Permit q CITY OF TIGARD ELECTRICAL PERMIT
I COMMUNITY DEVELOPMENT Permit #: ELC2011 -00205
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/20/2011
Parcel: 25111 CC19300
Jurisdiction: Tigard
Site address: 10325 SW GREENLEAF TER
Project: Blair Subdivision: SUMMERFIELD NO 5 Lot: 253
Project Description: Replace (1) 200 amp or less panel
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: BLAIR, ERNA JEAN
1709 SE 3RD AVE 10325 SW GREENLEAF TERR
PORTLAND, OR 97124 TIGARD, OR 97224
PHONE: 503 -234 -9900 PHONE:
FAX: 503 - 535 -2763
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 04/20/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 04/20/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 2 -001- 0. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ./ i� Permittee Signature: Q� // 807 / (
•
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.
Electrical Permit Application 1 OR ()I FICA': USE ONLY
City of Tigard lE w %!X Y �f t ' Pt No:E'7 // r I31SW all BlvdTigtt, O' `rk Y �L !' �(/
Phone: 503.718.2439 Fax: 503. C . i Date/fly: Other Permit:
TIGARD Inspection Line: 503.639.4175 O
O 7 f\ \1 Date Ready/By: hits —1 p El See Page 2 for
Internet www.tigard-or.gov [ t` ` It Notifted/Method: 7 ` Supplemental Information
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L'4+I EVIEW
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El New construction ®Addition/alt l l ' r Please check all that apply (submit 1 sets of plans w /items checked below):
❑ Demolition ❑ Other: 1 � µ Building and boatyards.
available f more 0
and boatyards.
CA1EORY O COPISTRUt:'it'ION" °°°:::: at lts or ❑ Floating b uildings , r
Service or feeder amps stories.
' - .... CX I C r e eds l O VA 1
„ s loss to g round ccda 1 4 . 000 i] Co mme r cial - use
►ii dwelling ~ ' agri cutttual
I and 2-family g ❑ Commercial/industrial 0 building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
' i0B '.bll s1NFO M TON M4Di LOivii 11(111N • : 0 Addition of new motor load of 0 larger separately derived system.
t
Job no.: 79402 I Job site address: I0325 SW GREENLEAF TERRACE 1001W or more occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD OR 97224 Cl Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ERNA BLAIR ❑ Service or feeder 600 amps or more.
'1P'EE SCHEDULE
Cross street/directions to job site: Description J Qiv. I pee, i Total I .
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no
Ea. add'l 500 sq. ft. or portion 33.92 1
DES�IO o wo , .: <.::. ,r...., : ..r Limited (with above sq residential 75_00 2
:
Limited energy, multi - family
CHANGE PANEL. JOB #79402 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ ?Pro za r ow:o ] TFN14111I 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 1 61- /1/7<_, /1/7<_, �_, S.N14- 601 amps to 1,000 amps 301.04 2
Address: .59- Over 1,000 amps or volts 552.26 2
City/State/ZIP:
Temporary services or feeders installation, alteration, and/or
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 I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amp 168 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
`" �l a ser or f ee d er f ee
: A JPLICAt!„, , :.. 1:._4:: C4 CL1tNGT PERSON, . 7.a7. 2
` each branch circuit
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/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and /or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
1✓ -mail' Pump or irrigation circle 67.84 2
:. CONTRACTOR 67.84 2
Sign or outline lighting
`' Signal circuit(s) or limited-energy
Business name: OREGON ELECTRIC CROUP panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1709 SE 3" AVE Additional inspection (1 hr min) 66.25/ hr
investigation (1 hr min) 66.25/ hr
City/State/ZIP: PORTLAND OR 97214 Industrial pixel (1 hr min) 78.18/ hr
V one: (503) 234 - 4900 Fax: (503)53.5 2763 / Inspections for which no fee is 90.00/ hr
,/ ../ specifically listed (% 11 mini T
CCB Lic.: 203 ✓ Electrical Lie.: 26 -95C ` Suprv. Lie.: 4549S ;Eer C fEgB
Y r c1 .,:-? � .- gE Subtotal: _ I00.70
Suprv. Electrician signature, required: �.:'D, -
Plan review (25% of permit fee).
Print name: RICK MCF.I.iJOTT • Date: 4 - 20 - 11 State su charge (12%ofpermit fee): 12.08 v
Authorized signature: C3 ;� C ` �.3:, TOTAL PERMIT FEE: 112.78
This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
Print name: RICK MCELLIOTT Date: 4 -20-11
' Number of inspections allowed per permit.
I:U 3uitdmgiPcrmasIEf.C- PemaApp.doc 07/01/10 440.46157*;11/05/CO54/WEB