Permit 1, CITY OF TIGARD ELECTRICAL PERMIT
I N °.`' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00218
Date Issued: 05/13/2009
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Parcel: 2S114BC00600
Jurisdiction: Tigard
Site address: 10155 SW RIVERWOOD LN
Subdivision: Lot: 0
Project:
Project Description: Install (2) 200 amp or less panels, and (1) branch circuit.
Owner: FEES
ANDERSON, LEIGH C /LEANNE P Quantity Description Date Amount
10155 RIVERWOOD 2 ea Services or Feeders - 200 05/13/2009 $160.60
TIGARD, OR 97224
PHONE: amps or less
1 crt Branch Circuits w /Purchase 05/13/2009 $6.65
Service or Feeder
Contractor: 1 ea 12% State Surcharge - 05/13/2009 $20.07
DOT ELECTRIC Electrical
1437 SE HENKLE RD.
CORBETT, OR 97019
PHONE: 503 - 695 -9805
FAX: 503 - 695 -6225
Type of Use:
Class of Work: Type of Const:
Occupancy Grp:
Total $187.32
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 i
Issued By: Center Those rules are set forth in OAR
952 - 001 -0010 through 0 R 952-001-0100. You may obtain a copy of the rules or direct questions to OUNC by ca . 46.6699 or 1 800.332 2344.
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Permittee Signature: e.
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.
Electrical Permit Application RECEIVED : h FOR okizi E l)SE ONLY •
' ' - '. Received
Y
III4 City of Tigard Received -. . • C t , Permit No. �` C •. - X
a 13 125 SW Hall Blvd, Tigard, OR 97223 MAY 13 2009
Plan Review
'[". Phone: 503.639.4171 Fax 503.598.1960 Date/By: Other Permit
T 1 G A RD. Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By. Buds: El See Page 2 for
Internet: wwrv.tigard- or gov
BUILDING DIVISIO Notified/Method:
-11-- Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition /altemtion/repldcement Please check all that apply (submit 2 sets of plans w /items checked below)'
❑ Service or feeder 400 amps or more ❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "A° "E" "1 -2° "1 -3
Job no.: Job site address: 10155 sw riverwood lane l001 or mote occupancy.
❑ Six or mmc residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qi'• I Fee. I Total I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. IL or less 145.15 4
Tax map/parcel no.: Ea. add'l 500 sq. It or portion 33.40 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
a out Limited energy, multi - family
Panel change residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less X 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/Z1P: 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, per panel
Owner signature: Date:
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 1
6.65 6.65 2
each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name: 46.85 2
first branch circuit
Address: Each add'l branch circuit 6.65 2
Miscellaneous (service or feeder not included) _
City /State/ZIP: Each manufactured or modular
dwelling, service and/or feeder 90.90 2
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: Dot Electric Inc Signal circuit(s) or limited -
energy panel, alteration, or
Address: 1437 SE Henkle extension. Describe: Page 2 2
City /State/Z1P: Corbett, OR 97019 Each additional inspection over allowable in any of the above
Per
Phone: (503) 695 - 3205 Fax: (503) 695 - 6225 inspection 62.50
Investigation per hour (] hr min) 62.50
(p . `j . U ce f S ► • to Industrial lant per hour 73.75
CCB Lic.: 148002 Electri ic.: 26 -1093c Suprv. Lic.: 46555 P P
- 1 1. ' r 1 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: . �e `' J P - Subtotal: I x6.93
Print name: Patrick Van Delden lN � Date: 4/8/09 Plan review (25% of permit fee):
State surcharge (12% of permit fee): 10.43
Authorized signature: TOTAL PERMIT FEE: - 3 '
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
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