Permit U CITY OF TIGARD ELECTRICAL PERMIT
s..._ COMMUNITY DEVELOPMENT Permit #: ELC2009 -00211
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 05/12/2009
Parcel: 2S114BB05700
Jurisdiction: Tigard
Site address: 10010 SW SERENA WAY
Subdivision: Lot: 0
Project: Rummel
Project Description: Install (1) circuit for heat pump.
Owner: FEES
RUMMEL, BRADLEY G & LORI A Quantity Description Date Amount
10010 SW SERENA WAY
TIGARD, OR 97224 1 crt Branch Circuits 05/12/2009 $46.85
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 05/12/2009 $5.62
Contractor: Electrical
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503 - 736 -0677
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $52.47
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 952 - 001- 0 You may obtain a copy of the rules or direct questions to OUNC by calling 246.6699 or 1.800.332.2344.
Issued By: 40\QU. 1 r ` Q �— Permittee Signature: OfZ ‘ li&n
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.
L
Electrical Permit of ik�� Application 1 ) FOR OFFICE USE ONLY
It N ,3 , 25`lV1lalllllvl 2 l � � , >� _� aq E(0 . 0
Phone: 503,(339.4)71 Fox: 503.5')8.1960 t � Other Permit:
I
� . -' —... .
Inspection Linc: 5113.639,41 0 Itcad of ) .
TIGA1tb Y Y � m See rage 2 for
Internet; wWw,(igdrd- Or.gov NoIllied /Method: :1 i JullplenieMal Inlor'nlaliou
_...., . — CITY OF TI __ _.. _.......
1•YrL Or WORK GGGG�IRD PLAN REVIEW
❑ New construction ) �U,LDING DIVISION Ph v%e check :,LI (11 141 ai - -- - — , —
`Y-" Addltton /aheratlnll /rep accinenl OIV 11 Y Iwbmn 2 sex ul' plans wlnuu%cbrcked below):
❑ 1)Clllulil inn ❑ ter vice or 1 1(11) amp% or more In Building over Ihn,e, %1»ru,R.
. , . ❑ Other: - -... _.. whcrc Ulc availahlc Bull c urrrul
..... _ ... Marina Anil lu,alyerd:
CATEGORY OF CONSTRUCi'ION exceeds I0,000 :imps al ISO woke or ❑ Floating huildinJy:.
1141% lu gran nd, o n.ceeda 14,1) ❑ Con»»ergi -tow )IgrieMhiral
I- and2- lal ❑Comm Commercial/industrial ❑Accessorybuildinp, ;imp %14r all oib1'ri »9laIIath,n9. buildings.
❑ Multi ❑ Master builder ❑ Other. ❑ lire pump. ❑ installation 0115 KVA or
JOB 81'1'13 INFORMATION AND LOCATION ❑Mll I> u Cy new lr ul
u Luger %CFI :11 ale'IV ilia IVCII %Y %tl'n 1.
. .. / 4 ❑Addiliu uP new ntm load ul
❑••A' • •1i .• • •l '•• • 4'
lob no.: t. .' 3 , 1 6( 0 f (a c, L. i Cr •'Yo sa 4...4 Gy 111111Y or more. occupancy.
.....__v
� 7
__.. Job site address: (
? ❑ six or more, rer.imaial .ni, ❑ Reciewioual vehicle pai t,.
City /State /ZIP: . C (/ 7 L- 7 yy- f p I Icalill -c u rc I ililiv�, 0 Supply voltage irn m ine Ulan
r - `U �lu j _ t,(.1 ( name: 1' I I // /�4.' � r/( . v ❑ f la'(yrrdo I on a1u 6181 VON!: nanunal.
~idle: /bl1l �' ' ' � e:lot. I Wl_ 4I1.. 'i_ , 1 J 6 � : ❑ til'rv,CU or feeder 6 amps ;ps or more.
-... p 1. nn,: I I FEE. SC'IlE1)1.11.E
( !s tr
Cross ions to job site: 6p,-.. i u.v3 o-- -- - 1rrL i, _j_ I, nil
.., . .... . . Nvw residential ,single- or multi- l:onily dwelling unit.
Includes attached garage.
Subdivision; 1 Lot no.: I ,U(IQ sq. 0. ur less 145.15 4
Tax oare
_._.___.__ — __. ... _......._.._____ _......,,_.... Ira. adll'I 51)0 sq. It. or portion :1140 1
cl 110.: _ I ,imi1C0 eilefuy, r'C%idh)Oiul -
l)LSCItI PTION Ole WORK with above %r . ft. 7$.011 2
Limited energy, multi-family
r• I 75.00 2
C( C i r-G, 1 l 1 o ♦ •r. "f /1 , e rt`,,idrllllal (wide almvc %I II.)
- - - -- -_ s&rvree,% or I ui,%I:III liirl
.... .... . .
n,_drnr:,rinn, :md /nl' raloearion
201) amps or less 11(1.31) 2
[ ] PROPERTY OWNER ❑ 'TENANT 201 amps to 400 amps 106.85 2
601 amps to 1,0011 an,
1vI a 111C:
4(11 tri to )iO(1 amp, 1611.611 2
C, Y (.W� -...._ ... amps p9 160 .611 2
Address: -- — .... -
L.. V� Over 1.000 ;Imps or voI)% 454.65 2
('fly /tit :tie % /.I I' Temporary services or Feeders installulinn. alteration, and /or
-- -- - - -' ....._ ...._. -- enln0tion
Y...... l - -
66.
I I 115 1
., .._. 201 amps to 400 amps 115).30
Phone: ( . r5 �� L I - 1 ? L � ) n :l r or e
Owner installation: This installation is bean I F ax: 1 made on property that t own which Is not 401 art, to . 2
intended for .ale,, lease, rent, or exchange, according to Olt 4 447, 449, 670, and 70 I . l = 519 amp,: 11.1.75 2
(weer sigualur'c: Dale, Branch circuits - new, alternlinr1, or et d
lvUon, Ilrr panel - -- -- ._ - A. 1 or branch circuits with
El -
❑ AI'PLICAN'l' ❑ CON'T'ACT PERSON above service or feeder fee,
6.65 2
r:■eh branch circuit
Business name: Ti , Fee for branch circuits ----
C onlac( mime: without service or feeder nix:, 1 46,85 l� V �( 2
limb branch circuit I
Address: 4111)'1 branch circuit 6.05 2
— ._. _. — -- Miscellaneous (service or feeder tint included)
City /State /ZII'; Loch manufactured or modular '- 91),9(1 2
- --
- rlwclline, service and/or Ice cr
Phone: ( ) Pax:: ( ) _.., _
Kccuunecl only 66.85
h: - mail: — Pump or irrigation circle 53,4(1 2
CONTRACTOR Sign or outline Ii);htim', -. 5: _._ .._
_ Signal circui1(s) or Iiiii ted-
1lusinesx name: WEST SIDE ELECTRIC CO.' _ energy panel, alteration, or
Address: 1834 Sl. S AVE. cxlcusiun, I)e%c11 4., Puget ?.
--
City /State/ZIP: POR I'I,ANI 4
), OR 9721 1 ?ach additional insnction over allowable in ally of III :hove
-- ... .... - - ... Pcr inspection 02.50
Phone; (5113) 231 -1541{ Fax: (503) 730-0677 - Investigation per hour (I hr min) 62.50
C'Cl3 Lie.: 13306 Flee)rical Lie.: 2 6 - 35(' Sllprv. Lie.: 46545 Industrial plant per hour .._ 71.75
TRICA
( T " - ELECI. PERMIT' FE
tiu
e t f / Q7---, 0
1)rv. 1s10Clile i:,ll signature, ru:yUlrt.d ; -c t _/... 2 e. '�' Su GI c
Prinl name; IAN I/Al.1. RO131 ?RTS _ Date: . f 4, 4 q plan review (251 .ul'permil Ice):
—... _.._„ Sl :dcwrehaipe( n1' permit. tcc): :7 L , 6 _7 ._
Authorized signature: TOTAL . PI1 RMI Hill: S2_ . L
Print inane: — __ I Date: - 'Phi% permit applicaliv expir'e9 if a permit Is not (Outlined withn i ISO
.... 4195 ale It has been uccrpu'd us cnmplcle,
- Number O inspections allowed per permit. B 347
I:li 1v i ldinewaitti, %1I:I A'' l'er ini iAly 115/; 3iiin 410-4.151) I I IIISn •nM/ W I'JS
17 ' LL90- 9EL(EOS) '03 o1.J.z.oa13 apes 'sari d92:i 60 90 ReW