Permit CITY OF TIGARD ELECTRICAL PERMIT
• • . COMMUNITY DEVELOPMENT Permit #: ELC2009 -00274
Date Issued: 06/05/2009
.T1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2 S 111 CC22000
Jurisdiction: Tigard
Site address: 10320 SW GREENLEAF TER
Subdivision: Lot: 0
Project: Robertson
Project Description: (2) branch circuits for furnace and A/C.
Owner: FEES
ROBERTSON, DONALD Quantity Description Date Amount
10320 SW GREENLEAF TERR
TIGARD, OR 97224 2 crt Branch Circuits 06/05/2009 $53.50
wo /Purchase Service or
PHONE: 503 - 624 - 1685 Feeder
1 ea 12% State Surcharge - 06/05/2009 $6.42
Electrical
Contractor:
BOB'S ELECTRIC
2700 NE BURTON ROAD #A
VANCOUVER, WA 98662
PHONE: 360- 254 -7200
FAX: 360- 254 -8219
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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. `
• Issued By: � r Permittee Signature: o' ,70 / — L/ e���
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.
• Electrical Permit Application P _ , FOR;oFFICE USE ONLY )
��
City of Tigard '� Date/
B : il� t��� Permit No. ,
Other Per
13125 SW Hall Blvd., Tigard, OR 97223 y
C _ g Plan Revie tm
- Phone: 503.639.4171 Fax: 503.598.196 U N O 3 2009 Date /Bkrv?O 4"..../A99?5sr
TIGARD Inspection Line: 503.639.4175 Date Ready /By: ® See Page 2 for
Internet: www.tigard - or.gov CITY OF TIGARD Notified /Method: IMII Supplemental Information
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'.PLAN RE IE - WTI
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❑ > New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /iterns checked below).
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
,`; i': .: °=> _s,, ., • 3 i ° t exceeds 10.000 amps at 150 volts or 0 Floating buildings.
7: : if tg,..i:.. , � ,: C °`OF CON azx_ ;.; .
"" "` "'` "" -" '` ' _
" "' ,'I " " " ` ° �' less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® .1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 KVA or
•,;.,,::,- . ,w, • x. j v . �„ ❑ Emergency system. larger separately derived system.
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• JOB SITEr _ LACATIOIV :-, *,, ;=_ ` _'. �•,
a_ :.�.�_ , °.'�:,�y . »�,» ...�.< ;y�rx �.a >v �.� . ,.� re, <. �, , �,°>.,� -_� _..�. ». , , .. >, . 4 - , e..., _ . ❑ Addition of new motor load of ❑ .. ., I . _
Job no.: J site address: I OOHP or more. occupancy.
09 -501 10320 SW Greenleaf Terrace 0 Six or more residential units. El Recreational vehicle parks.
City /State /ZIP: Tigard, OR 972 24 0 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.
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job site: D scr pt i o n w, e e . I `# • R a I ` * ~
Cross street /directions to
J Uescrip[ion � � ����� � �� �� �� Qty. � Fee. I Total �
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 4
Ea. add'I 500 sq. ft. or portion 33.40 1
Tax map /parcel no.:
Limited energy, residential
.:;( > E „.•. ; - ';r:.' 75.00 2
`ti,.
v
-� (with above s . fl
°'DESC " OF: W.OIIC�K: %
( 9 )
Limited energy, multi- family 75.00 2
A/C & furnace reconnects residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
OPERT.
: a
t»
PR Y OWNER
3 n. '6TENr1NT F 201 amps to 400 amps 106.85 2
Name: 401 amps to 600 amps 160.60 2
Donald Robertson 601 atnpsto 1,000 amps 240.60 2
Address: 10320 SW Greenleaf Terrace Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Pnrt1 Ind, DR 97224 relocation
Phone: ( 503 ) 624- -1685 Fax: ( ) 200 amps or less 66.85 1
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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
" �;, „a;" a; liiit ; ,fie " " °'^','s,t -' sr s,., - ,,:; i .;: e iii: "::t.;•.,e above service or feeder fee,
p °❑ APPLICANT t ®`CON i ACT' -> % -.";
:n• r
6.65 2
• each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee 1 46.85 46.85 2
first branch circuit
Address: Each add'l branch circuit 1 6.65 6.65 2
Miscellaneous (service or feeder not included)
City/State /ZIP: Each manufactured or modular
dwelling, service and /or feeder 90.90 2
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
i -, it =r`` 1,-i Si n or outline lighting ':,;.:1414111%-e si3' >COIYTRAC;7'OR , g g g 53.40 2
Signal circuit(s) or limited -
Business name: Bob's Electric energy panel, alteration, or
Address: 2700 NE Burton Rd., Ste. A extension. Describe: Page 2 2
City /State /ZIP: Vancouver, WA 98662 Each additional inspection over allowable in any of the above
Per inspection 62.50
Phone: ( 360) 254-7200 Fax: ( 3 6 0) 254-8219 Investigation per hour (1 hr min) 62.50
CC Lie.: 5 31 3 6 ( l lectrical Lie.: 3 7 4 3 C Suprv. Lie.: 4 3 2 2 Industrial plant per hour 73.75
12 I I Ii io <ir EIEC RICAL PERMIT;:EFES r ..; ,
Suprv. Electrician signat re, required: • 7I %� l I Subtotal: 53.50 t/
Al'
Plan review (25% of pennit fee):
Print name: Date: 5/29/09
K e V l ri B r O 11 e State surcharge (12% of permit fee): 6. 42 V
Authorized signature' � TOTAL PERMIT FEE: 59.92
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
* Number of inspections allowed per permit.
I:\ Building \Perin as1ELC- PermitApp doc 05/23/06 440- 4615T( I I /05 /COM/WEB