Permit ., 1
o CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2009 -00489
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/17/2009
Parcel: 25111 BD02400
Jurisdiction: Tigard
Site address: 9720 SW PEMBROOK ST
Subdivision: Lot: 0
Project: Lawrence
Project Description: 200 amp service
Owner: FEES
LAWRENCE, MERLYN J Quantity Description Date Amount
3713 OAK GROVE ST
NEWBERG, OR 97132 1 ea Services or Feeders - 200 09/17/2009 $80.30
amps or less
PHONE: 1 ea 12% State Surcharge - 09/17/2009 $9.64
Electrical
Contractor:
AMPHERE ELECTRIC
1350 SE 122ND AVE.
PORTLAND, OR 97233
PHONE: 503 - 775 -5311
FAX: 503 - 775 -5334
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $89.94
Required Items and Reports (Conditions)
This permit • - - ubject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do, - in accordance wi approve. • ans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day-. ATTENTION: Oregon I- . equire- you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
9 '- 001 -0010 through OAR 952-P0 -0100. y obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
ssued By: k . P ermittee Signature. K ,70-7 e . _ , f*
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 INSTA LATION ONLY
SIGNATURE OF SUPR. ELEC' II ' / -I / ! 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 Applic ,,:r I..' CEVED FOR OFFICE USE ONLY
• Received
City of Tigard R e e : OD p Permit No.: eke �o ?_iv
° 13125 SW Hall Blvd., Tigard, OR OR& 17 2.009 Plan Review
Phone: 503.639.417I Fax: 503.59 1960 Date/By: Other Permit:
TI GARD Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready /By: � /f Jtiris: ® See Page 2 for
Internet: www.tigard- or.gov p I�� DIVISION Notified/Method: C Supplemental Information
TYPE (R OR `7 V PLAN REVIEW
•
. ❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
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: ❑ Fire pump. ❑ Installation of 75 KVA or
IOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "l - "I - ",
Job no.: Job site address: 9720 SW Pembrook St. IOOHP or more. occupancy.
. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: 1,,..,Pr W Q��13(�� ❑ Service or feeder 600 :imps or more.
FEE SCHEDULE
Cross street/directions to job site: SW 97 Ave. .. Description I Qty. I Fee. I Total I •
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 I
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORT: (with above sq. ft.) 75.00 2
200 Am S ervice Limited energy, multi - family 75.00 2
•
p residential (with above sq. ft.)
•
Services or feeders installation, alteration, and /or relocation
200 amps or less I 80.30 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106.85 2
•
Name: 401 amps to 600 amps 160.60 2
601 amps to 1,000 amps 240.60 2
Address: Over 1,000 amps or volts 454.65 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) 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, Qcr panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 6.65 2
each branch circuit
Business name: 13. Fee for branch circuits
Contact name: without service or feeder tee,
46.85 2
first branch circuit
Address: • Each add'I branch circuit 6.65 2
Miscellaneous (service or feeder not included)
City /State /ZIP: . Each manufactured or modular 90.90 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 66.85 2
E -mail: Pump or irrigation circle 53.40 2
CONTRACTOR Sign or outline lighting 53.40 2
Business name: Soledad Electric, Inc. dba Ampere Electric Signal circuit(s)
energy panel, alterer limited-
or
Address: 1350 SE 122 " Ave. extension. Describe: Page 2 2
City /State /ZIP: Portland, OR 97233 Each additional inspection over allowable in any of the above
/ Per inspection 62.50
Phone: (503) 775 -5311 Fax: (503) 775 -5334
'0/, 40 Investigation per hour (I hr min) 62.50
CCB Lie.: 82102 4 1 96 "l ( e Electrical Lic.: 6 -7 8C Sue3ry Lic.: 4105S Industrial plant per hour 73.75
) ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: / Subtotal: 80.30
Plan review (25% of permit fee):
Print name: Edwin L. Wilson 71,14 Date: 9/17/09
State surcharge (12% of permit fee): 9.631
Authorized signature: . TOTAL PERMIT FEE: 89.93' gle'
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 pennit.
I: Building 'Permits\ELC- PermitApp.doc 05/23/06 440.4615T( I I /05 /COM/WEB