Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00675
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/01/2011
Parcel: 1 S125DA01100
Jurisdiction: Tigard
Site address: 9035 SW 66TH AVE
Project: Courtnier Subdivision: JACKSON WOODS Lot: 6
Project Description: (3) branch circuits.
Contractor: TRI COUNTY TEMP CONTROL INC Owner: COURTNIER, FRANK E AND KATHLEEN C
13150 S CLACKAMAS RIVER DR 9035 SW 66TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 557 -2220
PHONE: 503 - 246 -6313
FAX: 503 - 557 -0919
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/01/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/01/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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. ATTENTI•' . -•on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 th oug OAR 9 -001 -.: • B. You • :y obtain a copy of he rules or direct questions to OUNC by calling 503. 1987 or 1.800.332.2344.
Issued By: — /� Permittee Signature: 11111M � ._ �.ii
i' •
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 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.
CEIVED
Electrical Permit Applicat + I OR ill l I(i i `,l OM i
Cl of Tigard L 2011 Received / n ��a PermitNo' & C Q / / -
Iii City 0 E C 1 [ Date/0 :
• 13125 SW Hail Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 50 :S Date/0 : Other Permit:
Inspection Line: 503.639.4175 �i > `� F TIGARD Date Ready /Bye NM fib See Page 2 for
" "` " lnte met: www.li and -or. ov g g B UILDING DIVISION Notified/Meth Supplemental lemental Information
TYPE OF WORK PLAN REVIEW
Please check all that apply (submit a 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.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Catnmercial -use agricultural
®- I- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
JOB SI•rE INFORMATION AND LOCATION ❑Emergency system. larger E", separately derived system.
❑ Addition of new molar load of ❑ "A ", "E ", "I.
q O 5 /� / _� , at 100HP or more. occupancy.
Job no.: Job site address: "' U DW lfd Pat Recreationalvehicle inks
❑Six o r more residential units. ❑' P=
City /State/ZIP: TOrftild c0226 ❑ Health -care facilities. ❑ Supply voltage for more than
[I Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 0 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty_I RM. I Total I •
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'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. It) .
F G r' -) ( Q � L energy, multi- family 67.84 2
•
f ) residential (with abovesq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or. less 100.70 2
1 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
=
;Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: (5 ) 2.44 UuJ l3 Fax: ( ) 200 amps or less 59.36 1
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
Owner signature: Date: Branch circuits- new, alteration, or extension, per panel
g — A. Fee for branch circuits with
e APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: Same as contractor B. Fee for branch circuits //
without service or feeder fee, / 56.18 9 Ci •/q 2
Contact name: Diane Mason first branch circuit
Address: Each add'l branch circuit a 7.42 2
Miscellaneous (service or feeder not included)
City/ State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 , 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited -
Business name: Tri County Temp Control energy panel, alteration, or
Address: 13150 S. Clackamas River Drive extension. Describe: Page 2 2
City/State /ZIP: Oregon City, OR 97045 Each additional inspection over allowable in anyof the above
Per inspection 66.25
Phone: (503) 557.2220 J Fax: (503) 557.0919 Investigation per hour (I he min) 66.25
CCB I.ic.: 72623 Electrical Lie.: ca5 1 Suprv. Lic.: Industrial plant per hour 78.18
ELECTRICAL PE FEES
Suprv. Electrician signature, required: 2 J_� Subtotal: 7/ •o 2
Print nan Rn ' S Date: j 41 /I 1 ` Plan review (25% of permit fee):
t V'' 2.
State surcharge (12% permit fee): '.S
Authorized signature: , r TOTAL PERMIT FEE: 79 • 5'( .
This permit application expires if a permit is not obtained within 180
Print name: Diane Mason Date: I days after it has been accepted as complete.
• Number of inspections allowed per permit.
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