Permit :r%
CITY OF TIGARD ELECTRICAL PERMIT
`• . ° : COMMUNITY DEVELOPMENT Permit #: ELC2009 -00529
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/07/2009
Parcel: 1S 136CA06900
Jurisdiction: Tigard
Site address: 7590 SW SPRUCE ST
Subdivision: Lot: 0
Project: Kennedy
Project Description: Temp service due to fire.
Owner: FEES
ROUSE, CHARLES Quantity Description Date Amount
11916 SW ELEMAR CT
TIGARD, OR 97223 2 crt Branch Circuits w /Purchase 10/07/2009 $14.84
Service or Feeder
PHONE: 1 ea 12% State Surcharge - 10/07/2009 $8.90
Electrical
1 ea Services or Feeders - 200 10/07/2009 $100.70
Contractor: amps or less
SQUIRES ELECTRIC 0 ea 12% State Surcharge - 10/07/2009 $4.96
PO BOX 16851 Electrical
PORTLAND, OR 97292
PHONE: 503 - 252 -1609
FAX: 503- 253 -5831
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $129.40
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: V� t t ` Q LA)\ Permittee Signature: . P D •
OWNER INSTALLATION ONLY
The installation is being made on prope 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 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.
W. ..
Electrical Permit Application
octiVV.D FOR OFFICE USE ONLY
•
: . city , of Tici ard R.cceivcd 411 P"Thit :\1°.: • • 13125 SW Hall Blvd., Tigard, OR P
97223 fhtedly:
' ' 2 ' ' Phone: 503.639.4171 Fax: 5035•196C1 0s Q 1 0 - Da lit t a c is ite ;: iw
71 - • -. • • • ... - ... .
other Pe . It:
k3C. 1
TIGARD ' inspection Line: 503.639.4175 .,., a It
nte rilily/Ity: loci!: El See Page 2 fn
i Internet: www.rigard o f sura-- . _
, suPPIenteniat information
..::" .77 .." :10_1 . ..,..,:-. . . -,:':. . .. ' . .. -... -. • . • •-: . - , ■; 7. ,...:
.• .
n Addition/altereon/replacement Please all that (submit 2 sets of plans w/items the ked below):
0 New construction Y
0 Service or feeder - MD amps or wow 0 Boilcling over th ee stories.
.•
0 Demolition E Other: - where the available fault curt ent 0 MiLL
arit, slid boa yards.
4. OF etriNST,RUCWON:::•e. - :.' • - ''' . I
exceed; 10 amps 000 a al 150 volts or 0 Floating buildings.
less to ground or exceeds 14,000 0 Commeicial-usc as.ricultml
. 1- and 2-family dwelling 0 CommerciaL'industrial 0 Acces building amps for all other inataliations. buiidings.
•
0 Install:mount 7 KVA Of
• MIlki-raffIlly 0 Master builder 0 Other: ID Fife pump.
0 Einc-1 syMem. huger sap;mately derived system.
.,-.:',.: ... :::.:.:-... :••:' .. JOB Slf E' 071iTiR8 AND .1 "::-.-:-. -',.,,-;: ..':-.- . • :;;
El Addii inn or new motor load of
Job site oddress: 7590 CL„)
Job no.:
! ,: - 1001-EP or more. occupaiscy.
• Of rIAW 16 0 Six or more rc-sidential ulli1A. 0 Recreational vc ale parl:s. ,
C i ty/S tate/7 11' • A 0 Health-care tamIlD 1:1 eS. Supply voltage f t more than
•
' 'c' 17____Ctlyd ) I
• 0 Hazacib
rus local ions. 600 vlt nominal.
Suite/bldg./apt. no.: 6 Project name: A'' ject name. 0 Service or feeder 600 amps of mOre.
. . 7 .: . '.-•• • , . FEVSCIIEbtiLE ': .• .7: .,::: •::.', . ..;:
• Cross strect/direi.:tions to job site: Description '...--,.,,,..,r. Total
. ... . . .
• — _____ .....___. -.___. . -
New residential single- or multi dwelling tin I.
Includes attached garage.
. --.---- .
Subdivision: Lot no 1,000 sq. ft. or less 168.54 4
,:
• -- EiL add'1 500 se. ft. or portion 33.92 I 1
• Tax map/pared no.:
. Limited energy, residential
--. 67.84 2
. ..ii .:':-: • : ..._i: :',..,,::.: ....• LiE;Seitikt105= OF . WORK : ' •;:" . ' : - :y: . .;.'''..:::''. '; (with above so. h.)
Limited energy, multi-family
67.34 1 2
' 1 --- e--tal2 on) j,,_.. lite_ *to -r;;C._ r (with ahoy:. so. ft.)
•
Services or feeders installation, alters ion. audio Moeario
2(X) stops or less 1 / i 00.70 jpp.yo
; :':.i.,:.. - . • ...-:: '4.0 rkopiiii1 : '-':- , 1.:...... - :. , _ .: : '' 11:•_._If,NAW:, • .:.. ,. ;.•• • ' 201 amps to 400 amps I 133.56 I 2 I
Nume:
401 mo to 600 amps 200.34 21
, ,... •
601 amps to 1,000 amps 301.04 1 2 I
Address: Over 1,000 amps or volts I 552,26 I ••)
:-
Ci /State/ZIP : Temporary services or feeders installation, alteratifn, and/or
ty
relocation
.... .._._..._ ..-
Phone: ( ) Fax: ( ) 200 mp
as or Ics
.. . . .. 59.36 I
--.. •
• . 5.
Owner installation: This installation is beiniz made on property that I own which is not _201 amps to 400 amps l2 03 2 __ .. • •
. intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. .01 amps to 599 amps 168.54J 2
Branch circuits new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
.,.., .
• '.. • . ' • :''"::''' . . ..- : .'.: :.:••• • :-' . • atON'tACT:SRON .,.. -= - above service or ftedcr fde, 7
,7._
.42 14 /7) 2
each branch circuit / ;46 i
. ..
13usiness name: B. Fee for branch circuits
without service or feeder fee.
Contact name: first branch circuit 56.13
.._
. Pitch add'I branch circuit 7.42
Address:
_ . -- Miseeita neons (service or feeder not included)
.. ,
City/State/ZIP: Each manufactured or modular . 67./l4
2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.34 1
... — •
E . Pump or irrigation circle 67.84 I 2 ,
— -
''' . ::....---: ';'-'-: .,--',', _' ds4-ER .-:• ... -;.-:•• . . •.::,... : .: . • sign or outline fighting 67.34 2
_ Signal circuit(s) or limited-
Rusi n ess nam ;- , , ,, 4 it ) r e4 E , :ii■ r I' e._ energy panel, alteration, or ,
mension. lkscribe: 1 Page 2 1 2
•1 Address' KeS5/ 1
-
,--- .
1 cit bg 9'17..19..1 Each additional inspection over allow1*in any of the above
i . Per inspection 66.25 M
Phone: ( ) c:,-,--.1 '/110•61 Pax: ( )=253 '5'ga4 / Investieation per hour (I hr min) 66.25
CCB Lie.: /366S7 Electrical LAX /llpie,.. I Suprv. T.ic.: 41m.,6 Industrial plant per hour 78.18
• i
Suprv. Electrician signature, ram 1:
fr,,L) Subtotal: .
—
1
Plan review (25% of permit fee): ---
AEI
Print name: t e4.6 9 yd e.__5 Date: (4/0 9 1 State surcharge (12% of permit fcc): I I - ." -
Authorized signature: TOTAL PERMIT FEE: 11_ a .
. _
This permit application expires if a permit i not obtain 'd within ISO
Print name: Date: days after it has [wen accepted us cuMPlete
-
- — • NUmber of inspections allowed per permit.
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