Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00468
T i G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/07/2012
Parcel: 2S110AD90030
Jurisdiction: Tigard
Site address: 14890 SW 109TH AVE
Project: Baker Subdivision: CANTERBURY WOODS CONDO Lot: 30
Project Description: Reconnect
Contractor: Owner: METLIFE BANK
BY QUALITY LOAN SERVICE CORP OF WA
ATTN: NICOLE M LAZARD
2141 5TH AVE
SAN DIEGO, CA 92101
PHONE: PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 08/07/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 08/07/2012 $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 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 OAR 52-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.19877
i or 11.8000,3
Issued By: .,I�I.LG/ atd .1 Permittee Signature: DAL P' _ t!.4i /
1 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.
Electrical Permit Application RECEIVED
I- OR OFFICE USE ONLY
City of Tigard AUG 0 2 2012 Received / sr- Permit N . po <4
Date/By: 5 1
IN 't 13125 SW Hall Blvd., Tigard, OR 97223 p� Plan Review
m Phone: 503.7182430 Fox: 503.598.19fCM'OFTIGARD Dmc/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 B V IID11VG IZIVISIO ! Date Ready/By: ) v y ® See Page E for
Internet: www.tigard -ongov Notified/Method: h Supplemental tnrormotion
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit a sets of plans w /iteins checked below):
El Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground. or exceeds 14.000 0 Commercial -use agricultural
® I. and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations, buildings.
❑Multi- family ❑ Master builder 0 Other; 0 Piro pump. 0 Installation of 75 KVm or
.1011 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑Addition of new motor load of El "A", "E - . ") -2 ", "1 -3 ".
Job no.: Job site address: 14890 SW 109 AVE 1001IP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/Z1P: TIGARD, OR 97224 ❑ Health-care facilities, ❑ Supp voltage for more than
❑ Hazardous locations, 600 volts nominal.
S u ite/bldgiapt. no.: Project name; ❑ Service or feeder 600 amps or more,
'V FEE SCHEDULE
Cross street/directions to job site: r)cxriPtioa I Qt 1 Pte. 1 Total T
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. f, or less 168.54 4
Ea. add'I 500 sq, R. or portion 33.92 1
Tax map /parcel no.; Limited one residential
2
DESCRIPTION OF WORK (with abovesq. ft.) 75.00
^ RECONNECT ELECTRIC POWER OFF OVER 6 MONTHS LOCK CODE Limited energy, multi 75.00 2
IS 0421 ... residential (with above sq. R,
Services or feeders installation, alteration, and/or relocation
PLEASE CALL WHEN COMPLETE.DEBI 971 -998 -7514 200 amps or less 100.70 2
El PROPERTY OWNER 1 C.:1 TENANT - 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: FANNIE MAE 601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation _
200 amps or less 59.30 I
( ) •
Phone: ( ) Fax: 20I amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 _ 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701, 'Branch circuits — new, altcration extension. per �Ianel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I j] CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: MSQ PROPERTIES B . Fcc for branch cireuits illror/r
service or feeder fee, First 56.18 2
Contact name: DEW BAKER branch circuit
Each add'I branch circuit 7.42 2
Address: 8040 SW HALL BLVE #200 Miscellaneous (service or feeder not included)
— Each manufactured or modular
City /State /ZIP: BEAVERTON, OR 97008 dwelling, service and/or feeder 67.84 2
Phone: (971) 998 - 7514 I Fax: : (888) 486 - 3140 Reconnect only 1 67.84 67.84 2
_ Pump or irrigation circle 07.84 2
E -mail: MSQDEBI@YAHOO.COM Sign or outline lighting 67,84 2
CONTRACTOR Signal circuit(s) or Iimilyd.cttcrg
panel. alteration. or extension. Page 2 2
Business name: Each additional iection over allowable in any of the abov
Address: Additional inspection (I h r min) 66.25/ hr
Investigation (1 hr min) 66,25/ hr '
City /$ta[@ /ZIP: ,
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) I Fax ( ) Inspections for which no fee is 90.00/ hr
r
' listed (Vs hr min)
CCB Lie.: Electrical Lic.: I Suprv, Lie.: ELECTRICAL PERMIT FEES
` Subtotal: 67.84
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee): 8.14
TOTAL PERMIT FEE: 75.98
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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