Permit lki ' . CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2009-00570
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/27/2009
Parcel: 2S103BB12700
Jurisdiction: Tigard
Site address: 12305 SW ANN CT
Subdivision: LAKE TERRACE NO. 2 Lot: 20
Project: Hand
Project Description: (2) branch circuits for a/c and work plug.
Owner: FEES
HAND, ROBIN R Quantity Description Date Amount
12305 SW ANN CT
TIGARD, OR 97223 2 crt Branch Circuits 10/27/2009 $63.60
wo /Purchase Service or
PHONE: 503 - 341 -6609 Feeder
1 ea 12% State Surcharge - 10/27/2009 $7.63
Electrical
Contractor:
CANBY ELECTRIC INC
790 S IVY ST
CANBY, OR 97013
PHONE: 503 - 266 -7878
FAX: 503- 266 -5543
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
Required Items and Reports (Conditions)
This permit is e su jec • the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done i ccordance with app • ed 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. A ENTION: Oregon law r- : • o to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 0010 thr•ugh OAR 952 -01 -0101 - obtain a copy of the rules or direct questions to OUNC • -: • '41.11116,,,..,' : ' , 6.6699 or 1.800.332.2344. •
A
Issu By: �L - � I Permittee Signature: ' ' ...1/ Xi"( -
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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' ' ` _ Q 1 V 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.
,.,. Electrical Permit Application IZECEIVED .,,,„,,,,-. 0, - --_ ,r - _ . -- - . ... _
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• .. :. ,. , .4 ,i.: .:i . City of 'Tigard OCT 23 2009. Received
' 1 P,1111,1 Nu Et
4 . 1.3125 SW Hall Blv0., Tigaid, OR 97223 __,.,-
Plan ReViow _
• , ' -7, . , 2 ..:''.,' Phone: 501 619 4171 7 ax• 50:3 59R 1940 00. ii,,,,,ii 4 . 14 ) .06 1 _ —056 3
Date/Bvt
. '.7'''' 'Y . ' . -.. " ' ‘) 17 ' TY OF TIGARD — , --('--
• • Inspection Line. (13.6.,,, /1..1 IJati Ready/By: Ju 1 0 SAN'. Pao 2 for , . .
': • • - Internet: wwsv.tigard-orgov BUILDING DIVISIOIN No 4, G
tified/Method: Supplemental InforMan011 '
. .. ...-
. .
TYPE: 'OF .WORie ''..'' ',.': ,..i''. ..,:,:: ' .„,...., , pt.AN REVIEW ... . • :i."
.. . CI :New construction Additio[vaiteration/replacement - pi.„ cheek all that appty oup,,,,(2 ,ets of pliles wiii,..Ins checked below):
0 Service or feed tam -1.41.-
er 400 amps oi e nl i4 Id ul
.e us. throe stories
. ' . 0 Demolition Ei Other: w th evat r;, c D Mar inas and boatyards,
',
. , CATEGoRY OF CONSTRt&IONi: . ' •:''''' ''.." . '' .' exceeds 10, 000 :imps a( 15r) s,.■10, ci 12 l'Iclali4 huildinlla•
. .
: . .
., --- less to ground, of exceeds )4.500 1:1Conlincteial-ust agriO,ult orl
a
XI - and 2-family dwelling 0 Comm;cial/industrial 0 Accessory building amps fur all ()ORA htMalhitions 5uildill0,
. .
0 Mufamily E Master builder 0 Other: ORR pump Li Installation of 75 KVA or
. larFer yupaiotely derived syF:Ielii.
. . , . JOB strE INFORMATION 'ANEI:::LOCATON'''. 0 Addiimo of i c,,v motor loii,i ot
. ....,
. . . .
Job no,: Job site address: j?...3 °
0 g 51„ Ay 1 n (-4--, I 00HP or more accupalley ., '
.. ..... Six or more residential oink C Recreational vehi,...le.parka. '
Cit!.,"/„561e/Z11'' 1 , (2._ 2:4 . D Healthcare facilities 0 Supply vine for more than
q
_)..1W ) 1--7' 0 Hazardott Ioeatb, 600 volts nentioal„
/-
Suite/bldg./apt. no.: Project name; 5 1 D service or feeder 0(8) irrtpi, cml mole.
Cross strect/direCtiOns . • . . . .
,--' I 014 i'' ....
. — - — FEE SCHEDITLE . ...:.,......;.:.:
in lob situ;
hrscrip■ion ...„... 1 (.2.y. I r J Total' I •
_,..,..... _
.
New roidential single- or multi dwelling unit.•.
. .
. . Includes attached garage-
„ . • ..
--
. . ,
• SubdiviSion: I,,ot no.: 1,000 sq. ft. or Less F 145 15 . . . 4
'
— Ea. add'l 500 sq. R. or ponion 33.40 . ' 1.
Tax map/parcel lat.:
- -- limited energy, residential
. . . WORK
. ..
: . . DESCRIPTION OF:', . ....,... : . :.,i ....., , (vvith above .,;41. n)_,,,..
._......._ .
. . Limited energy, multi-Tan-illy .
.
. : 7500 2:
.
. .
A7(. icr Pc • / — residential (with abOVO 3g. 7k ) •
........
- Services or feeders intaitation, alteration, andio 'relocation. ...._..
. e
. ' ---- —_„- 200 amps or less 80.30 ' 2
0 PROPERTY OWNER amps 1o400 .onsps — 106.85 • ' 2 -- TENANT ...., .....
•' NITIe:
k11-4)—.' i 401 amps to 600 amps itA).00 . 2' '
_...... 6°1 amps to 1.000 amps 1 240.60 • 2
A ddress.
Over 1,000 amps or volts ... 454.05 •
(wFu—:(-- " - _,,, 2 ,
. __—
Temporar services or feeders installation, alteration, and/or
. . .
City/State/ZIP I P 5 :
relocation ,
, .
Phon ( g ) 5 - 79 _ 05 - 5 ci,i - TEax: ( ) ,. 200 amps or Less I 66, l:5
, :1
. . : . Owner inStallation: This installation is being made on property that 1 own which is not ,., amPs to 400 amps 100 0 2
„....
intended for sale. lease. rent, or exchange. according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 . 2
I .
ilranch circuits - new, alteration, or c‘tension, nr .anel •
Owner signature:
- ,..---- ...., - Date- ' ----- A. Fec tor branch citC:uit; %lath
' , . ." • .:,-. -;,'' 0 APPLICANT , . ., ,....
::: ,,... .. P CONi:A:e.r:'... ...:. : , ..--.. above se; vice or fecal I•ce.
. ..,_ - - each branch cnt;on 6.65
. . IF/1111
Business name: B. Fee for branch circuits
:.,--
..,„
_ ..... -
without service or feeder fee, ,
r l I 46.85
_
Contact narne. --
first branch eircoil
Address
- ' -
• Each addl branch circuit i 6.65 Irigr
... : - .- .... ..._
. ... ___. ...._ _ -- _ -‚ •— Nnseetianeous (service or feeder not included
....,. ......_.
. ' . il:yi:St4tertii'; Each manufactured or modular
009Q NM 2
- . -" - ' dwelling. service and/or l'eedc■
Phone; ( ) Fax; ; ( ) , Reconnect only 66.85 .• • '2
_ ...
„... ___ _.,
E .
: Pump or irrigation circle C (.40 7
... ..._._. . ..
.
53,40
CONTRACTOR ... - ,. . . .. ..... ... .., . , . Sign or outline liglaing
• ,, ._ .,,- 2
1 --,_ ,
Business name' V) ti ----,--- 1 .4 (""\ -- --"." _ Sianal circuit(s) or 'limited-
energy panel, alteration. or
.... extension. _.. Describe. a 2 2 .
Address: n CA 0 C D . ...L -. ' _ .. -
.
City/State/71P i - 1•
Each addition l a inspection 4» 4f4' oie in any of the shove
per inspection , 6'2 50
._... ---
Phone; G - 0 7 . 9 - 2 C 4 („__, 7 - - - 1 , .,::: . _ I . ELM; ( d'9 - 1( z ,( 0 --, ' , S - 6 .t.-.,...Ts _ investi hota ( I a aao i : 62.:,.0
_.... . .._.... - Industri31 plant per how
CCB Lic.: - ,..,--‘ t H•locts ietil k 7c _ Suprv. Lie.: e"? I, .2, 7 c . ....__..... ........... . ..__. ______.
Et..ECTRI1141. rtArsirr l'EES /10
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supry, rIcetrik signume. n.,;11■L:1.1 \-44A..._,.....„.: C.'1,..,,,.....2 S411144)441.
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-- - • ' ---. '''-'' Ilan ICS WS I .'.'"/. t II 04:1101 fes" I.
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-- s--.. • Date: _.... ____. .....
Print name --\ ----.. ___ ._____.. .._ - .... ....... .........
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,...._........ , ..... _..... _ _., _ ....... St ale •.tili•hiiit6. I I .''' a ol 4)4."4 ICC)
14 ) \ ' l'' 10/111 i I.1 • ^ g '
Authorized WOO OIL . .:,,, k) ...')L,.._,..,..___,' .... — - -
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it01 Wihi n l 80 2
Print flhlliL .- C - • C ' I'1•Ltc: i ilii■ . A Ii 1 t,,1 h,,..11 AV Ot ;1 0/MPlett. 71.
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