Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00455
Date Issued: 09/04/2009
T1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S104AA01100
Jurisdiction: Tigard
Site address: 12400 SW BELL CT
Subdivision: BELLWOOD Lot: 60
Project: Kearney
Project Description: (1) 200 amp service for repair of meter
Owner: FEES
KEARNEY, STACEY L Quantity Description Date Amount
12400 SW BELL CT 1 ea Services or Feeders - 200 09/04/2009 $80.30
TIGARD, OR 97223 amps or less
PHONE: 1 ea 12% State Surcharge - 09/04/2009 $9.64
Electrical
Contractor:
DYNALECTRIC
5805 SW HOOD AVE
PORTLAND, OR 97239
PHONE: 503 - 226 -6771
FAX: 503- 226 -7720
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
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 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: V Permittee Signature' (77°/?' -�4�
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.
- 2009. SEP, 02, WED 12:47 DYNALECTAIC SALEM FAX No, 503 391 - 2817 P. 002
Electrical Permit Applicatio
n� e ' w E a ()Ii orr;<cE USE ONLY
City of Tigard Receives . 7 A Perntim- a -ze„oo 9-4,0 vss-
- r' 13125 SW Hall Blvd,, Tigard, OR 97223 c :::: : e\ v Phone : 503,639.4171 Fax: 503.598.1960 EP 0 2 2009 i OlhcrPcmut;
TIGARD Inspection Line: 503.639.4175 ,� Aare head /B �� EZ Sec Page 2 fbr
• Internet: www.tigard- or.gov CITY GF TIGARD Notifea /lvletbod: Snpplemcntal Information
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❑ New construction „ Addition /alteratioll/replaeement Please check an that apply (submit2 sets of plans , v /items checked below):
❑ Service Or feeder 400 amps or more ❑ Building over three stories.
El A itiori ❑ Other:
where the available Fault current ❑ Marinas and boatyards
1 '•!! ;." %:`'',iP ;) �; .r Y .. y r ,, A rxlu , _, 11. exceeds ln,UOO
.
r .,:.
I C,tA� , �c�,dl2�• 1 �i" r�GS .. „ �'�t > L1,.
tl t} 1 � � ' �� •� ���1�� ? i y.T amps at 150 volts or 1:1 Floating buildings.
" ""! �l' lass to ground, or exceeds 14,000
yt 1- and 2-family dwelling 111 Commercial /industrial 111 Accessory building Commercial -use agricultural
g amps for all oilier instsllations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: . pump. ['Installatio of 75 KVA or
7-'7772. ; .i ,' ; y , : „r:, ,. « , ,. ! a ; , e . , , .n - 2: p -r ❑mergtncy sYSlem. a e
;' ;�'�'� ; � Q • i 1 � P a f °' 1 rH r separately derived system.
' •;(r 1' b24 1 i, ❑ A t r`1 -2" ••1 -3"
.� tir a � s �r }. aa of motor load of lj "A" " E" t
�0'''. - 7 ` / ) 5A `/ 100BP or more. occupancy,
Job no.t ��'� Job site address: f 7 {' � X �/
❑ Six or more residential units, ❑ Recreational vehicle. parks.
City /State /ZIP: �/ rr ❑ Health - care facilities. ❑ Supply voltage for more than
['Hazardous locations. 600 volt; nominal,
Suite/bldg. /apt. no.: Project nalne: 9� �`62 , ❑Service or tbeder 6ao a , r
/+ A.. � / n s o men. •
Cross Ll t�" I• t•. ;111!i ^' ,' ,.� .p . P...,..: y ' •r .f y:X:An...-!•,, ,
9?;:11:. ;::,'1i��, �1 .�,' ; r� ;ti�'C�.Ijt { is ,'. a, 7i,. tt�!. ta' t�trrlldi _i�rK ;if ;�!'tr.Sclfr'(.1
s et/direcfions to job site: Aeacription
Qty. Fee. Total •
New residential single- or multi - family dwelling unit. .
Includes attached garage. ' .
Subdivision: rf %'r ;l,tr'° l Lot no.: 1,000 sq. ft. or less I45.15 4
/parcel no.: L Ea. add'l 500 sq. ft. or portion 33.40 1
Tax map
,• /a r: , • , y�y : r • +� r Jk ",1 u, • �I . Limited energy, residential
, 1 :�_ ; :i. z '` '''. »{°'P1 C� . :q vo ie ti . ts l'at 1, "hilts 3 : ; im (with above sq. R) 75.00 2
t , f Limited energy, multi- family
• 4 . ' . 4111-. f•`' -- ,�j 4 . , . _ _ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less / 80.30 SAW 2
,1:, 1 �,�,y Y " � '72,7. P 7'I
r. ! iPl:Yt ' ab, � ! r k t � i .' ;I ' 6 " 2'1 � ,'_ �,ri' „� ' I . rleatr 201 amps to 400 amps 106.85 2
Name: /E'4,�ey s 779-C-&-- .`` 401 amps to 600 amps 160,60 • 2
- � / 601 amps to 1,000 amps 240.60 2
Address: , Over 1,000 amps or volts . -
q 454.65 2
City / State/ZIP: Temporary services or feeders installation, alteration, and /or '
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I n which is not 201 amps to 400 amps 100.30 2
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intended for sale, lease, rent, or exchange, according to ORS 447, 449, 070, and 701. 401 amps to 599 amps 133.75 2
Branch Circuits - new, alteration, or extension, per panel
Owner Signature; . Date'
re'
' n;•..m' i8�:; iiili, ;xa ;saat ` ,. .;. t ,, } ;• s „o � tt A. Fee for branch circuits with
4'
-r'nI °�° ;.ue!zti� ( v cP U t I i i'! MOON: _e ' _It �yll tiki'r-ii above service or feeder fee,
6.65 2
each branch circuit
Business name: B- Fee fbr branch circuits
Contact Warne: wi0toar service or feeder fee,
:/5 .5 first branch circuit 46.85 2
Address: .. Each add'l branch circuit 6.65 • 2
lvltscellaneous (service or feeder not included)
City /State/ZIP: lilaoh manufactured or modular
Phone: ( ) Pax: :
�� dwelling, service and /or feeder 90 2
�f'' 7 7' ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2 �
. ; " �'• �.`,i' r• }i;�l:i ! :'. ;T r.N t' F ,. ti • ,, ,, iT. tt>; •Md''' ' i , i a • g . '4 ' 1.
. 1 . ,1 i :,' 1, ,, .:: t�, 'a ,, -. - , . -- _ i ..'&f .: a,n_ia7,,,i, IY.4 ,0: Luc i t 1 i �c Sign or outline lighting 53.40 2
Business name: Signal circuit(s) or limited -
l• i /.. .; energy panel, alteration, or
Address: r � 4 r 0 / / extension. Describe: Paget 2
City/State/ZIP: 6 , , + E ach a dditional inspection over allowable In any of the above
Per inspection =1 62.50
Phone: (4.4?3). 6 77 Fax: (6
/ / v�.0 Investigation per hour (1 hr min) EN 62.50
i CCB Lie.: P leetrical Lie.: .g Suprv. Lic.: Industrial plant per hour 73,75 •
/ I ,:rltl,g ldr,' �', ;ilb t 4�'' r l; S , ! `ItS4. i. •.=
•fr r.
Suprv. Electrician signature, required: ,, { ii' hip r ' .' ! �` " °x' `'rY
•,,,-,d : �.. : l� l` subtotal lo. s o.
Plan
Print name: . an review (25% of permit fee
-It'd_ . .._t• a. Dater b , ( p fee):
State surcharge (12% of permit fee): 5
Authorized signature: -,�+ `�` �� J • TOTAL PbRMIT FEE:
Print name: y�� Date: This permit gpplicntlon expires 1f a permit is not obtained within i8o �j
¢ drys After it has been accepted as complete.']
• Number of inspections allowed per permit ?.Y'
I: \euildineTti mit, \HLC- PemticApp.doe 03f33m6 440- 4615T(11 /05/COMIWI?H
•
Z009. SEP. 02, WED 12:47 DYNALECTEIC SALEM FAX No, 003 - 391 - 2817 P. 001
Dynal � Dynalectric Company
ectric 5805 SW Hood Avenue
Portland, OR 97239
An EMCQR Company Phone: 503.226.6771
Fax: 503.226.7818
ccb: 66793
Facsimile
Number of pages including this cover sheet: 3
Date: 09/02/09
To: Electrical Permit Dept Tel:
Company: City of Tigard Fax: 503 - 5981960
From: Lynne McEachern
•
Message: Following is and Electrical Permit Application to be processed.
•
Oyna -013 Rev_ 02/17/04
T-258 P . 001/001 F-325
EL i_C_Rc--oct— o
09-18-2009 03:51PM FROM-
j 07 9e £ £// di
1!fa,1%, Request to Energize an Electrical Insta.fiation
' •Ma i Jurisdiction address:
lb '. iset4rir. ;
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Name of supervising electrician: --- 7 XV X • /77 _ Date of request: pl /0 c
Supervising electrician's license number: 4 . Date installati )11 was completed: 9 /9 /c 9
Electrical permit no.: atte0 %Ts' If a temporary permit i S posted at the job site, p!ease thclotle a cop) of it with this form.
!?.li,'-..!.i'...7';.';,.;.1::,EIVIFI,LCY,yriNG,,:r1Eti 07P9ItALP,'=14{ RACTORMN.FOITMATIO.;!,;ifi'k6igia;ge!.'i,::::.;.:1,!:;',,I,;:;,
Name of electrical contractor: c.0 .042.. le&4'--,'1 ').-r)/2_./:?..y..____ License no.:
Business address: L6c_ 05 ) fi=-0 /
( City: z.'2,c:).0-1/-44=2(-)c-.Z
State: (:)..4 ZIP:
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Phone: ...W . & 7 Fax: - 0.5 - c.R7$ , 77 E-mail: '
_
i7,F.7,C4',' '.;:;!:,Ii'tI:.I.Qt;;;-ai.V;&;4.4!‘'IMIIU!',;.:N)!R:.VCCISfriOltiE '2INFOR:IVIAFTION4M4f'i•i%4640% f;igg',Y' 4140.Fgff;q0,;.::::tkf!t,
Customer's name:
•
Customer's address: I 24.- (oo : -.1-1/ C1
ity: 7...,_
State: '... ZIP:
Address of installation if different than customer's address:
-
:::iryt
State: ZIP:
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•
Z:,•!'.,..'}t T •'; ; ;attI RVOMA*t . W...:irilgf:,:'::•:,;V-I ' 'REC iiiNGIAITTOCRIPY,:;i1NROBli/IATION31.7 ,r!,•Mf•71);;:;;iS.V;:':i'a.:10t;iWti•V:M ,
iqithority having jurisdiction to inspect: C,+ a rc- T't - ,,,a . Phone; - -
.—
.F.ddress:
C •ty:
ZIP:
State:
_ _______
•lf iP :' i;4';''f: 1' !"+ .. NG.'4IE8 E;C: YA N FOR NATI o't 1 v,—T57';',F,..;',..77w-pTir,-1,--7
. __,—,_,....:..._., , - T . ' • "T". '' ` '• .1ft.`. i71.^;,IT- :
N ime of electric utility receiving request: -pa Phone: L5253 _ 7..%
—
AI: dress: AR / 520 4..2.2.1' ,17L' - _ _
City: ,PeD.L,V-../a 40
State; c2,f? ZIP: 9' zp
A,. Restoring electrical service that was inteirupted or disconnected because of either a:
R_Service change or 0 Uncontrollable event, such as fire, flood, or severe weatlie.-;
,
or
B. Electrical service at a remote lotation needs to be:
El Initialized 0 Restored
..I
:;ZE.:■:;:;..1,..:;A!‘.r.4.'r.-4., r,!P.:.'F','g 5:(.".N,,);r:'i',' VCOVI 17A4E31P,0711,N.$7130 CXIONS.ARD ; , S' l alS1 :j::'6:"!Se" ? ••g';'';..';‘;•lM.t 1 :'' , 01'1 , :;•,•! . t' -)::;.'..';'-;::, ,','%';
Supervising electrician El ectrical contractor
Pie,: se note — After sending this form to the electric Please note —13y close of business on the first business
utiliry named above, you must send a copy of this form to: day, following energizing of 8 completed installation in
(I) tile electrical contractor, (2) the customer, and (3) the response to the above request, you must: (1) notify the
in :cting authorit ,, 0 / -- 4,--
c
•
..1[Ai 11 t._ _, . 1. 'A / • - C) - authority having jurisdiction that the installation has been
energized, and (2) request that the authority inspect the
.
completed installation.
Superl..sin c1ectrician's RignatuiT. i Dille
ra4 ET Vsrli
i .
LL5 4-s5
a5 LNT iER viCES
0•0948- (9/08/CONI
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