Permit CITY OF TIGARD ELECTRICAL PERMIT
�. COMMUNITY DEVELOPMENT ELECTRICAL
ELC2009 -00145
T [GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/02/2009
Parcel: 2S112BCO3100
Jurisdiction: Tigard
Site address: ,14705 SW 83RD AVE
Subdivision: HAMBACH PARK Lot: 15
Project: Whitlow
Project Description: Bond gasline to range.
Owner: FEES
WHITLOW, LEONARD A III & Quantity Description Date Amount
WHITLOW, CATHERINE C, 14705 SW 83RD AVE 1 crt Branch Circuits 04 /02/2009 $46.85
TIGARD, OR 97224
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/02/2009 $5.62
Contractor: Electrical
DUIT LEVEL TOOL CO
19461 SW 89TH AVE
TUALATIN, OR 97062
PHONE: 503 - 692 -1428
FAX: 503 - 692 -3652
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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.
Issued By: k Permittee Si g nature: )C_�l .f)
OWNER INSTALLATION ONLY �
1
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'N 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.
rrom:CONDUIT ELECTRIC 5036923652 04/01/2009 11:09 #079 P.001/002
• Electrical Permit A licatia CENED FOR OI FICL USE ONLY
oi .,...' City Of Tl;ard Dat`e/By
p : L �) t • • (')Q �C\ Perm,t Na.. �) ``.2 Q� .. 0G l
13125 SW Hall Blvd., Tigard, OR 97223 W v _
1
2 . Phone: 503.639.4171 Fax: 503.598.196APR _ 2�� Pl R ev i ew
Date/Bv: Other Permit: (Q (V ocf ., O(1uu
Ti GARD Inspection Line: 503.639 � Da te Ready /By: 1 t 57 See Page 2 for
V
inter wtw,�.tigard or. O + iSI ` t N o tt fled/Method' l (. Supplemental Information
. TYPE OF p I- , I� • .PLAN ` REVIEW
❑ New construction V . Addition /alteration /replacement
Please check all that apply t,submn 2 sets of plans w /items checked below).
' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: I 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 ❑ Commercial -use agricultural
(- 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 INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", ") "1= ", `
Job no.: aCG S lob site address:
`" Q re [� `' p 100F� or more. occupancy.
I U f
� O� /`C �4 l j ❑Six or m ore residential units. ❑ Recreational vehicle parks.
❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: ! n 'i.Yf Or G7aaLl
`�" ❑ Hazardous locations. GUO volts nominal.
Suite/bldg./apt. no.: Project name:
J A N1,10 LO ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site: ne,eriotinn I Qt I Fee. I Total 1 •
I New residential single- or multi - family dwelling unit.
l Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 14
Ea. add'! 500 sq. ft. or portion I I 33.40 I 1
Tax map /parcel no.: Limited energy, residential
75.00 2
' ` DESCRIPTION OF WORK (with above sq. ft
Limited energy, multi - family 75.00
C rl //p .b (1 rr 4. V1 � f y , - residential (with above sq. ft.)
2
C- 0 (! V Y Services or feeders installation, alteration, and /or relocation
200 amps or less 80.30 •
: •❑ PROPERTY OWNER ❑ TENANT '' 201 amps to 400 amps 106.85 I 2
Name: l 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts j 454.65 2
City /Stale /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1 1 '
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. I 401 amps to 599 amps 1 133.75 j 2
Branch circuits— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
. ` ❑ APPLICANT I . ❑ CONTACT PERSON above service or feeder fee, 6.65 • 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: fist without service or feeder fee, I 46.85 L J(,.,-�' 2
first branch circuit 1 `J
Address: Each add'! branch circuit 6.65 2
— Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) Fax:: ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2 •
- - CONTRACTOR • . • • • • • .... • Sign or outline lighting 53.40 2
Signal panel, e r t rt n ,
Business name: Conduit Electric or
energy panel, alteration, or
Address: 19461 SW 89 Ave extension. Describe: Page 2 2
I
City /State /ZIP: Tualatin, OR 97062 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: (503) 692 -1428 Fax: (503) 692 - 3652 Investigation per hour (I hr min) 62.50
•
CCB Lie.: 109669 I Electrical Lic.: 26 -905C I Suprv. Lic.: 4501S Industrial plant per hour 73.75
'ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 1) b
I Plan review (25% of permit fee):
Print name: Charles Parker ' Date: Al � D State surcharge (12% of permit fee): 5
Authorized signature: / n ' ' 11111) TOTAL PERMIT FEE: , —
L / This permit application expires if a permit is not obtained within 190
Print name: J Date. days after it has been accepted as complete.
• Number of inspections allowed per permit.
Ia Buildinr\Permits\ELC- PermiiApp don 0523/06 440- 4615TOI /05 /COMAVEB