .:,,:. .- . . •
0 New construction D Addition/alteration/replacement Piety& chock all that apply (submit 1 sets of ohms w/iteins checked below).
. 0 Service Or feeder 400 amps or MCWC 0 %Mil% OW three vories.
0 Demolition 0 Other: .
i
, . where the available faul or t current I: Marinas and boalyawls.
.." • exceeds 10,000 snips at 150 volts 0 Floating buildings,
less to ground, or exceeds I4,000 1:1 Commercial-use agricultural
Cil
I. and 2-family dwelling 0 Commercial/industrial [3 Accessory building amps for all other installatiuns. buildings.
1 Multi-family 0 Master builder El Other: 0 Fire pump. ID Installation of 75 KVA or
.. :
___ :jiiii...tir ,X1,404b610 ..1i; ,‘::, \ .; ,,i:,: •:;.:,.:; 0 Emergency system. larger sepsnately derived system.
,
i Cab 1 t ' ' ' 26 14725 SW 83
'-- Site address 83rd : 101511P or more.
0 Six or mole icsidential units. occupancy,
—
Ci Recreational vehicle perks.
(...113/SLutZIP: Tigard, OR 97224 0 Hen/lb-care facilities. 1:I Supply voltage for more than
.,_
—, - 0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no,: Rrujcct name; 0 Service or feeder 600 amps or Mole.
.,.:::".:t..... ........... r 73:557?... t - ..
CI iris 'so ID job site:
Description it , Pee 'row
New residential single- or multi-family dwelling unit.
includead 11pe.
- ___ —
•
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
' ......_, Ea, add' .
1 500 sq. ft. or portion 33.40 i
Tax map/parcel nu.: -
;
Limited energy, residential —
5.00
•BiESCRIPTION. OVW,Ditii :........!: ,, -::. ::[...,.; i' ; :; .. (wall above st)„.1) 7 2
---- '
,
Sub feeder for work _ Limited owergy multi-family 75.00 2
:
residential with above a.. 8,
:
,
.
Services or feeders installation alteration and/or relocation
,.
. .. .. ‘ .. .. ‘... .. .. . , ... 200 amps or less 1 110.30 8 • I 2
ID PROPERTY OWNER 7 - ..• I: .. : : :•4:1.•fENANT.• ., • v: Y •.::. 201 amps to 400 amps 106.85 2
..,..
Name; 401 amps to 600 amps II 160.60 2
Ed Hoitsg,
-- 601 amps to 1,000 amps 240.60 -
2
Address: 14725 SW 83rd Over 1,000 amps or oohs 454.65 2
City/State/ZIP! Tigp.rd OR .. 97224
. Temporary services or feeders installation. alteration, and/or
relocation
,
.,
Phone: ( 503 526.3705 Fax: ( ) ,
:
200 amps or less ______ 66.8 ,, I
-- Owner installation: This installation is being made on property that I own Which is not 201 amps to 400 amps 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 circuits - alteration, or extension, per panel
Owner signature: Date: ; — A. Fcc for branch with
Ai4LICANt .: '• ' ..:' • .: . ;., ,..,,. ;',' C;'40i1 v:. s ' :61',i .. ..!itiii.,;" ....:::...:.,..: above service or feeder fee, 3 6.65 19 . 95 2
each branch circuit
Business name:
R, Foe fbr branch circuits
wuliour service or feeder fee,
Contact name:
first branch circuit 46.85 2
Address:
Each add'I branch circuit 6.65 i 2
- - —_,
----.---- Miscellaneous (service or feeder nut inetaded)
City/State/ZIP: Each manufactured or modular
•• 90,90 2
dwelling, service and/or feeder
Phone: ( ) Fax; : ( ) .
Reconnect only 66.85 2
F-mail:
Pump or irrigation circle 5340 2
,
.. , ',. :. .. . , ..-. v,: '......,•,.,••; ___L .,_.,.j.. _ .„ ,. .,:: Sign Or outline lighting 5340 2
........ ... •
Signal circuit(s) or limited- .
Business name; JD Miller Construction DBA Mikes Electric ,
energy panel, alteratiom or
4
'
e
Address: 11070 SW Allen Blvd. extension. Describe: Page 2 2
• - - ,
Ritons , ectliin over allowable in an of the above
City/State/ZIP: 13eaverton, OR 97005 Each ddi i i
,..,,
...-- I Per inspection
non e. 1503) 649.6991 Fax: (503) 641.1902 , . _
Investigation per hour ( I hr min) 62.50
•
......
CCB Lie.; 050209 1/ Electrical Lie.; 34 V Suprv, Lic.: 420 industrial plant per hour 73.75
S
. ...:7., ) 7.7. 7 ,7 7 D - AtEr1I 1 7:i: 7 .7
Suprv, Electrician sign j•:•;". - ' .
ature, required;
Subtotal: 100.25
Print name: Douglas J. Miller -. Date: 08.0i.09 Plan review (25% of permit fee):
State surcharge (12% of permit fec): 12.03
- —
Authorized signatute: ,___0,44.6,,■14,,,,t TOTAL PERMIT' FEE: 1,12a8 t••••''
is Permit application ecilireS If a permit ii not obtained within lea
Pri Th
nt nam —
e: Date; ,
,
dars after It has been complete!)
accepted as comple
i • Number of iittpeetions allowed per permit.
I \ linlItlinaermiishiq.C.ermitApp tine osni3O6
440-461511 i nosicot,t/wca
1