Permit r
II CITY OF TIGARD ELECTRICAL PERMIT
: COMMUNITY DEVELOPMENT Permit #: ELC2009-00355
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/21/2009
Parcel: 2S 111 AA02800
Jurisdiction: Tigard
Site address: 8640 SW GREENSWARD LN
Subdivision: Lot: 0
Project: JDR Property Investments
Project Description: Electrical reconnect
Owner: FEES
JDR PROPERTY INVESTMENTS LLC Quantity Description Date Amount
PO BOX 404
GLADSTONE, OR 97027 1 ea Reconnect Only 07/21/2009 $66.85
PHONE: 1 ea 12% State Surcharge - 07/21/2009 $8.02
Electrical
Contractor:
PHONE:
FAX:
Type of Use: SF
Class of Work: OTR Type of Const:
Occupancy Grp:
Total $74.87
Required Items and Reports (Conditions)
■
This permit is d su•1 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 ccordance with ap• ov • - .s. 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 NTION Oregon la , requires yo to follow the rules adopted by the Oregon Utility Notifi - • enter. Those rules are set forth in OAR
952 -001- 10 th ough OAR 95 I • r 100. u a ' obtain a copy of the rules or direct questions to O • • efinut_ 03.246 6699 or 1.800.332.2344.
Issuecky: i of , / Permittee Si. • ��; _ %A ► �i !r
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 thejob site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
i
, f . Electrical Permit App 7/94/61 Cal6 Eix_Ao7-tz5z-
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TYPE OF WORK PLAN REVIEW
El New
JUL q 1 ase check all that apply:
New construction ❑ Addition /alteration/replacement Other: �i Service or feeder 400 amps ❑ Hazardous locations
��G'�' pVll mast: j or more where the available ❑ Service or feeder 600 amps or more
CATEGORY OF CONSTRUCTION CITY OF TIGI RDf ault current exceeds ❑ Building over three stories
r) I j tNG DIVISION000 amps at 150 volts or ❑ Marinas and boatyards
N d 2- family dwelling Commercial/industrial El Accesso
less to
ground, or exceeds
gro ❑ Floating buildings
[] Multi - fa mil ❑ Master builder ❑ Other. 14,000 amps for all other ❑Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION installations. buildings
❑ Fire pump
1 ❑ Installation of 150 KVA or larger
Job no.: Job address: 91140 brG(/ISWQ t'L► LPL ❑ Emergency system separately derived system
❑ A ddition of new motor ❑ ..�.•.. .... -2 „•q -3•� occupancy
City/State/ZIP: �� _Z�� load of I OOHP or more
U ❑' Recreational vehicle parks
Suite/bldg./apt. no.: Project name: ❑ Six or more residential units l_.1 Supply voltage for more than
Cl Health-care facilities 600 volts nominal
Cross street/directions to job site: „ F , t , a , FEE SCHEDULE
Description I Qty. I Fee I Total I
Subdivision: Lot no.: Residential single- or multi - family dwelling unit.
Includes attached garage.
Tax map /parcel no.: 1,000'sq. ft. or less 153.00 4
DESCRIPTION OF WORK Ea. add'l 500 sq. ft. or portion 43.00
Limited energy, residential 61.00 2
\.0 t./ hGtd - D iraNte. 1 r1f (• t_ _ t (with above sq. ft.)
►�c%� Limited energy, multi- family 67.00 2
r ry (_ L _ . _ 3 �_ Owl . residential (with above sq. ft.)
PROPERTY OWNER I ❑ TENANT Services or feeders installation, alteration, and/or relocation
200 amps or less 92.00 2
� Pr Dp e r v �,� s t! I� 201 amps p 122.00 2
Address:
Name: � [t �__, ps to 400 am s 184.00 2
goy 4 401 amps to 600 amps
/�
601 amps to 1,000 amps 275.00 2
City/State /ZIP: (m ie,. .4s•�'''ei b12. ertO2- Over 1,000 amps or volts 514.00 2
Phone: (.ri3 ) – 7s( 40 . !j Fax: ( e• V 4<< -4PU Temporary services or feeders installation, alteration, and/or
relocation
Owner installation: This installation is being made on residential or farm property owned by me or a member of 200 amps or less 79.50 2
my immediate family. This property is not intended for sale, exchange or rent. (ORS 479.540(1) and 479.560(1). 201 amps to 400 amps 110.00 2
Owner signature: Date: 1/!7( Del 401 amps to 599 amps 153.00 2
rst APPLICANT I tcp CONTACT PERSON Branch circuits – new, alteration, or extension, per panel
A. Fee for branch circuits with
Business name: 31 i ;-y� 4� above service or feeder fee, 8.75
each branch circuit 2
Contact name: . it % e t B. Fee for branch circuits
without service or feeder 61.00
Address: -Pp B--O)< 46 Li fee, first branch circuit 2
� t � Each add'I branch circuit 8.75
City /State /ZIP: r v , ` /� fJ`� �L 0.102,77
r .� Miscellaneous (service or feeder not included)
Phone: )151 a . z4 D� Fax: it?, 5
) • (O 0 /475 Each manufactured or modular 104.00 2
/}/}/ r,, _ _ � dwelling, service, and/or feeder ter`
E - mail: `i�k I r ''1%CO ® ► Wl ►yle111 • L!y'Vl Reconnect only i( 1p�(i'g> I
'� CONTRACTOR Pump or irrigation circle 61.00 2
Business name: N Sign or outline lighting 61.00 2
Signal circuit(s) or limited -
Address: energy panel, alteration, or 61.00
extension. Describe:
City/State /ZIP: 2
Fax: Each additional inspection over allowable in any of the above
Phone: ( ) ( ) Per inspection 90.00
E -mail: CCB lie. no.: Investigation fee (seecomprence)
City or metro lie.: Other:
Electrical lie. no.: tY
ELECTRICAL PERMIT FEES C�
Supervising electrician Subtotal 1(110. 0 5 /
signature, required:
Plan review ( 25% of permit fee) _.—
Print name: Date:
State surcharge (I 2% of permit fee) g, o o,
Authorized TOTAL PERMIT FEE 711, 8-7 signature:
This permit application expires if a permit is not obtatne
Print name: Date: within 180 days after it has been accepted as compl e
' Number of inspections allowed per permit Revision 6/08
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