Permit I; CITY OF TIGARD ELECTRICAL PERMIT
--'• - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00590
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S112CA08700
Jurisdiction: Tigard
Site address: 7556 SW ASHFORD ST
Project: Takasumi Subdivision: RENAISSANCE WOODS Lot: 13
Project Description: Electrical grounding after water service replacement.
Contractor: CASEY'S PLUMBING Owner: TAKASUMI, RICHARD C & DEANNE L
PO BOX 30075 7556 SW ASHFORD ST
PORTLAND, OR 97294 TIGARD, OR 97223
P
PHONE 503 - 624 -1183
PHONE: 503 - 253 -0030
FAX' 503 - 262 -8251
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/21/2011 $67 84
Specifics:
1 ea 12% State Surcharge - 10/21/2011 $8 14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75 98
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 ac • _ • -- . ith 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 AT TION Oregon - r- -•ir :s you to follow the rules adopted by the Oregon Utility Notification -nter Those rules are set forth in OAR
952-001-4010 through OAR 952 -00 0090 ay obtain a copy of the rules or direct questions to • , • - • • • 232 1987 or 1 800 332 2344
i _ t
/ Issue By: / /� ,..t J Permi Signature: //24r.--,
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:
_••NTRACTORINSTAL . TION ONLY
SIGNATURE OF SUPR. EL �7 �� J , 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.
Oct 21 11 07:31a Case's Plumbing 5032628251
(11110
Electrical Permit Applicati
. FOR OFFICE USE ONLY
IN eceived b [ 17 eD 'r
" '� A City of Tigard p T 21 2011 R Q� Permit No : C� d
13125 SW Hall Blvd., Tigard, OR 9722., Pa R
Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Datc/Bv: Other Permit:
TI CARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: tuns: El See Page 2 for
Internet www.tigard- or.gov DIVISION BUILDING DIV Notified/Method: Supplemental Information
TYPE OF WORK \l L� V Jtlild PLAN REVIEW
❑ New construction Addition/aiteration /replacement Please check all that apply (submit 2 sets of plans whtcros checked below):
❑ Demolition El Other:
El Service or feeder 400 amps or more ❑ Building over three stories
where the available fault current El Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 0 Commercial -use agricultural
I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations buildings
Multi- family ❑ Master builder 0 Other: ❑ Fire pump ID Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A", "E', "1 - 2 ", "I - ",
Job no.: Job site address: i S 5 , / L f734 /�) ( l ix more. occupancy.
CJ � ❑Six or more residential units ❑ Recreational vehicle parks
City/State/ZIP: - 71,7i (�j, I cC G 3 ) & . ❑ Health -care facilities ❑ Supply voltage for more than
CI Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Descri. lion NM Wrill IMMIIIIISE
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea add'I500 sq. ft. orportton 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R) 75.00 2
Limited energy multi - family
// / 75.00 2
l er- f - i t .
i' .- -- {J 7 GC en (� residential (with above sq. ft.)
`// Services or feeders installation, alteration, and/or relocation
200 amps or less 100 70 2
ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: r r / --� 401 amps to 600 amps 200.34 2
G•�C ��ii c1 it ct . -0e fri LC. /Gtke- ..cr vLt
601 amps to 1,000 amps 301.04 2
Address: r " -
f , g')---- - Over 1,000 amps or volts 552.26 2
City /State/ZIP: - lJ G (a' � Temporary services or feeders installation, alteration, and/or
►t c °" !! �/ relocation
Phone: (5'73. ) (,2 L /, % f CY 3 F ax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extensionper panel
Owner signature: Date: A. Fee for branch circuits irilh
1 APPLICANT ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: R E - icv - 0 � _s E_AP c ( € B Fee for branch circuits without
service or feeder fee, first
Contact name: 1-', \.\, CCLS= branch circuit 56.18 2
,�
Each add'l branch circuit 7.42 2
Address: G �
C (- ) (DX '3�
G ) 'S
Miscellaneous (service or feeder not included)
City/State/ZIP: +` .� ci Ge_ 0 � ! Each manufactured or modular
c- t 1 dwelling, service and/or feeder 67.84 2
Phone: e ) ULA:;_ Is3� Foe :: ( - a „5 Reconnect only ' 67.84 (fi l 'el 2
E -mail: Pump or irrigation circle 67 84 2
-S�Y' `L- (1 _ CCC_ Je'•/ 21,:,.&Y\t n o 1 t \
or outline lighting
CONTRACTOR ` , C O Sign li li °' 8 67.84 2
_ Signal circuit(s) or limited - energy
Business name: 1't f� (- _ c E t ,, t ,, panel, alteration, or extension. Page 2 2
Address: /� `' Y �' ach additional inspection over allowable in any of the above •
V , 1 ,1 .2X.L) - 7 .. 011%A Qla K6 /�rP dditional inspec[ton (1 hr min) 66.25/ ltr
City /State /ZIP: 1 n Inveshgation(1 hr min) 6625 /hr
,,7 Ck%1c� ; CYO C l cl��
Industrial plant (1 hr min) 78.18/ hr
Phone: (& C (I - 5's j 174/ ) -) LG ' ( ` Inspections for which no fee is
CCB Lic_, i O �7 I \ specifically listed (IA hr tntn) 90.00/ hr
Electrical Lie,: Cpl- ii Suprv. Lic_: c.)5 ELECTRICAL PERMIT FEES
/ r /O /
Suprv. Electric]. si • attire required: � f Y � 3 Subtotal: ( / ' 5'1
I � �`� J Plan review (25 %of permit fee):
t
Print name: V �, ` L iii ` Date: /6 1 2 / ii State surcharge (12% of permit fee): SS'' /
�-' TOTAL PERMIT FEE: 7 •"!r�
Authorized signature:, �(, ,x,t,L( L '
This permit application expires if a permit is not obtained within ISO
Print name: jsj (01_,C 1 ` 6 r .L - -fL I Dat f i ~ J /_(f days after it has been accepted as complete.
* Number of inspections allowed per permit.
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