Permit d•
CITY OF TIGARD ELECTRICAL PERMIT
1 . . . g..:, COMMUNITY DEVELOPMENT Per mit #: ELC2009 00251
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/02/2009
Parcel: 25111 DA00400
Jurisdiction: Tigard
Site address: 15435 SW HALL BLVD
Subdivision: Lot: 0
Project: Schmidt
Project Description: Install new grounding system, water service altered.
Owner: FEES
SCHMIDT ACRES LLC Quantity Description Date Amount
12525 NW JACKSON QUARRY RD 1 crt Branch Circuits 06/02/2009 $46.85
HILLSBORO, OR 97124
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/02/2009 $5.62
Contractor: Electrical
ROSS ELECTRIC INC
2870 SE 75TH AVE #203
HILLSBORO, OR 97123
PHONE: 503 - 642 -2800
FAX: 503- 642 -5815
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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. A NTION: •regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -001 -0 10 through OAR t5. • r -015 8 , You may obtain a copy of the rules or direct questions to OUNC by calling 5J13- 246'6699 or 1.800.332.2344.
Issue By: ■ ∎ / / � �� i • Permittee Signature: l
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'N . _ r J� 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.
05/27/2009 11:42 5036425815 ROSS ELECTRIC INC PAGE 02/02
Electrical Permit A i • iicatio. ,
1114 City Of Tigard a . i V 0 13125 5W Hall Bivd., Tigard, OR • 7223 D/p permit No.: s Phone: 503.639,4171 Fax; 503.598.1 IIIIIIIIIIrjMIMIIIIMpR:eRwcevidew
Inspection l site: 503.639.4175 M 1 7 2 009 Date/By, Other Permit:
1: Ct311'R i7 Date Ready/By: Amy; fa see Pop 2 for
Internet www tigard or.gov Notified/Method
l • oNITr n1' irlf` t��3, Supplemental Information
f 4 :t'Y1 '.. t M-M w :t�ke: nag ) i n ) kfi 4r il 1 t 5r sn � a i i'I r"t .X `'r"r• ',I a'ii' 1 ; w
t _ �� , 9.ar�'�"attY���ti i., ��aM� • . „i�.a . ,��:.tai�a � w�i' ^��r��� r n � Y h ! .
❑ New construction Addition /al'teratiol%t'epl M Please check all that apply (submit 2 sets of plans w /items checked below);
ID Demolition [lion Other:
Service or fe eder 400 amps or more ❑ Building over three stories,
vi fl ; ^ !+ti {irz l l r tt } � c: r t i p � t K u i u• t p Y where the available fault current boatyards.
1+,v ii «V IT.
r �, r t 1 , � " °'��' ! . �'. i'�: y' c� � , �� � ! s� l + a � f] Marinas and h os t r rds.
r ?tG{i rt,t' t'�, t: l >$ `o!, ,., "!. . , 111 {, '+'t,' f t, t a , � : exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
{� ' t building Iess to ground, or exceeds 14,000 Cl CoId . l -use agricultural
i - and 2- family dwelling ❑ Commercial /industrial 0 Accessory y
0 ultr famil amps for all other installations. building,
y ❑ 1Vlaster builder g
� +„ t a • ❑Oth er' Fire pump.
�!Y ; �, wrlit ;� a Imo,. t� �, a,_ ,,•vas i „ f Installation of 75 KvA or
h V n s) s ;? y t k 1 £N r. } 4: 0 1 0 1 +;fit, r ❑Emergency system. lar er separately derived s step
a '� ° t i,; it i ❑ Addition of new motor load of > Y Y
Job no.: Job site address: C' (�Zf� j ,001-1P or more. occupancy,
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP:
1 _ r. A (Dia I.. —a ak.>1 0 Health -care facilities. ❑ Suppl voltage for more than
ma
.. 0 Hazardous locations, 600 volts nominal.
Suite/bldg./apt. no.: — Project natne: ❑ Service or feeder 600 amps or more. yy
, 7 t�,�. 4, il „:ir
Cross street/directions to job site: � 6 ti /' Li k " - rd a e e. a6 To tH: :a •
l rw .i:u�� fs S .� g,l?ie r t` i <,�;�q6 ����
�.� Description Pt . Fee. Toot
w New residential single• or mold- family dwelling unit,
Includes attached garage.
Subdivision: )Lot no.: 1,000 sq. ft. or less 145,15
4
Tax map /parcel no,: Ea. aad'l 500 sq. ft, or portion 33 1
pV i + ?i Limited energy, residential
r. u 7s�. t r� -' ti:. ,� '.FhI } � (with above a.. R.) 75.00 2
L.) C- ry t,ti_Q l i e ` r , -
Limited energy, multi family
f Q CP--1 residential with above s.. ft. 75.00 2
to r a o
Services or feeders installation, al raEion and /or aloe ti n
iJ.; f,t °q t.. rY ,g"" tr w�rrWi ..a G n 200 amps or lcss
u R 4;lk . uJUa 80 30 2
. , »'t 46?. n wH -� �rJ aril liz a f �r YlAik4.. t ritic -.t t r . t ,ii�lr , 201 amps to 400 amps 1 06.85
2
Name:
Al 57 /v(,,; 4.4 401 amps to 600 amps 160.60 2
address: J C /�(� 601 amps to 1,000 amps 240.60 2
`i ' ,.,.. � M over 1,000 amps or volts 4
r •�f Temporary 54 lte ' 2
City /State /ZIP:
l 4 q 7 i porary services or feeders installation, alteration, and /o
relocation
Phone: (q ) ) �{C7 q Fax: { ) 20U a mps o leas r' ' 66,85
Owner Installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps IEE
Owner signature: Date: Eranch circuits— new, alteration or extension er panel
r 'iYC, j ` r l «,,. � , p� �.„ A. Fee for branch circuits writ
p -,- t ;t,t, *iii. `{rra e ggg ___ I j� TE57 0EMSE n
.�n ,. ..��•,t�IS ,t�",�,•�,IxH, �,::af�f~�, +,,,.�Y mot' + "s' !1# E altoveservice feeder fee,
Business name: each branch circuit 6. 2
B. Fee for branch circuits / Q[
Contact name: without service 6 1 ice or feeder fee: R / �V,.J
frstbranchcircuit 2
Address: J Each add'i branch circuit 6.65 El
City /State/ZIP: ,__"_ Miscellaneous (service or feeder not included
Each manufactured or modular II
Phone: ( ) — dwelling service and /or feeder 90.90 III
Fax; :( )
Reconnect only 66.85
E-mail:
Pump or irrigation circle � �
r` ��� NE
,4'. . r ,r� � � .) �� e,�,trtlr' tl � S �t `
��"+r�uI.�IJw�> t Id �, ah7 �' +. t � , t
;al rt �€a�, .t : ,: n4\ a�, L AM rr hr" e nl„ Fitt V, AGi ail 4' Sign or outline ti :Ming 53.40 MEM
Business name: Ross Electric Inc. Signal circuits) or limited
energy panel, alteration. or
Address: 2870 SE 75 Ave extension. Describe: Page 2
City /State /ZiP: liilillsboro, OR 97123 Each additional ins ection over allowable in an of the above
Phone: (503) 642 - 2800 Fax: (503) 642 -5815
Per
Investigation per hour (I lir min) 62.50
CCB Lic.: 157891 Electrical Lic.: 34 -436C Suprv. Lic.: 4 1232s Industrial plant per hour • al
Suprv_ E ectricr. signature, required4 � •l t tJ . l t O ' ° ., V r , ` t a �f 1 S ,.
^ Subtotal: ��
Print name: Stephen Ross Date: 01/1 5/2009 Plan review (25% of .ertrtii fee)
State Surcharge (12% of permit fee): 5
Authorized signature:
TOTAL PERMIT FEE •
This permit application expires if a permit is not obtained within 150
Print name:
w Date:
days after it has been accepted as complete.
Number of inspections allowed per permit.
1 deul4 ie5\PermiistELC- vermitrlpp.J°c 05/23 /DG 440.461ST(II /05/COMU,'Cn