Permit CITY OF TIGARD ELECTRICAL PERMIT
° COMMUNITY DEVELOPMENT Permit #: ELC2009 -00385
1 3125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/29/2009
T.LGARD Parcel: 2S110CB08900
Jurisdiction: Tigard
Site address: 12420 SW ST ANDREWS LN
Subdivision: Lot: 0
Project: Wilcher
Project Description: Spa hook -up 3 exterior receptacle circuits
Owner: FEES
ERIK WILCHER Quantity Description Date Amount
12420 SW ST ANDREWS LN
TIGARD, OR 97224 4 crt Branch Circuits 07/29/2009 $66.80
wo /Purchase Service or
PHONE: 503 - 867 -1029 Feeder
1 ea 12% State Surcharge - 07/29/2009 $8.02
Electrical
Contractor:
PORTLAND ELECTRIC COMPANY
3963 NW 148TH PL
PORTLAND, OR 97229
PHONE: 503 - 747 -2305
FAX: 503 - 747 -2306
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $74.82
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
��.C
952 You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
. -1
Issued By: ../ ln ' `' Permittee Signature: — ry-f)
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.
To: Page 3 of 3 2009 -07 -28 07'37'47 (GMT) 15037472306 From: Nicolas Valentine
y • ~ • r'Hl]t ' tiL • - 1 L t LJF LrJ rJ:J Ll. JO 'J 41 LO:JOLUO
ECEIVE
Electrical Permit A>rDpliCa #i t t,w r l l l It l� t '
Pa
City of Tigard _ I II R eceived ?ern* Na
13125 SW Han 01vd,, Tigard, OR 9728 _ ` 2 Zo - . > -Lao pq 00.3s 5 • kllone: 503.639... Plea Review
, .:..:. �•� 4171 Fax: 5035981960 • DeaFB Other Other sant.
::I:I `:' i t;` Inspection Line: 503.639,4175
lnterr�t:.vww.tigard NO
i CITY OF TIGARD I>Nu, RaedyfBy. RI Sze Page s for
^Or. 4V l ",-. DIVISION Notified/Method: ( Supplemental Information
(] New conSttuction [ 'Addition/alteration/replacement Please ctteelt all that apply (submit 1 seta of plans w /items checked below):
0 Service at feeder 400 Props or more 0 Building over three stories.
Q Demolition C7 Other: whore the available fault aurora • 0 Marinas and boatyards.
CATECOiri olifd e llaa ' extxcds 10,000 amps at 150 vote or 0 Floating buildings.
' leas to ground• or exceeds 14,000 0 Commercial -use agricultural
( 1- and 2- family dwelling 0 Commercial /industrial 0 accessory building
s
Multi-family amps for all c±Rtcr inaWllatitPts. bttilttmga.
Y 0 Master builder 0 Other: 0 FireMoog. 0 lnatallatioo of 75 KVA of
JDl3 0 Emergency system, larger separately derived system
. d Addltt of new motor load of ., "E" " 1.2" "1 -3�
Job no.: ' f. q`/ Job site address: p I005 or more. oecupt Y,
._�,_ i Z `i L o 5 v . 51. P •te ., 5 [a... L - ci $i 9f iao residesAtiat ;mats. . 0 Reereat onel vehicle parks.
City /State /ZIP: - „ v,. 4 7 y Zt-/ 0 dealt -ore facilities. 0 Snpply voltage for more than
O faterdous Iocalians, ' 600. volts man si.
Suite/bldg. /art no,: P roject name: (, : \c c r ra `� 0 Service or faodet 600 flaps or more. ,
..,-- ........,.. ), 7 ; . , , , '". n' tl�b IC➢II 4/LI
Cross street/directions to job site: ,,,, ; , z ;
t'•
„ .. /2...7 /,47.- 7....... !✓,. fit, n.�ma 1 ran. i ,att. rut 1 1
New residential slugle, or magi- fatally dwelling unkt.
Includes attached garage.
Subdivision: LO1 ma 1,000 sq. R. or loss 145.15 4
- Ea, add'I 500 sq. ft- or portion 3340 1
Tax enaplpart el no.: Limited energy, residential
Ili ' OF W (with shave sq. it. ) 751t0 2
1 - Limited energy. multi- thmily 75.00 2
'S 7 A `.too L. -...� e Z, 4.-ste iHL ecee to 1nt,,�L Cd c
Pt, g� residential (with above sq. it,) _ .
Services or feeders tnxtaiptitt alteration, and/or reloc
200 amps or less 80.30 t 2
'a Og£RTV m tJ 'T NANt 201 amps to 400 amps 106.85 2
Name; t 401 amps to 600 amps 160.60 2
- - 601 amps to 1,000 amps 240.60 2
Address 12- 20 ,t ,-) '' 1. ri o r' •,, L f. Over 1,000 slops or voila 454.65 2
City /State/Z1P: ,,,, A b I- p -7 Z z Temporary asrvites or feedere installation, alteration, aed/ar
reioeation _
Phone: ( 503 ) c d. 7_ I v .Z e1 Fax: ( ) 200 amps or less 66.85 1
-
Owner installntlolat 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 5 9 9 amps 133.75 2
Branch circuits -new, alteraU t or extension per panel
Owner signature: Dom: A. Fee for branch circuits with
. ® APPLICANT : } ' ' C CitititiTAtt PP t above service or feeder fix,
each branch circuit 6'65 2
Business name: --3 0. 7�",-wa 6-k a� e e..- B. Fee for branch circuits
without service or feeder fee,
Contact name; IQ t Lu t r, .% . • U NI a.,, q. ./C_ first branch circuit I 46.85 (a 5n S 2
Address ll Each add'1 branch circuit J 3 6,65 I i 4, 9 5 2
,-� Miscellaneous vmrvice or feeder not included) '
City/State/ZIP; r9 lz7L- .e,, , . e x'72,7 . 90.90 2
a c t manufacturod a modul
Phone: dwellin &, ser ice erudite feeder -- .—.
( as ) 7 Y 7 34 c Ea x: ; (44 3 ) 7'i 7 -2 36 6. Reconnect only . 2
E -mail: A z em p 1k f t,, 0',c) .eelC- v iQ Pump or irrigation ircle 53.40 2
Sign or outline lighting 53.40 2
Business name:' Signal circuit(s) or limited . ,
�DR'7r Lt ,..» � - 9s t er: c_ t,v+w p �}•, y energy panel, alteration, or
Address: J extension. Describe: Page 2 2
3C1(" 2, /Ls(.. -) 1 � g }k PIA L(.
City /State. /ZIP: A G r 4 9 722 a Rack additional Inspection over allowable in any of the above
Phone: - - -- Per inspection _ 62.50
( 5o ) 7�t7 z3 Fax: ( So3 ) 7Y7- 2 ,5 0 c, Investigation per hour it tirniin) 62.50
BCC Li .: ^ -7 El ; l �C .: GO uprv. 1,ic,: '? 29 Industrial plum per hour 73.75
Suprv, Electriel I signature, l tBB
gnature, rnquirt d: Y l Subtotal L. (, .
Print name: l r t C IA a ,4 +e C, r t D ate: "7- 2 4 1 ' Plan review ( o f permit fee):
/ state ypretutrgc (12'14 of pcnnit fee); `a - 0 {
Authorized signatw'e: �i - �— -�— TOTAL PERMIT PEE: 7`-J . Is• 1 .
t !n • Than pernai spldlaatfoe aspires tra permit b not obtained within 150
Print name: "" / Date: 0 9.2 n -
,�,,, R+�L� r< 7 t days abler It has base eaeeptad w complete • . . Number of inerectioin eib.ved per prrolt.
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