Permit CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2009 -00431
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 08/19/2009
Parcel: 2S103DA00800
Jurisdiction: Tigard
Site address: 13175 SW WATKINS AVE
Subdivision: Lot: 0
Project: Braden
Project Description: (2) branch circuits for NC and GFI.
•
Owner: FEES
BRADEN, ROBERT W & KATHLEEN J Quantity Description Date Amount
13175 SW WATKINS 2 crt Branch Circuits 08/19/2009 $53.50
TIGARD, OR 97223 wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 08/19/2009 $6.42
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503-472-2530
FAX: 503 -435 -0157
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $59.92
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 OA 2- 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: Permittee Signature: 60✓ 49P1.l C"9
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 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.
cg RECEIVED
Electrical Permit Application AU FOR OFFICE LSE oaa - : • ,
Ci of Ti g and `.J 1 8 2a • ' eceived
D_ a1e16 : 61- ! �i� Permit N. /j /` �� / 3
111
• 13125 SW Hall Blvd., Tigard, OR 97223 CITY OF `
er
Phone: 503.639.4171 Fax. 503.59 1960 TIG Oth Pernit:
T 1 G:n RID Inspection Linn. 503.639.4175 BUILDING DIV' ° ' i . ^ • ' eady/ay torn /// Information
See race 2 for
Internet www.tigard NottfiediMethod- 7/ u Supplemental Inforation
TYPE OF WORK PLAN REVIEW
I
Plea check al that apply (submit 2 sets of plans xtlileirt; checked lnlmvt
E1 New construction Fl Addition /alteration/replacement
❑ Service or fcder 400 amps or more ❑ Building over three stones
❑ Demolition ❑ Other:
where the awilable fault current ❑ Marinas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,00 amps at 150 volts or ❑ Floating braidings
less to grour J, or exceeds 14,000 ❑ Commercial - use agricultural
VI I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all ether installations. buildings.
0 Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
0 Emergency - ystem, larger separately derived system.
❑ Addition of ew motor load of ❑ "A ", "E ", "f -2 °, "t -3 ", I
( �2 ! -7 100HP or m occupancy rc. opancy
Job no.: Job site add ress: J l 15 S'( LJ�+k _- s 0 V � ecre ational vehicle arks.
❑ Six or more esidential units Cl ❑ P
City /State /Z1P: 71„ „ . OR_ ❑ Health -care aeilines. ❑ Supply voltage for more than
1 1r^ 1 ❑ Hazardous I cations. 600 volts nominal
Suite/bldg./apt. no.: Project name: ❑ Service or feeler 60D amps or more.
FEE SCHEDULE
Cross street/directions to job site: nereiption I (Ie. I Fee. I Tots! I
New residen ial single- or multi - family dwelling unit.
Includes embed garage.
Subdivision: Lot no.: 1,000 sq. ft. c less 145 15 4
Ea. add'/ 500 sq. fl. or portion 33 49 1
Tax snap /parcel no.: Limited enerLy, residential
• DESCRIPTION OF WORK (with above ;q. ii) 75.00 2
Q f 0 Limited enemy, multi - family
r Tr ✓ C,�.. , cAt . ,i e r a T. - G F residential with above sq. Ii.) 75 00 2
Services or f eders installation, alteration, and/or relocation
200 amps or ms 80.30 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to. 00 amps 106.85 2
Name: 401 amps tot 00 arnps 16060 2
601 amps to ,000 amps 240.60 2
Address: Over 1,000 a cps or volts 454 65 2
City /State /ZIP: Temporary services or feeders installation. alteration. and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or ass 66.85 I
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 00 ■ amp 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to . 99 amps 133.75 2
Owner signature: Date: Branch elm its— nea, alteration, or extension, er panel
A. Fee for branch circuits ,•irfr
❑ APPLICANT ❑ CONTACT PERSON above senace or feeder fee, G.65 l 2
each brand circuit ,
Business name: B. Fee for branch circuits
Contact name: withou se vice or feeder fee f 46.85 J f � 2
first bran 1 circuit t
-
Address: Each add') blench circuit 1 6.65 (p ( 2
Miscellaneo s (service or feeder not included)
City /State/ZIP: Each manufactured or modular 9
= 0.90 2
dtvellitrg, ser ice and/or Feder -
Phone: ( ) Fax: : ( ) Reconnect orly ' ' 66.85 2
E -mail: Pump or crrition circle r 53.40 2
_ CONTRACTOR Sign or outfit e lighting 53.40 2
Business name � 1 mpso-- t om - � Cn c �st _ _ _ /7 . Siena) p a ne l 'a) or ( i o n r
'v l `+>ti.l 1 [� IC�]'�{..O energy panel alteration or
Address: aIL , NC ' + -,, r d / ,,-v C extension. D scribe: Paget 2
City/Sla[e/ZIP: �)q IM s ' � �' s k' r t4t� 1 1 Each additirnal inspection over allouahle in any of the above
Phone: ( f �� �
ff r, 7 l •l , / G , CY`I �� Per inspection 62.50
.� �-Y F .z - ~ D Fax: ( c�[.t� ) 57 ✓ investitior per hour (1 hr min) 62.50
CCB Lie,: + 3�gaj _ i _l Electrical I__ 8� Suprv- Lie.: �1 s Industrial plrnt per hour • 73.75_
t0 to ELECTRICAL PERMIT FEES
j Suprv. Electrician signature, required: Subtotal: 53 S
Print name' r n Date: it Ga 109 Plan review (25% of permit fee):
S 'ste surcharge (12% ofperrnit fee): rp, ff r,
Authorized signature: TOTAL PERMIT FEE: 59. 2 t."'
Print name: Date: This permit ipplicalion expires if a permit is nor obtained within 180
._ lays after it has been accepted as complete.
• Number of nsaections allowed per permit,
I \nuddirtg1Permils1ELC-PcrrnttApp • doe 05127/06 440- 1615T(11105/COM'WEB
L'd L91.0 NOSdWI NIA3>i °66.60 60 8L 6ny