Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
COMMUNITY DEVELOPMENT
Permit #: ELC2009 -00167
T t GAR D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 04/17/2009
Parcel: 1 S136AC04200
Jurisdiction: Tigard
Site address: 7130 SW PINE ST
Subdivision: Lot: 0
Project: Dickoff
Project Description: Install (2) branch circuits for a/c and plug.
Owner: FEES
DICKOFF, WILLIAM G & MARGARET Quantity Description Date Amount
7130 SW PINE ST 2 crt Branch Circuits 04 /17/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 04/17/2009 $6.42
Contractor: Electrical
CANBY ELECTRIC INC
790 S IVY ST
CANBY, OR 97013
PHONE: 503 - 266 -7878
FAX: 503 - 266 -5543
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through AR 952- 001 -0100. You may obt in a copy of the rules or direct questions to OUNC by calling 50 46.6699 or 1.800.332.2344.
�n1 \
Issued By: ,! � _ Permittee Signature:
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.
Permit A
l P
: • tlectiicaermpplicaon
..!.: . . ., .. ... Application . FOR OFFICE USE.ONLV •,' 7 : - • •
• • City of Tigard Ree 31 eive 1 c' ' i tft'OC( . , . • •
Permit Mt.. Cle2Ogi (it 1( .
D e/13 '
• 1 ' ' . ...--. ": - 13125 SW Hall Hlvd., 'lig. ilik 2 • .Plan Review
..-: . % ' . Phone; 503.639.4 171 Fax 5') 9 Q.„. , ,_ ,.- DateiBv: Oilimr PEI III I i • •
.
napection Line ' 503 .639 4175 . • • TIGAP,D . i • Date Roady/By:
M E s l soon - •
.. . ' Internet: www.tigard-or.gov APR 1 6 2009 .?..lotifiecVMsthod:
•
•
• , • ..-.. . .... :.-.• , .! :.efzic*: . ?.,.... 1,0 ,„„;:1:,,,t. .4, ., .,,!. ■ , 2„ii.".,N*4.i........ .•puotlaviEW;;ri:''!:
`..:r. , - " • • • , :!.:.sf ... • "4 •.: :._' , ' , 1 - ..0I.• ..,...4.1, 11 !: . • .. .. . • • ••.:a..t. IN• '44 '
' . 0 New 'Construction . Additi. At 1. • • . 1111 . Please check OII th apply (subnt it 2 sets of plans w/it oms checked below): .. .
. 0 bemolition • Othcf3UILDING D ISION • • • 0 Service or feeder 400 amps of more 0 Building over three itaficd: • .• . • where the available 11.1111 current 0 Marinas and boatyards. . . . '.
0 Floating buildings." • • : .
.. . . . .., ...„
: ..• ..." • • .....'; :''.'''':.•CAT,?P.0,1POP. 44147modia$VMMIMI exceeds 10,000 amps at I SO volts or
W410 ground Or excccds 14000 0 c
• •. /I 1 - and 2 dwelling El Commercial/industrial 0 Accessory:building , umin. c ial agricultural . :.
amps for all other installations buildiags.
• ., II Multi-family 0 Master builder 0 Other.., .. . '• • 0 Fire pump. 0 Installation of 75 KVA
-.•-• El Emergency system.
. '. ‘!' . . .:10 ' . er• . 0 .96 :fl-f tto-c. • • la' ger Ceparatcly derived system.
. .. . . ... , ... • •
. . .: ....,.. ,.. ,,..,.....,., 4 .,.. ,•,. TA.,„ „.,...,-.,. -.... ak.t. 4,1,1l4 '31;i.iATM ..,.), rA1.1 0 Addition of new motor load nr
• ... • Job tio. • Job site address: li m i 31) '
..N / /
... .
. .,- O 100HP or more. oectipancY.
&M or more nzIdenlial milli,
0 itccriatbirinti vehicle parks,
City/State/ZIP: 1
C
1 ir,e '° . • 0 Health-care facilities. 0 Supply voltage for more than
0 Haw-d 1=1601 lh. 600 volts nominal, •
- . - •
•'...; Suite/bIdg./apt. no.: 1 Project name: / ' . . ,
A'. ., :. o Service Qi feeder 600 amps or InOrt.
. . ..
, • i tWar gir7
,Cross.street/directions to job site: . • . • Desert , riot I ' • fee. ErJr-naii .:
.
' . - New residential single- or multi-family dwelling unit.
. . • . • . Includes attached garage. .
- ..----------
• .subdivision: Lot no. i sq. ft. or less ., 145.15 . . -' 4
- E& add'l 500 sq. ft. or ponion 33 ." IIIIIIIEI '
.', .. ' rnap/paree I no.: Limited energy, residential
......,..,•.... • .• ....:.•,, ....„,..,,,...,,,„,,.t...,:,., ••,,,,,,;,„...,„,••:.:•.
.. • ....-:•••••:-..;.•,:;„,..:::::.,:..: • 4 . .•;.ntsOrr.nc•* A n
.mts*.P.W..:*11-cfrALihtioitaiik4,..6g with above : . •
- • Limited energy, multi-family
• 4 g _. 4.. ii 4.-t- -- residential with ttlutvc %W.fi. , 75.00
-
. ..
• . : Services or feeders installation. slte.ration, and/or relocation
. - • 41
200 amps or less 111 80.30 • - .
• . . . .
• • • OW
PROPE ..s. :,,,._ .." ' AP:10d .." ,; '.... '1 - • - 'Ili ..
. • : '..:.!' o . .. C' ;'‘.• . ' 1:1' RTY.: I■fER 6,.. ••••••! 1"ikrii` 6;7,2 A 4 * 201 amps to 400 amps -- l068 •
. -
Name: • . a ‘( k.n f14 . 401 amps to 600 amps
--- • • - 160.60 - . •
601 amps to 1.000 amps 240.60
. „ . .
... Addrcs: • 454.65 . •. Ei•.
.
. - .• city /St 5 Over 1,000 amps or volts a7fitt-- . Temporary services or feeders installation, alteration, and/or
- relocation
-
. l . 1 .
'.... ' • Phone( 543 ) LyS - _3 Fax: ( ) -- 200 amps or less 66.85 . -- •
---------- s . . • II
, '.. • . Owner. installation: This installation is being made on property that I own which is not 201 amps to 400 amp 100.30
- . • intendedforsale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
' - 133.75 • . ..
Branch circuits - new, alteration, or extension, pc ryanel -*
• -, Owner.Signature: DaW:, • . A. Fee for branch circuits tvith •
• .
‘•; .. :*PPLIC-ANT . - . :':: . - .1 i----1.6137:403,ki above service or feeder lee. 6.65 , 2 . .
each branch circuit
. . . .. •-• - -. •
. .• Business name: Et. Fee for brunch circuits 1 • ., .' • ' ,
. . without service or feedef fee, I 46.85 (14,.
COntact name: first branekcircuit
- -
• • Each add'l branch circuit I
.--: . • AddreSs: •
- tviiseelianeous (servicc or feeder nniineluded)
. .
City/State/ZIP: "Each manufactured or modular 90.90 , 2
.
an
" dwelling. service cVor feeder ......... •
'1. ..
:hone : ( ) Fax: : ( ) Reconnect only - 66.85
.
E • Pump or irrigation circle
.... 53.40 . : 2
. ..: ir,. . ..7. .. , .. , ,,.. -...::.,:.;.:coNtriii:Or.tokitat..9y,pg"1`1?,,..;:4741a,,:..i'ik,740,igt Sign or outline ligJul np, I 53.40 . • .. • • - 2 .: •
Signal circuit(s) tit limited I
Business name:
. : • k ' 4%-A c • energy panel, alteration. or 1 '
Co ‘,, , ,
"--
. r -
extension. Describe: I • Page 2 2
Address: .1 .. jj...c... -_sI..
City/State/Z11 „
r. ).q_ .. ci, --t 0 t --23 Each adtiitional inspection over allowable in any of the above
. Per inspection . . _I .. I 62
-...
Phone: (Y3) .2 ( i li ? 1 F.: ( 5 (3 7,4,6 '- 6 Li 7s _ Investigation per bout It Iu imn) i 67 50
CCH Lic.:
, .. . - . . Indutri per I - I 73 75
-2 - t 7 '''1.,_t t 2, c_ Suprv. Lic.: .2_ i 7 c .. ....: sal plant hour , .
ELECrit 'Pt:RIAU FEEVi.:'.t)
--....
a - 1'
Suprv. ElectriOau tanalurL, ti..tifitrut. , a .,....... 2 . ___ sub,,,,i
..._. ........ .._..... ....._ . . . p revi,s, , ,..„ to permit ice)
t--...
Print name: - ) A ... i. i .:e . L._ .\.;) • ., . c 0,-.1
'---- Lp..1 ' 1)ate;
--
Staio..1ncItaritc1•:.'.'....1.,: ncriniiicel: -- G. - 6 (0
- .... .___ ...:._ ..____. -..
Authorized L.
ill (,._: • k -.0-'---. •1(11..v..tet itm11 I 51 3k
--. - l'his perinii al pit ii oltii I l 1 iN Ilia uhtnined ithiu 0
---. •--. - Fate' dim , tat cr it 11;v. tit,-.1 a v
vtClittl at. , omptett.
Print name: -.) 4..r.4 :- .4 k .‘) . (-) n.4 i G..4 .
---:------ ---- • 14umnet 1 tr,...p.. ,i0.•,..•... !t...• ,.,•tiitti
• , , • - , 4,10.46151111/05te0Wwmt
I thuil,hile■Pei mit, i I -5 ..,., .' '
Ed WdTO:SO 6002 SI . . - idU 2OSS99220S : 'ON NOHd DNI 31810D13 AENUO : WONA