Permit q \4 CI 1 1 OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT PERMIT #: ELC2009 00077
DATE ISSUED: 2/25/2009
TIGARD 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 1 S 133DD - 05400
SITE ADDRESS: 11568 SW LAKEVIEW TER ZONING: R -4.5
SUBDIVISION: VILLAGE AT SUMMER LAKE PARK 3 LOT : 093 JURISDICTION: TIG
PROJECT: CRISS
Project Description: Install (1) branch circuit.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KENT & TERESA CRISS BOONES FERRY ELECTRIC INC
11568 SW LAKEVIEW TERRACE PO BOX 628
TIGARD, OR 97223 WILSONVILLE, OR 97070
Phone: Contact #: PRI 503 - 682 -4936
FAX 503 - 682 -7946
FEES
Description Date Amount Reg #: ELE 3 -223C
[ELPRMT] ELC Permit 2/25/2009 $46.85 LIC 88482
[TAX] 12% State Surchar 2/25/2009 $5.62 SUP 4918S
Total $52.47 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. 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 than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952 - 001 -00111 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: � 7 111 k Q Permittee Signature: ' 4 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'N: 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.
MIL Feb. 25. 2009 9:46AM 'No. 0153 P. 1
t.41,,r�G.RL rermit A Heat'
ECEIVEn
Y Tigard I OK ')FFICL, L15L ONl., ,
,, . City of Ti and Re ceives
Date/
13 ° 13125 SW Hall Blvd., Tigard, OR 97 Date/13 S • Ciq J Permit No.: . t 0_200 - 003
a.
Phone: 503.639 4171 Fax: 503.598.19 06 2 5 2009 Plan Review
Data/B : Ocher Permit
TIGARD- inspection Line: 503,639.4175 DateReady /By: ® See Page 2 for
Internet: www.tigard-or.gov CITY OF TIGARD
�� c. �`'„'+�` °- ' � 'fl 14i�,:;i. a� 'a�� wi�'l�i"�,�s;r ,�fvir �''e�tl �'r,.;. Notified/Method: s � �ry� Information
k� G Supplemental 1 f
L � �� , , W L :. r>l' r „ts k.,-,.., .F. g t) ' s � ' Zi r - t i 9 a-
STJ. .1 �tsfe: �, Td terep fist ry , ✓ 1, 1a.�w 4M.L.^ nu:�k• ,ea u` `1 4 �{ rCrr�r�µ� :, �r .,ai `r
New construction ❑ , Addition/alteratlonlreplacement Please check all that apply (submit h sets of plans w /hems checked below):
❑ Demolition ❑ Other: d Service or feeder 400 amps or more ❑ Building over throe stories.
rrt, where the available fault current ❑ Marinas and boatyards.
1 1 Ala y�r ? " ��A.s ttg� 4 , , ixf 8 exceed 10,000 amps at 150 volts or ❑ Floating buildings.
I and 2 - famil dwellin less to ground, or exceeds 14,000 O Commercial -use agricultural
Y g ❑ Commercial /industrial El Accessory building amps for at other installations. buildings.
❑ Multi- family C] Master builder ❑ Other: ❑ Fu. pump. ❑ lnstallatioo of 75 KVA or
1).t tfi :y B 411M, d t r "`. r a l m =. l� Emerenc
gy system. I
2'''' r'.°'1--1 .a RS b yk a 'q'q1 13 � 41 anger separately derived system.
IH R �w.."�$1N Trzr `w'r' �m4M `� .
�� , *�• , w , .• s � : - � l
`i;z ai`>a.'cldt Q Addition of new motor load of
Job no.: fit 4j O Or Job site address: / / 56 S S -' Ja. k F v; 0&/ 7'z Sin or Or m ore i occupancy.
❑Six or mare resdanlial veils. ❑ Recreational vehicle parks.
City/State /ZIP: 7j G " j O.1 ❑ Health -care facilities. ❑ Supply voltage for rnore than
0 Hazardous locations. 600 volts nominal.
Su ite/b Hg./apt, no Project name: CI r ; s -- /1/ 1/4/ ❑ Service or feeder 600 amps ors m�� F�fTvlv�'NitF :4�Ir
morn.
.:t ..ia va:Y.T.kc 4 Cross stint ddilections to job site: '" . ;� r o P
Dtheiptiun Rh'- Poo. Total •
' New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1 sq. R. or l ess 145.15 4
Tax map /parcel no.: - Ea. add'1500 sq. R. or portion 33.40 1
n, n + Limited energy, residential
i t .1 �3 "e - u 2 T 75.00 2
� i�.,T,+�.� rd 5 G a i ® .. � .�,,..� re, 6
;� - �:. ;;,...i�''�,� =�', (with above sq. ff.)
Limited energy, multi-family 75.00 2
C,r Y gR
�U / / ') residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
s 200 amps or less 80.30 2
1, s li ¢ 01 1: 'rs ` . Pt t,�t, Se, 3!r r: u t r # L tf ;t ~
����.��w�� .,,�'��.`" 201 amps to 400 amps I06.85
Name: T r e s s C h r; 5 401 amps to 600 amps 160.60 2
,dress: A -
601 amps to 1,000 amps 240.60 2
Over 1,000 amps or volts 454.65 2
City/State /ZIP; Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 66.85 j
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps _ 10030 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch
k^ t an h circuits with l u a r =
yam" h rt A t w .� r "k { t , above service or feeder fee, • 2
Business name:
each branch circuit 6.65
B. Fee for branch circuits
Contact name: - without service or feeder fee, .) 46,85 2
first branch circuit
Address: Each add°1 branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
Phone: ! _ dwelling, service and/or feeder 90.90 2
( ) I Fax. ( ) Reconnect only 66.85 2
E-mail: Pump or irrigation circle 53.40 2
•. 'fv "n t it , � fZ v :' W-� w : ...,. r .
': �o-r. ,; it s ; , r? t° s t ,lIha . '"rrs# ` ?,. ;l i•6 y, . + .mows Sign or outline lighting 53.40 2
Business name: Boones Ferry ;Electric Signal circuit(s) or limited-
energy panel, alteration, or
Address: P.O. Box 628 extension. Describe- Page 2 1 2
City/State /ZIP: Wilsonville OR 97070 Each additional inspection over allowable in any of the above
Phone: 503 6$2 -4936 _ Per inspection 62.50
( ) Fax: (503) 682 -7946
-
Investigation per hour (t hr min) 62.50
CCB Lie.: 88482 Electrical Lic.: 3- 3C Suprv. Lic.: y / B 5 Industrial plant per hour 73.75
Suprv. Electrician signature, required: - ir•�R
Subtotal 6 S
^ nt name; _VI cn _ _14 r' rr a •■ Date: 2 / Z,_f / .0 1 _ Plan review 25% of permit fee): .--
State surcharge (12% of permit fee): $ 6 Z
Authorized signature:
TOTAL PERMIT FEE: S. , '} 7
Print name: Date: This permit application expires if a permit is not obtained within 150
days after it has been accepted as complete.
" Number of inspections allowed per permit.
1:\ Building \Pennils1£LC- PCrmitApp.doc 05/23/06 440.4615T(II /OS /COM/WEB