Permit ( •
CITY OF TIGARD ELECTRICAL PERMIT
1111 • `' COMMUNITY DEVELOPMENT Permit #: ELC2009 -00530
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1 S134BD10100
Jurisdiction: Tigard
Site address: 11664 SW SPRINGWOOD DR
Subdivision: Lot: 0
Project: Bailey
Project Description: 2 Branch circuits fo NC and Plug
Owner: FEES
BAILEY, CHARLES K AND Quantity Description Date Amount
SUSAN R, 11664 SW SPRINGWOOD DR 2 crt Branch Circuits 10/07/2009 $63.60
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/07/2009 $7.63
Electrical
Contractor:
ROTH HEATING & COOLING
PO BOX 1265
CANBY, OR 97013
PHONE: 503 - 266 -1249
FAX: 503 - 266 -3478
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: M A 1/ Permittee Signature: &L App
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 503.638.4175 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.
.4.
1 OCT-05-2009 MON 05:11 PM ROTH HEREICEIYED FAX NO 5032663478 P. 03
pechicalinitAnplication OCT a 2009 1.014 01.1..R .I.: 1;s uNIN
City of Tigard Received
11 L- - • 13125 SW Hall Blvd.. Tigard, OR 9'7223 CITY OF TIGARD .. 138 . tetlar Permit No.: e L c .2 " _ 0 0 5-3D
,,,..
• -• ' Phone.: 503.639.4171 Fax: 503.598. l ' . 4 1LDING DIVISIO1 r m eBy , w Other Permit
; inspection Line: 503.6394175 . , Date Ready/By: kris: RI See Page 2 for
Internet: www.tigard.or.gov 1 Le c_15..11 S el Notified/Method: Supplemental Information
rYk.O ' :!;: ::, :' 7 ' '- '. :: , 7.. ..-..';''.7. .L:.:......', 7....'!■r-71i‘::i:.014K.01**%"‘-:.:::;.',,--':.,,.:
El New construction rill Addition/alteration/replacement Please check all Mat apply (aubmit 2 sets of plans w/items chocked below):
0
El Service or feeder 400 amp or more 0 Building over three stories.
Demolition 0 Other
wham the available thult current 0 Marinas and boatyards.
,.'.,:;., ....: ....'::. CkPlidINRY011': CokilligigOilog:. .,:-..„ .. ...':•;! . ., , 'i. ,.`.: . : ';':. ' ;". exceeds 10.000 amps at 150 volts or El Floating buildings. • less to ground Or exceeds 14.000 0 COMMUIVilli-UIC agricultural
tig 1 - and 2-family dwelling 0 Commercial/indusirial 0 Accessory building amps for all other installations, buildings.
o Multi-family 0 Master builder 0 Other CIF= pump. 13 Installation of 75 KVA or
larger aeparately derived system.
? ,:;..,::...:1 ;, :; •i ;..-. 7, ..: ...: : 1
JOB SITE ANKTIOTION410 LOCATION' ,' :,r!.:,..:: :',.: .::::::: .;'. ['Addition anew motor load of 0
Job no.: 443 Job site address: I ts t suo S 1 , 05 k ,00 0 0 1 0 s ia : HP °I. men. occupancy.
or more residential Ural& IM Been:tallowi vehicle parka.
City/State/ZIP: 1 1 a r o t , Die Of 7 2.:2: )7) r Cillealth-eare tellItles. 0 Supply voltage for mom than
0 Hazardous locations. 600 vole] nominal
Suite/bldgJapt. no.: Project name: Cl SOTIfiC0 or feeder 600 amps or more
,:......::,....,,, i .„,: : - .:: ., :*BE.scitEOULE: - .:',: 1; lp:: : .' . . - ...'::' : ' : . ::•:::,.:,,
Cross street/directions to job site:
Darription I Qty71 Fos. I Total i .
New residential single- or =WI-family dwelling unit.
Includes attached garage. . _
Subdivision:
I Lot no.: .1,000 sq. ft. or less 145.15 4
- - Ea. add 500 sq. ft. or portion 33.40 , 1
Tax map/parcel no.:
Limited energy, residential
75.00 2
Limited ily energy. multi-fam
MA) a Le_fi YTAA.Jr , 2\ U residential (with shove sri. 11.) 75.00 2
Services or feeders installation,alteration, and/or relocation
200 amps or less 80.30 2
?'';Z:;. "' '...::::::-.. 201 amps to 400 amps 106.85 2
Name: (Maxi' ' r 4 cuSa,r1 &ctrirfAi 401 anms to 600 amps 160.60 • 2
601 amps to 1,000 amps 240.60 2
Address: 1/4.% VII L Over 1,000 amps or volts 454.65 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: (5(2510 .., q o q co 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 70L 401 amps to 599 amps 133.75 _ 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date:
A. Fee for branch circuits wish
1:3 ■ii.iip1,10100.- - !.;•.;, i; ,-.!.. ;:::;.. I ::;1... : :;';:' ..', LB ;: jrppritE4010f :.il,;.:' .: above service or feeder fee,
6.65 2
each branch circuit
Business name:
B. Fee for blanch circuits
4,
Contact name:
without service or feeder fee. 1 46.85 2 2 -
first branch circuit •
Address 1 Each add'I branch circuit _ I 6.65 2 " ILO
Miscellaneous (service or feeder not included)
City/State/ZIP:
Each manufactured or modular
dwelling, service and/or feeder 90.90 2
Phone: ( ) I Fax: : ( ) Reconnect only 66.85 2
E-mail:
Pump ur irrigation circle 53.40 2
..
,i,, -..,.::::..:.•':•••::.:::-, ':..,!.;:: •:,::: ;: •:..' :.,:.'::',...•• •.': CONTRACT& !',y ,,,I .: . ...:••,;: - . ...::: i :,•:,!.2.•:1:::;:i.: :": Sign or outline lighting 53A0 2
Signal circuit(s) or limited-
BusineS name: Rk)t-1-1 \ - \ -c 0, n ti QX_ .1.6C3 energy panel, alteration, or
Address : \ 0. C 12..l5 extension. Describe: Page 2 2
City/State/ZIP: C cu L,L , Da Cl 1 c.) I ; Each additional inspection over allowable In any of the above
Per inspection 62.50
Phone: (5 2 utj ,- i7..t/ Fax: (6O a ti)( - 1 g
Investigation per hour (I ie min) i
62.50 -
CCB Lic.: 1 Li 00 y Electrical Lie,: C S 1 Suprv. Lic.: 5Lrl k S Industrial plant per hour 73.75 eit
:.,,:,::.: ,E1LIECEli1Ciii;PERMIT;;FEF,&:!:,
Suprv. Electrician signature, required: ..r.... .
Subtotal:
Plan =view (25% of permit fee):
Print name: 'Fr•(2d V,...1 i .Sov Date:
State surcharge 02% of permit fee): Lo....1,4-7_,. 143
,..._
Authorized signature . ....\ ( ) 2A. y,..t.t,-\it,t._ TOTAL PERMIT FEE: L54.,41-2. A Z
Print name: (ii 'AC - ( 7 k 111 C.) d'A.PA, Date: ...
0 5 - o ei Thls penult application expires If a permit la not obtained within 180
0 j days after It has been accepted as complete.
• Number of inspection]; allowed per permit.
1 : 1 Buildins■PeemOOELC•ParnircApo.Oor 05/23/06
440-4415T( I I /05/COM/WED