Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
11111 •
: • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00318
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/09/2011
Parcel: 2S104BA10700
Jurisdiction: Tigard .
Site address: 13643 SW LIDEN DR
Project: TEAFF Subdivision: CASTLE HILL NO. 3 Lot: 137
Project Description: (6) branch circuits for kitchen remodel.
Contractor: ALL AMERICAN ELECTRICAL CONTRACTORS Owner: TEAFF, JANET
PO BOX 1426 13643 SW LIDEN DR
GRESHAM, OR 97030 TIGARD, OR 97223
PHONE: 503 - 657 -4351 PHONE.
FAX: 503 - 496 -3995
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 06/09/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/09/2011 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 through O - 52- 001 -0090. You m- • • - • - • • of the rules or direct questions to OUNC by calling 503.232.1987 or 1 800.332.2344. ii
1i
Issued By: iIL .-! '�i! -i - Permittee Signature: __, 0 e'1
OP 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.
. <5: \ )
Electrical Permit Apulication �y 6
� .� Received / 1 .. v
l4/ /7/ lermitNo..
City of Tigard . L S O., Date/fly: /
K� .pram RCviCW Other l'crn,it: �v► CaU I I - ( ' � [
11,...• •
13125 h 5 550 I tail .4 17 1 , Tigard, OR 97 Q
II Phone: 503.639.4171 Fax: 503 59 *19 1=-y' �� C \ ivrlt: l BI See Page x fur C'p t,5c Date Ready/ y: 1 Supplementer c e 2 fnforrnatfun
I'[t t*.l.> inspection I,in
e:: 503.639.4175 �\ !'�� �� Notified/Method: - J
Internet: www.11gar(i-or.gOV 'O .'"°,,__. f' ^��• ... - ,w
.� PLAN REVIEW
TYPE OF WORK
������ Please chock all that apply (snbmil j sets ol'pinns wlitcmw x chucked below):
AdditlnnloltC [Anon /re ❑ Service nr feeder 400 amps or mole ❑ Uuilding over three %tulles.
❑ Demolition Other construction ���
Other where 1110 available bull dlllTCnt ❑ Mslivas and ho:dynrds.
❑ 17C11101ition uxcceds 10,000 maps at 150 volts or 0 Floating buildings. CATEGORY OF CONSTRUCTION less to gn,und, or cxeeed% 14,000 LI Cwnnterrial -are agricultural
Accessory building :naps fora other tulullati0us. huildirw.
1- and 2- family dwelling ❑ Commercial/industrial ❑ Y
❑ Multi - family ❑ Master builder ❑ Other: ID rind pump, ❑ Installation ur 7s xvn or
_ ppmergettcy system. targ11 separatciy der nedsystem.
El
of new mote' load of 0 "A" "E ", "1 -'2 ", "14 ",
JOB SITE INFORMATION AND LOCATION -- IOOUt or more. occupancy.
crcmional vehicle paints.
Job no,: Job site address : 1 310` 3 11) r A'n'y G i 0 Si:c or more residential units. O Ite St y r ly cohugo far more the„ 0 Health-vale facilities. l
S /bldg apt �� g i j �Q1 ❑ Servic Of fee feeder. 600 volts nominal.
- � 11 -= ^ " � —" ID Service or feeder 600 amps or ,Wore.
Suite /bldg. /apt. no.; P roject name; -^ _ FEE SCHEDULE
_ .� t'. oral 7a�e1�,^"_
D,, oolau
Cross street /directions to Jab rile: .r �� New residential single- or multi- family dwelling moll.
Includes attached garage.
�, 168.54 t
Loon .vq. or less
Subdivision �^ ^ „' 1 Lot no.: Fn• add'I fl.
sq, It. ur portion 33.92 !
��
T.imited fncrgy,
. —„ 75A0 2
Tax map/parcel no.: _ with shave sq Il.) -- -
DESCRIPTION OF WORK I,i,nited energy. multi- family 75.00 2
( �Zt"[ �t tv. Ir{ find
_ residential (with bove a
� � " r -fi t Services or feeders in�taltation ; niteretion, and /or relocation 2
f 200 amps ur less 100.70 —
❑ TENANT 201 amps104UUsnips
133.56 El PROPERTY OWNER 4 01 a mps to GUt1 amps ?00,34 2
� 301.04 2
Name
601 amps to I ,000 amps
— 552.26
: Over 1,000 amps or volts
Address: v . - 'temporary services or feeders installation, alter don, and /or
City /State /'LIP: _ relocation „
2 00 s nips_or teas 59 1C, i
Phone: ( ) Fax: ( ) 201 amps to 400 amps 125,08 2
Owner installation: This installation is being made on property that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. Branch circuits - new, aUe�tlon, or extension cr franc/ _
Owner signature: Date: ..— A. Pee for branch circuits with
above service or feeder feel 7.42 2
❑ APPLICAN'1 l _ ❑ CONTACT PERSON each service
circuit e
_ -� R. e a ct'br branch wallow
Business name: service or feeder fee, first ( S6.I S '4.18 2
-- branch circuit
Contact name: Each add'I branch circuit j' 7 .42 r/� 2
Miscellaneous (service or feeder not Included),
Address: �'" — Fach manufactured or modular
67,84
City /State /%IP' _� dwelling, service and/or feeder
_ _Reconnect only / ,7.84 2
} }hone; ( ) 1' "ax:: ( ) pltn,p or irrigation circle 67.84 2 2
Sign or outline lighting 67.84
E -mail: —. - -....T _
CONTRAC i" - Signal circuit(s) or limited - energy
— , panel, alteration, or extension. pa 2
Business name: 4'i, ii m Iltl L2 - N - Each additional r ext l ion over allowable in any of the about
Additional inspection (1 hr min) 66.25/ hr -
Address: ... 1 Liu, ., p - Investigation (1 hr min) 66.25 / hr W�
/7,1P __ _ r� e 40 ,.., ow__ / p3 I ndustrial plant (1 hr min) 78.18/ hr .
Fax: (So3) / q4, - 3 �j ' 5 Inspections for which nn foe is 90,00/ lir
Phunel - -- (p��'? - t f3ty specifically listed (%, hr min) ---
(;CB i.,ie -:
(‘ Electrical Lie,: e Suprv. L ie.: t r ) 1 ,j ELECTRICAL PERMIT FEES
Subtotal: Q, 24, _ �
Supty, Electrician sign rasa }rct1: i , ^ .. . J Ptan r eview (25"/" of permi fcc): .ice
Dote: 79/ // State surcharge (12 "/a of permit fee): It I
Print name: IAA k (Elul Va-li TOTAL PERMIT FEE; (Oc( 4! •
- //
- , / "
Authorized Signature: Ibis permit application cxp[res If s perm/' is nut Stained ISO
�(/ ,- --� `�- , r � days prier it has been accepted as complete.
name: � K •
t tt Date: G _ q (1 { • Number of inspections allowed per permit,
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