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Permit CITY OF TIGARD ELECTRICAL PERMIT IIII 2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00238 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012 Parcel: 2S 109DA03400 Jurisdiction: Tigard Site address: 15393 SW GREENFIELD DR Project: Chang Subdivision: SUMMIT RIDGE Lot: 11 Project Description: Electrical reconnect only. Contractor: Owner: CHANG, JAMES 29455 SW ST TROPEZ AVE WILSONVILLE, OR 97070 PHONE: PHONE: 503 - 706 -4467 FAX: FEES Quantity Description Date Amount 1 ea Reconnect Only 04/25/2012 $67.84 Specifics: 1 ea 12% State Surcharge - 04/25/2012 $8.14 Electrical Type of Use: SF Class of Work: ALT Type of Const: Occupancy Grp: Total $75.98 Required Items and Reports (Conditions) This p is issue. •ject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will be ne in accordance w 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 d s. ATTENTION: Oregon - - -s you to follow the rules adopted by the Oregon Utility Notification Center. These rules are set orth in OAR 9 2- 001 -0010 l •ugh OAR 95 • . :0. ou may obtain a co •y of the rules or direct questions to OUNC by calling 503.232.1 • : •r .. x.332.2344. IF /� . / A r u ed By: ' Permittee Signature: _ - „, 7 • • 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. 2012 -10 -25 16:03 JC 5034540709 » 5035981960 P 1/2 Electrical Permit ApplicationRECEIVED t 111,11 l 1 1 i 1 1. t 1,. 1, City of Tigard 1 � 13 !guilt No.: e Ica -00 ,23 $ .. 13125 SW Hall Blvd., Tigard, OR 97223 PR 2 5 2012 * I �`� i/ ^�-� a Phone: 503.718.2439 Fax: 503.598. 1960 oft: Inspection Line: 503.6394175 B See Page 2 for t i i.; A r. D hit Internet: www.tigard -or.gov cro TYPE OF WO title Supple mental Infotmation R PLAN REVIEW ❑ New construction ❑ Addition /alteration /replacement Please ter all that apply (submit a sets of plans w/items chocked below): D 5er m viao or feeder 400 amts or mare I:1 Budding over three stones. ❑ Demolition rgr Otttcr: wlroro the available fault =rent ❑ Marinas and boatyards, CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. less to grotmd, or exceata 14,000 D Commercial-use agricultural ❑ 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installation. buildings. ❑ Multi - family 0 Master builder ❑ Other: D Fire maim D inslsumion 0 K VA or -'� JOB SITE INFORMATION AND LOCATION 0 Emergency system. larger separately derived system. ['Addition of new motor load of 0 Jnh no.: (Job site address: /S3 t/tJ 9 e re h p�, / � r • t�H mare. . 1 "' f�l ❑ more nr more residential units. 0 Recreational vebiek patina. City /State/ZIP: t ?I ci rd 0 r - / Z / (,4 ❑ Health -care famlities. 0 Supply voltage for more than ID Haaldnus M ations. 600 volts nominal. Suite/hldg. /apt no.: Project name: User/ice or feeder 645) amp or more, Cross street/directions to job site: FEE SCHEDULE 1 naert a l 4w I ve. r�rsi _ 1 New residential single- or mold-family dwelling uni ,� Includes attached garage. Subdivision: I Lot no.: 1,000 sq. ft or less 168.54 4 • La. add•t 500 sq. fl. or portion 33.92 1 Tax map/parcel no.: —_ M. Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above sq. R.) f - """"""' - - - - - Limited energy. multi- family 75.00 2 Oe.2 NfieGt residential (with above sq. tt.) Serviees or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 $t PROPE.RTY OWNER .^ I ❑ TENANT 201 amps to 400 arms — - 133.56 2 Name: �L}/Li - G f • fg :,(J t 401 amps to 600 amps 200.34 2 _ 601 amps to 1,000 mops 301.04 _ 2 Address: ,,ZR5-55) 5T reop62 q.Jc Over 1,000 amps or volts 55216 2 Temporary services or feeders Installation, alteration, and/or City/State/ZIP: W /L.SO,) U (LL ©p q 7o 7 n relotatton Phonc: (5'03) 7 6 4 4 6 7 M Fax: ( ) 200 amps or Inn - 59.36 ` I 201 maps la 400 amps 125.08 2 Owner Installation: 'Ibis installation is being made on property that 1 own which is not 40I strips to 599 amps 168.54 2 intended for sale, lease, renteor exchange according to ORS 447, 449, 670, and 701. . �/ Z Branch eireuics- new, alteration, or extenaon, per panel j" r/ Owner signature: . . . .'S' Date: 1/4 A. Fee for branch circuits with � Pg APPWC I ❑CONTACT PERSON above service or feeder fa' 7.42 2 each branch eireuit Business name: B. Fee for brand circuits Without service or feeder fee. first 56.18 2 Contact name: Match circuit Each midi Imoich circuit 7.42 l 2 Address: . „ ? _ , . 9 5 - 5t) sr Tt 'P 5 Z A-iJ.. _ Macdyneous (service or feeder not Included) Each manufactured or modular City/State/ZIP: I.J/LS c) 4,/ Vth 4 D e 9 7° 7 G dwelling, emit= and/or feeder 67.34 2 Phone: (5V3 70 6 -- u(/ 7 I Fax: : ( ) Reconnect only / 67.84 4 r.kit 2 Pump or irrigation circle 67.84 2 E-mail: j air c S C . j c a 94ra 7/ ,gods. Signor outline lighting 67.84 2 CONTRACTOR Signal cireit(s) to Iimited- enrrgy Business n1nne: panel. Actaeon, or extension. Page 2 _ 2 Each additional inspection over allowable in any of the 'boys Address: Additional inspection (1 hr awl) 66.25/ hr Investigation (I hr min) _66 hr City/State/ZIP: _ -, - -�- — ---- industrial plan (1 Iv thin) ^ 78,12/ hr Phone: ( ) Fax: ( ) Inspections for which no fee is 90.0W hr s 'fl nit_ eshy listed (A Iv min) l CCB Lic.: I Elecincal Lic.: I Suprv. Lic.: ,---- ELECTRICAL PERMIT FEES - Subtotal: Suprv. Electrician signature, required: Plan review (25% of permit fee): Print name: Date: State surcharge (12% of permit fee): , /V Authorized signature: 'IOTAI. PERMIT F'P..F: 7 9g- This permit application expires if a permit is not obtained within ISO Print Hartle: Date: days after it has beta accepted es complete. ter. ••••••••••–•••• Number o .'BuldingV�mia\r1.C- PermitApp.doc 07/U1/10 saU4e151111/051COwwM9