Permit 1
CITY OF TIGARD ELECTRICAL PERMIT
II
a : COMMUNITY DEVELOPMENT Permit #: ELC2009 -00611
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 11/13/2009
Parcel: 2S110BD03200
Jurisdiction: Tigard
Site address: 14916 SW 116TH PL
Subdivision: HELM HEIGHTS Lot: 9
Project: Hopkins
Project Description: Add /alter (2) branch circuits for heat pump and furnace.
Owner: FEES
HOPKINS, GENE H Quantity Description Date Amount
14916 SW 116TH PL
TIGARD, OR 97224 2 crt Branch Circuits 11/13/2009 $63.60
wo /Purchase Service or
PHONE: 503 -684 -6202 Feeder
1 ea 12% State Surcharge - 11/13/2009 $7.63
Electrical
Contractor.
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 $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 thro gh 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: Z tit QAb Permittee Signature:
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' CO Date:
LICENSE NO.
Call 503.839.4176 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.
p r4c 2009 6:25PM West Side Electric 503- 736 -0656 p.2
Electrical Permit AnDlication RECEiv 1 (1 1 1 I n. l . I S 1 1)\ 1.1
City of Tigard i 1l(
'F..,: Permit No.: _ 6 • • • 0
■ 13125 SW Hall Blvd., Tigard, OR 97223 Plea Review Other Permit: 1 r /1 _20 rp 5c?
7
Phone: 503.639.4171 Fax: 5 03.598.1960 NO V 1 2 2009 D M lX `^' l 09 W 71
t ,- ..• i . t , Inspection Line: 503.639.4175 Dace Ready/By 13 See Page z for
Internet www.tigard- or.gov CI , No Notified/Method: G Supplemental Information 1 : r,. 4 i-r-; ?.tort a '.F : - m:`- - '•+�i : ='FiF: `•:ri.`;p: as r_ , ei • `
'�r��,,' _ ..ii; .fie, r J: . i . ,. ,d fi ".., •re. , ... •', .� 1 rs : -,. r >_ ; - -- ��dd ,, ��77 • • •
�° a�,�' ..! +a:r v:`5.1 = .�'..v ,.'t , r � C �ui�..c4_. �ia I �: .?r c• �..... :: ' '= ::'� ?I'a'r �Gka.4C�,l4,',iatl•�1y i' _
❑ New construction i l Additionlalteration/replacemen 0 1 Please check all that apply (submit a sets of plans wlaems checked below):
❑ Service or feeder 400 amps or more ❑ Building over throe stones.
❑ Demolition ❑ Other: when, rho available fault current ❑ Marinas and boatyards.
I: ,'�,. , . = ,i fi g s},!,., '•te !!�" • "$,:,;!....`!-..'''..'..,;.-. ' `lt°i " " 7" t ` ? + _s �t . -,r , k5 :: :- E exceeds 10,000 amps sr 150 volts or ❑ Floating buildings.
b'ti�41.44 r y r'�'i._ r ,!_. . cc - ..,1 i .0 •... . i :- ... 3' r .. f .n'�N,gel _..- ,. ....
less to ground, or exceeds 14.000 ❑ Commercial agrieulnaal
K 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all other installations. buildings.
Multi - family ❑Master builder ❑Other. ❑ F� wnsp• ❑ Installation of 7S KVA or
_:c-c:..- --•�ar.c;::aa.�••-� ❑ EmagencY system. larger separately derived system.
. �k ,�� :�:q.- •�+• .s.._ .- ,- .. .r• ,_ , ..... • .s'`ri. ^'i�`,?;�: _.:�:i'•. = ` D Addinon of new Tastes load of ❑ '•A•• • . •E• , ,.•1•Z . • • • . I_3••
Job no.: J-1/63Z. 1 Job site address: /11176 ski //6-r,„ � ❑ S�or more residential uaita. ❑ Retreat oral vehicle parks.
1 City/State/ZIP: T /fa `. ae 4 7Z Z y O Health-care facilities. ❑ Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bidg /apt. no.: Project name: H 0 Service or feeder 600 amps or more.
Cross street/directions to job site: neerimion On. Pea roar •
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: 1 Lot. no.: 1.000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: _ Limited energy, residential
i 67.84 2
5 Cy'..•!r 1 r �,,... ci•� ^�e 7� , ,av i!4 (withabo
"�:•
{ 4aai'+ rt , =; ;;�, ; ; • r r , . 7.104 }r"�'__ '_;- w so. R)
r Limited energy, multi - family
/4'01/1940 �7./ //7QQZ 1.4 4r//4q residential (with above sq. ft.) -
67.84 2
/ Services or feeders installation and /or relocation
_
i, T= - -:wr.•x , M ?. k' "'t::.• ,'i:l'i'ms.,,0.c,s -,: . _..,, zl �• 200 amps or less 100.70 2
X ,. t.:�:. ; i` ,' •c••els . : 1 ,I,St- 13356 2
,�..� "�,, .� ��,. � IS.F!.�1��j'.•: i� ?, r.:l;'':l tiinirl�n -i ; . .. •-, �''J =r�;;, .,t'": t� @.: 201 amps to 400 amps 133
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/StateJZIP: Temporary services or feeders instaltatloa, alteration, and/or
relocation
Phone: ( ) , Fax: ( ) 200 amps or less 59.36 ' 1
Owner installation: This installation is being made on property that 1 own which is not • 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, altera don, or extension, per panel
8 A. Fee for branch circuits with
_ .
;r_tlS �y::`a ... v,yr.�.-,n•nr..-_ 4:'a' `5.r?" : 1? z.! ..:1 a•-It 1 e t 111 { i7. P':*1
° -al °, � _ urW �. '.�.. -• �•.= above service or feeder fee
MS. .ice ?i�w7�I,x , .;.y ...... ab 7.42 2
tech branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, / 56.18 S6 / g 2
first branch circuit I
Address: Each add'l branch circuit / 7.42 7 ' 2
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular 6784 2
dwelling, service and/or feeder
Phone: ( ) l Fax :: ( ) Reconnect only 67.84 2 _
E -mail: Pump or irrigation circle 67.84 2
r {�•- .r
l:''r •r�:�.:`w- - .:t,�' riNI 't�, h,4.ar.: t".4 x:�:: . Fzi;:St° .i Sign or outline lighting S=R6 s�'rF,•= 'a::•�3Vi.:V ?i �`•`i:':;i;i1S;,: . t.. �•� •a,e� 'u, �"��:r _a, :i
;. � �4;;� . • ii' , '� ±is'::' e:t:.�...;:::.._.:.x.. •K;r:; -_r: Sn 8h 8 67.84 2
Signal circuit(s) limited-
Business name: West Side Electric
energy panel, alteration. or
Address: 1834 SE 8th Ave. extension. Describe: Page 2 2
City /State/ZIP: Portland, OR 97214 Each additional Inspection over allowable is an of the above
Per inspection 66.25
Phone: (303)231 -1548 Fax: (503) 736 -0677 Investigation per hour (I hr min) 66.25
CCB Lic.: 13306 Electrical Lic.: 26 -135C Suprv. Lie.: 4654S Industrial plant per hour 78.18
... ,r . mm._.
_ ;µ :iii,$,,VI' _.. _. •-''%' r .. " � ,,, .t:: :::.` 1::
Suprv. Electrician signature, required: Subtotal: 63 sd
Print name: Randall F Roberts Date: 1 / / /0/G Plan review (2596 of permit fee):
State surcharge (12% of permit fee): '7 .!
Authorized signature: • TOTAL PERMIT FEE: 7
This permit applicadun empires if a permit is not obtained within ISO
Print name: Date: days utter it has been accepted as complete.
• Number of inspections allowed per permit.
I: t8uading■Permss1FLC- PamitApp.dee 1001/09 440.46157(11.!OS/COM/WEB
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