Permit Y CITY OF TIGARD ELECTRICAL PERMIT
` s m COMMUNITY DEVELOPMENT Permit #: ELC2009 -00487
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 09/17/2009
Parcel: 2S 112BB00600
Jurisdiction: Tigard
Site address: 8505 SW COLONY CREEK CT
Subdivision: Lot: 0
Project: Dawson
Project Description: (1) 200 amp service.
Owner: FEES
DOWNES, PAUL W Quantity Description Date Amount
13712 SW HALL BLVD #6 1 ea Services or Feeders - 200 09/17/2009 $80.30
TIGARD, OR 97223 amps or less
PHONE: 1 ea 12% State Surcharge - 09/17/2009 $9.64
Electrical
Contractor:
ERTELL ELECTRIC LLC
PO BOX 279
FOREST GROVE, OR 97116
PHONE: 503 - 841 -4511
FAX: 503- 359 -5652
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 o herapp'icl able 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 w6rk is suspende for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Itotiftcation Center. Those rule 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 c in 503.246.6699 1.800.332.23
Issued By: Permittee Signature:
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' � / !/fir 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 ApplicatimRECENED __ FOROFFICEUSEONLY
Received /r
City of Tigard SEP 7 2009 Date /B : 7 � 7 O Ate, _ PermitNo. C 0200 ,iii y
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
' _ Phone: 503.639.4171 Fax: 503.598.1960 Date /B : Other Permit
TIGARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: loris. El See Page 2 for
Internet: www.tigard - or.gov BUILDING DIVISION Notified /Method: 7-"-- Supplemental Information
~ s „:. x -.. , TYfE= A , OF WORK2 ° f � ,- rr � ., ' . L,- L `, W, P` ' , -e , ,, REVIEW _ : x r : •, ,
Please check all that apply (submit 2 sets of plans w /items checked below) New construction ® Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
7 � - a ;, exceeds 10,000 amps at 150 volts or ❑ Floating buildings. >
�e { ��"�ATEGORYAF CON 5TRUCTIOiv Ott � t a �: ' , P 6
" ° � � � � " °� " "'� �� " '' `"" less to ground, or exceeds 14,000 El Commercial-use agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
s',,,, ,. : x ,.. _- .:.... ;AID' . .. .,, ° .- A;m,* m. system
t. L I Alr Emergency syste larger separately derived s st
• .it JO ; INFO A ND- LOCA ; i A ` i '
aol t ❑ Addition of new motor load of ❑ "A", "E ", "I -2 ", `1 -3 ",
Job no.: Job site address: 8505 SW Colo35ny Creek Ct I OOHP or more. occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State /ZIP: Tigard Or ❑ Health -care facilities. ❑ Supply voltage for more than
. ❑ Hazardous locations. 600 volts nominal
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
A -FEe$01„EDUL1a ; : _r
Cross street/directions to job site: Description I Qty. I Fee. I Total 1 *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Tax map /parcel no.: Ea. addl 500 sq. ft. or portion 33.40 I
Limited energy, residential
-° -i ,- .:..a: �� - .�.g...;DESCRI PTION 'O>'+.a WORK4`' '„ z,"' '(a ,. (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00 2
Remove and replace existing meter base that was damaged. Power was removed by residential (with above sq. ft.)
serving utility Services or feeders installation, alteration, and /or relocation
R a� a .
ate 200 amps or less 1 80.30 80.30 2
.
amps 106.85 2
m 4,,. / a "" ' .` PROPERrC OW TcR: , � � ? " NI
EAA\+T �" 201 amps to 400 am
�f . ._, � � . . a.._ � �o� ® ��, �� � .� tea:• P P
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 66.85 I
Owner installation: 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 599 amps 133.75 2
Owner signature: Date: Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
l above service or feeder fee, 6.65 2 F ,t i,d a u - ,,. $ a ONTACT PLRSON l 1 i ,4
. ' E .. ▪ ® APPI ICe�NT C �,A a a
each branch circuit
Business name: Ertell Electric, LLC B. Fee for branch circuits
Contact name: Dylan Wentworth
without r anch circuit service or feeder fee, 46.85 2
first branch
Address: P.O. Box 279 Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Forest Grove, Or 97116 Each manufactured or modular
90.90 2
dwelling, service and /or feeder
Phone: (503) 841 -4511 Fax: : (503) 359 -5652 Reconnect only _ 66.85 2
E -mail: dylan @ertellselectric.com Pump or irrigation circle 53.40 2
.`s "e '' `'_ s" ° ,4 s*� `; .. CONDirAV;r ,, ; „,,, m E Sign or outline lighting 53.40 2
�' ��_ ” Signal circuit(s) or limited -
Business name: energy panel, alteration, or
Address: extension. Describe: Page 2 2
City /State /ZIP: Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( ) Fax:
Investigation per hour (t hr min) 62.50
CCB Lic.: 180540 ✓ Electr ic.: C390 • Suprv. Lic.: 5420 S ✓ Industrial plant per hour 73.75
r ,; ELECTRICALS PERiVIIT FEE3 11 a , ; 7'
Suprv. Electrician signature, required: ( Subtotal: 80.30
—
/ Plan review (25% of permit fee):
Print name: Dylan Wentworth ��/Date: `t6Sep09
.-- State surcharge (12% of permit fee): 9.64
Authorized signature: - / ( TOTAL PERMIT FEE: 89.94
t �- This permit application expires if a permit is not obtained within 180
Print name: Dylan Wentworth Date 6S - ep09 da af ter it has been accepted as complete.
* Number of inspections allowed per permit
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Supervising electrician's license num. =r 1 .' Date installs :ion was completed:
Electrical permit no.: lfa temporary permit is posted or the fob say, plearc includes a copy of It with tins font!.
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Address of installation if different than customer's address: _
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Name of electric utility receiving request; ? Phone: 53 -7
Address:
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ing tri aI service that was interrupted or disconnected because of eith,.: a:
r "a Service change or ❑ Uncontrollable event, such as fire, flood, or severe weather;
or
D. Electrical service at a remote location needs to be:
0 Initialized ❑ Restared
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Supervis 1ng electrleia i ' U Electrical contrac — T
Please note •-- .,After sending this form to the electric Please note --19 cl I;;e of business on rho first business
utility named above, you must send a copy of this forty, to: day, following eiuergz.ing of a completed installation in
(1)- the ele al contractor, (2) the customer, and (3) the response to the above! request, you must; (1) notify the
inspecti 1 : tharity. authority having j ith diction that the installation has been
W AY i ' g _ o'^ energized. and (2) request est that the authority inspect the
completed installationa•
Shp , sin eicclricinn sai mature Date
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