Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
2 u COMMUNITY DEVELOPM Permit # ELC2011 -00598
Date Issued 10/26/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel 2S111BD00406
Jurisdiction Tigard
Site address 9675 SW MARILYN CT
Project Fannie Mae Subdivision DARMEL NO 3 Lot 27
Project Description Electrical reconnect only
Contractor Owner FANNIE MAE
888 E WALNUT ST
PASADENA, CA
PHONE PHONE
FAX
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/26/2011 $67 84
Specifics: 1 ea 12% State Surcharge - 10/26/2011 $8 14
Electrical
Type of Use SF
Class of Work OTR
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 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 ATTEN • • -•on law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952 - 001 -00 . thr.ugh OAR ' 2 -•.1 4 %•0 You may obtain - copy of the rules or direct questions to OUNC by calling 32 1987 or 1 800 3 2344 t
Issued = �/ ; 23
Permittee Signature C-PT(t1 — mas. •
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 a l ! �/_ r %'�' 'ec
all 503 639 417 •y 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 15:25 FROM RE /MAX fppeSSYe \ E 5036268994 T -728 P 001/007 F -999
LICCti 641 r CI 11111. 2•1141111:41 1•f+a11�. 3�
City of Tigard f ' 21 2.011 l mewed
nteaty- / 11 � �/ o,QJ Penn°No, 1��579
' • 4 13125 SW Hall Blvd., Tigard, OR 972g, 1 Plait Roviaw
I Phone 503.7182439 Fax 503 598 1960 Dmday Other Permit
• '1'1CARLi tnspecnon Line: 503,639 4175 r. tV OF "fGAf Pole Reedy/ny. 'lure Sec Page for
Internet www.tigard or gov vIl + ' lAt I�ISlars �D fa NonRod/Mtthod • 9uppic,,,er,rnurforrrarion
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I ••'t , t ��d� t .:1 A,f��.'��''�f,',TT':.�ii�i l” .w- �
New construction I71 Addition/alteration/replacement alveoli nil thin apply (submit? sds of plans w /items checked below).
['Service or teeder 400 amps or more 0 Building over three stones
I-I O
Demolition ther: wh ere the available fault current LI ❑ Marinas and boatyards
exceeds 10,000 amps at 150 volts or ❑ Flon
,' r 2 1-1 f ig H Iy Ial�s/ "� " „ �T'�"}�� s mr'"ti"�G�m,`p_ i.IUJi i
fi lgllIi l,;F:t II.I :tfi ; r;fn'<' nng bmldutgs
.'. 1I :''! Tits! rttrytiRL?n!.�li,iir„"fii1!�lt9n; r1Yr.1'�'!'7'�:•i�l , ^�r',..'d•;�v�
kW lo Ground, Or exceeds 14,000 ❑ Can agricultural
W and 2- family dwelling [] Commercial /industrial 0 Accessory building amps for all other instillations. buiidines,
❑ Multi- family 0 Master builder [7 Other ID Fire pump El Inemllabon of 75 KVA or
ii17-' u � , � !r (' " y•.7 ^� u1 t r „tF J Q_ rl' I;r”: ter; lb
fxie•e " ❑ Emergency system larger separately derived system
�+M��:r +gd"i. ,t: "".'�C "l+,rbde'� . a 11. - � �_. )I �.��k iI � 'A�Y, r . 1 . 't +� I)° , 5/'L,. �s.b-. ❑ Addition of roan motor load of 0.. .. ,. . 2 ,, ..1.3 ",
Job no.. I Job siteaddress: 91075 Si.1�(•Y ✓ 1 I V 1 lT Sx occupancy
� [] lir or more rresidential aril.. ID Recreational vehicle perks
City /State/ZIP: .(9011 1ccvi4 D iC oi 1 a a'471 / ❑ 1 lennhwnm facilities. 0 Supply voltage for more than
J f � Hazardous 0 Hazards'cannons 600 volts nominal.
Suite /bide /apt no.: I Project name: I / IACL ✓jI yi (I+ O Service or feeder 600 amps or more.
I/ ' ,74.4 d c41 Yr ,:'FIi!'i ciat(fkt 106 i
Cross street/directions to job site odaripimn 1 95/ 1 r.. I Trani I -
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no 1.000 sq ft or less 168 54 4
En odd'I500 sq. ft or portion 33,92 I
Tax map /parcel no.: , O5 C7 pl, Limited energy, residential
_ �,�p � `
; ,g',. %i 'si'd•.."'i- .�''ia.� .Q;1.r.'.v`A'.QPll:,KrS.I ',.s+=:'Mp�ti�wi'Leif'�Y-.e`t KRri.e,f:44 (with above sq 0) 7500 2
Limited energy, multi - family 75 no 2
IE ✓�1 e l ((1 Q�� - �� �— _ ���7 t V1_ residential (with above sq 0 )
' --tt - - - - - -- - S+YJ Services or feeders Installation, alteration, and/or relocation
7I,{) eft br, 200 amps or less 100.70 2
IS di Il it iMai g`t.1 lull �'.��� ing'E iMitut$"ANYVtl ri /A : ,Ai.' t � ` , 201 amps to 400 amps _ 133 56 2
Name: I Mn ..� 401 amps to 600 amps 200 34 2
sf 1A � t !� Mae:
C C � t a'-lTC. t 601 amps to 1.000 amps 301.04 2
57
Address: D I liar l n. V 1� ^� '-/- Over 1,000 amps or volts I 552 2
City /State /ZIP
p : ' ( �� /f l Temporary services or feeders Installation, alteration, and /or it relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59 36 I
201 amps la 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for salt, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: ,( D a a l t r e � : ��� nb r' A Fee for branch circuits wah
',fi M i'1t 1'n '!� - „ ' c.!„ tg L Ifilga*6rfd1• „ resit 1 above service or feeder fee,
ah "?P e., a' 0 60 ".ILr 742 2
'�' �� 1 n � t 11 ^ each branch circuit
Business name: Re ( �( p Q G p r u p B Pee for branch circuit% without
rifle, service or feeder fee, first 56,18 2
Contact name: ' Y a-• I n • (OIZC D ' brunch circuit
Each tidd'I branch circuit 7 42 2
Address: 97 ?& sap t m U i t s ,41vcr Miscellaneous (service or feeder not included)
City/State/ZIP: n � s ,t , I Of 4 Each manufactured or modular
CI 67.84 .2e,A v , 1 `W r � dwelling, service and/or "ceder 84 7
Phone: 1 2jg5 ;) (9 45 Fax: •(5)3) Kt95 Sa;rZ Reconnect only 7 6764 / tg4 2
E -mail: }iV1e( s mei y /✓l b /'caaz( ump or lighting circle / 6 84 IC ` 2
.t' ' co LD� Sign Or outline lighting 67 04 2 re
ii `1 t, 5 l Y ,. P'.5'' I, ci114'i4 a.:� `5nilr, 'waf a"''i)iu
- ' '�' ' � "apt- Signal circuits) or limited-energy
Business name. panel, alteration, or extension Page 2 2
tio ilNmvuble in any of the above
Address: A Gseh vesta ti (I hrmn nspec
(1 h m un m over a) -` 6fi25
City /Slatc/ZIP• investigation ti hr min) 662.5/ hr —
Industrial plant (1 hr min)
` 78 18/ hr
Phone: ( ) Fax: ( ) inspections for which no the is 9000 hr
specifically listed ('h hr mm)
CCB Lie.: Electrical Lic.: Suprv, Lie.. 08 7c . rai;, , f} rip; : Ir '7,'I�ic -,EI4
Snprv Electriciansignature,required' Subtotal: - ") .$q
Plan review (25% of' p ermit fee)•
Print name: Date: State surcharge (12i of penultfce): gag
TOTAL PERMIT f EE' 75 ti;
Authorized signature:
This permit application expires iris permit is not obtained within 180/
days after it has been accyiled us complete r((/
Print name: Date • Number of inspections allowed per permit
I \auddaaaNermite\ELO-PrrmliApp dsr. a7NHin 1- 10 -4615T(I pr's /COMM'LO la /-