Permit t
A N
CITY OF TIGARD ELECTRICAL PERMIT
t rt Permit #: ELC2009 -00531
s -
COMMUNITY DEVELOPMENT
• 13125 SW Hall Blvd , Tigard OR 97223 503 639 4171 Date Issued: 10/07/2009
TIGARD Parcel: 1S 134AC06900
Jurisdiction: Tigard
Site address: 11011 SW GENEVA ST
Subdivision: Lot: 0
Project: Alway
Project Description: Panel change
Owner: FEES
ALWAY, BARBARA L Quantity Description Date Amount
11011 SW GENEVA ST
TIGARD, OR 97223 1 ea Services or Feeders - 200 10/07/2009 $100 70
amps or less
PHONE 1 ea 12% State Surcharge - 10/07/2009 $12.08
Electrical
Contractor:
SQUIRES ELECTRIC
PO BOX 16851
PORTLAND, OR 97292
PHONE: 503 -252 -1609
FAX 503 - 253 -5831
Type of Use: SF
Class of Work. ALT Type of Const:
Occupancy Grp:
Total $112 78
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
b.���R�w �..V
Issued By: t Permittee Signature: rY Ike 4-014V
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.
e
Electrical Permit Applicatio i OROFFICELCEOALY
City of Tigard OCT ® 7 2009 KCLe "'e" Perini( e - av�3)
L+ Date /By. _
4 13125 SW Han Rlvd . Tigard, OR 97223 Plan Rcvicw
- Phone 50; 639 417 Fax 5 "s. 'Oai°YY OF TIGARD Daic'uv Chhcr 1'c, mil
inspection Line' 503.639 4175 Drily t<eetly /Ry u n I E7 sec Psgc'- for
TIGARD, g B UILDING DIVISION l I
Internet Ru�W Cl ar d•or.rov I NnhfieciN1¢ -1l,ad So n ec Page 2 tntormatiorl
A TYPE: OF WORK PLAN K'! VIL�Sr
❑ New construction jr�i Ad;!It ion /<alteration /rcpliiocniefll Pita:, heel sill dial ,: P1 >ly (.ubm,: 2 ,er . of 3>1'stlr. wAtCmS Checked h tow)
�_� ❑ Sco re 0 feeder 400 snips or more ❑ }lidding avert dace stories
❑ Demolition ❑ Other: wlcer . tlm available fault current ❑ Marinas and bo:liy d.
C. TEGORY Ott CO' STRUcT1ON e..eed ri 10,000 ,� n .a 150 , r,i ❑ (hating buildings
- Ives to ground, oicecceds 14.000 ❑ Commotciaiau:n agiicultural
n 1- and 2- tamily' dwelling ❑ Conimcrcial /industrial n Accessory 1)1 11[ding taps for -ill other in bmklir
' • Multi -family ❑ Master huildci ❑ Other: 0 !'ire ratio ❑ installation 01:75 KVA or
❑ Enter,'. icy system I, -,'er , eparxel v at% vcd sy stern
JOB Spit; iNF'ORMATION AND Lf1C :Ai ION ❑Add lion of n,w moroi load of ❑ "A" "E " 1 -'" ' t
Si,, oi
Job no. Job slleaddr : / /e� / l OW ,ors ❑ t.< ' .xmore `eeupaney
■Cn1dCArrd1 units
et5 ❑ e cie:ei.008i vehicle purl
City /State /Z1 � � n rar/ t ' ❑ ] lealth -care fnt,ilrties ❑ Supply vultste for more thin
nominal ,
❑ Hazardous locations 600 volts
�il /bldg. /apt. ties: �Pr tjr,Ct name: �� / ❑ Snwcc ored 600 311p�Ot 0101C / . FEE SCITEDI I,E'
Cross street/directions to job Site: - — Vrs ipi 0, ( W oty . I Fee i Ion' 1
,
— - - -- - Ncvv residential sirl�Ie- or multi - family dwelling unit.
Includes attached garage.
Subdivision I no.: 1 1,000 sq ft or l oss 1l>854 I 4
lax ma / irccl no.: La led 1 500 sq h a portion ! 33 92 !
p p" _ Limited ener_y. residential
1 DESCRIY'l ION OF WO1t*,� . — (wrth Above Ng it ) 67 h4 2
' 70Atj Limr��, mfmily 67 84 .) L3 C. / resrd en ( above ulti -a eq h) �- i
Services or feeders installation, alteration, and /or relocation
,
200 amps or less ( j 100.70 LIDOS? /) 2
D PROPERTY OWNER I, 0 TENANT ' 201 amps to 400 amps - i 133.56 _.. 2
Name:
401 amps to 600 amps 200 34 2
- - - -- 601 amps TO 1,000 amp. 301 04 1 2
Address: Over 1,000 amps or volts 552 26 2
City /State /LIP: T o
cm services or feeders installation, alteration, and /r
. relocation
Phone: ( ) 1-a\: ( ) 200 amp; or less 59 .39 I I 1
Owner installation: This installation is soma made on property that I own which is not
201 amps to 400 amps 125 08 I 2
iniendeli tilt sale, [case, runt_ or exchan, c, according to ORS 447, 449. 670. and 701. 401 amps in 599 amps I 168.54 I ' 2
Branch circuits - ilea', alteration, or ea tension. per panel
Owner signature: late: _ A 1 for branch circuits with
❑ APPLICANT • 1 [ I ' CONTA( l' PERSON shove ssin Or tccdcr fcc, 7 42 2
-- each breach circuit
' Business name: F3 f for branch circnrts
. I
-- ii rrharu scivlcc or feeder fcc
C ontact name: 54'18 2
first branch arcuit
' Each add - I branch circuit 7.42 2
address
- Mieccllarieous (service or feeder not included) n
C :ity /Statc/LlP rah munu(actured of modular i ( >7 84 2
d wellin i, Sell lcc and/or feeder
Phone: ( ) 1 Fax:: ( ) hccnnncct only 67 84 2
E -mail: Pump of iifrgatiofi circle -- 67 84 j 2
. C ONTRACTOR 1 I Sign or nuumc lichtin,? 67.84 2
} r i e sl v p attI. (s) er or a lat
Business nO or
rtle. � ` I �.
r� eIIefg AIICI, pltcrho, or
b x ` L r5 extension, Describe Page 2
Address J t3
6 2
ppoo,, �q C Each additional i rls P ecti0 11 Over allowabl in any o f th 91 f
/ Per City /'St // .11 //^ a V 7 � � �� above
�6 w , / / Fax r g etinti inspection 6 2 5
Phone: .
-
�' Fa\ ) e �'�.�� �axz5 � � It,vcti[tgA[totl pCf holly (t Or min} 66 �
C:CB Lic.:/4 , Electrical Lies ,� -- uprv' Lic � hidu: trral l >ltlntperh our 78 IS
- b.F.F.C:.TRICAL FERMI f 7I ECS I
5uprv, b.lectrtcian signature, requtr : Subtotal:1 ADD. AIP
Plan review (25 °u of pcmin. fee)
Posit name 1) , e _ a Lf I re ...4 Dale: /p1)11/01:11
Slate •urcharc (12°/0 of permit fcc)
Authorized signature: L TOTAL PPRMIT FEE j ,J a . ' _ 1
1 1'h., permit application espies ifs permit is not Obtained wilful) IRO
Print name: l Date: l (lays after it has been accepted as c0111NtCte.
Nurrbci of nlspepuii allowed per permit
1\ 60kimg1Permm1da . -1 rt■rnpp doe 10/01110 440- S6151(1 /UsJCOV(/R'LL
Z00 / d 009E# 0Ia13313 S3aIfluS LC89C0ZC00 90 bl 800Z/1.0/0l