Permit CITY OF TIGARD ELECTRICAL PERMIT
1 :7- COMMUNITY DEVELOPMENT Permit#: ELC2013-00497
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/21/2013
Parcel: 25111 DB07500
Jurisdiction: Tigard
Site address: 15515 SW ALDERBROOK DR
Project: Homesteps Asset Services Subdivision: SUMMERFIELD NO.7 Lot: 369
Project Description: Reconnect only.
Contractor: Owner: HOMESTEPS ASSET SERVICES
5000 PLANO PKWY
CARROLLTON,TX 75010
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 08/21/2013 $67.84
Specifics:
1 ea 12%State Surcharge- 08/21/2013 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _
Issued By: — _ Permittee Signature:
�1
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 the next available inspection date.
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.
REcevED
Electrical Permit Application AUG 2 0 ?01 • FOR OFFICE USE ONLY
City of Tigard Recei Received ,3 J
,IN ....
CITY OFT1GAR i1 D..2), 87/2., //f /3.- Permit 1 Gc--nl'—�oo�l el /
13125 SW Hall Blvd.,Tigard,OR 972 n Rriew r jj G�
0 Phone: 503.778.2439 Fn.: 503.598.1 ILDING DIVISI�1 , Other e•Bv:
:xi GAR D Inspection Line: 503.639.4175 Dote Ready:By: 1tyyppprrt�ss B Seei'ace 2 for
GAR Internet: v. -or,gov Notitied'Method �CD Supplemental lnformati on
TYPE OF WORK I PLAN REVIEW
! ❑New construction ❑Addition/alteration/replacement Pease check all that spplp(submit 2 sets of plans wiitems checked below):
❑ 1)d di101itiOn ❑Service or feeder 400 arnps or more l=Eui:ding aver three stories.
F�Sher where the,v il,•�b:e fmdt cuneat 0 Marinas cod bcotvards
CATEGORY OF CONSTRUCTION ew:es 10.000 arrgts a:15(1 rclb or ❑Floating b.rildings.
less:o ground or eceeeds 14.00: ❑Commercial-use,:agricultural
1-and 2-family distilling ❑Cor*unercial/mdu;bial ❑Accessory building I nmpc for all other installations. buildings.
❑Multi-family ❑Master builder ❑Ot her: ❑Fee puma. ❑Installation of 150 K A or
.100 SITE @IFOR314Ti01 AND LOCATION • ❑Emergency system. largo seperately derived system.
_ /� ❑Addition ofacw motor load of ❑"A-.-E-."I-2-,'1-3-,
' Job Go.: I Job site address: l 5 S 1 S SLIJ rt kip/4 ..- 4" ,' '� IMEP or more. o ancy.
11 �••1, ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: T cA J oc. ❑l•ladth-eare toc.lities ❑Supply vncege for more thou
f ❑Hazardous Iccatitts. 600 colts nominal.
SuitsJbldg./apt.no.: i Project name: ❑Service or feeder 5010 amps or more
FEE SCHEDULE
- Coss street/directions to job site: Darwinian I Qh•, I Fee. 1 Tam] ,
New residential single-or multi-fandly dwelling unit.
Includes attached garage.
Subdivision: i Lot no.: 1.000 sq.'I.or less 16834 4
Tax map/parcel no.: Ea.add'I 500 eq.R.or portion I 33.92 l
! :.:Bred energy.residentmS 1
(with above sq.ft.) 75.00
DESCRIPTION OF WORK 2
( Limited energy.multi-family
1 , 75.00 2
e`C-�7 IOC. I eC�,11* `(- :v�idadial(with above s..ft.)
f Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER 1' ❑ TENANT 200 amps or less I :00.70 2
r �. 201 amps to 40U amps :33.56 2
Name: �kS1�ps r4s5€f .,,2rV,:C-ES 401,1
1 7 ups to 609 amps 200.34 2
Address: ' 601 amps to 1000 amps 301.04 2
S� 1 �=vi4 {�(C�tI
(1 -�-�� Over 1.000 amps or volts 552-26 2
City/State/al: ((Q t, ^/ t n 7( 0 ta E Temporary services or feeders installation.alteration,and/or
Phone:( ) Fax:( ) ; relocation
200 amps or lest 59.36 r 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 4011 am?, 125.08 2
i intended for side,lease,rent,or exchange,according to ORS 447,449,670,lull 70]. 401 amps to 599 amps 163.54 2 I
Owner sig ature: Date: Stanch drains-new,alteration.or extension,per panel i
• •_PPLICANT - ❑ CoATACr PERSON X Foe for branch circuits with
above service or feeder Fee.
7.42 2
Business name: each bron:h tircuit
��., B.Fee for branch ciratits withoer
x
Contact name: S f e-)t , �era service or tixder.fee.iInt
q AN/Q-
•
,�
branch:ircuit SG.IS 2
Address: ' i S , 4j I Jta f� /:1/Q Eat+add I brands din uit 7.42 • 2
v MIGeethuacous service or feeder not Included
City/State/ZIP: re S ika i Q ( Included)
Each manufactured or modular
Phone:( 3 ) .1 13 {—t.�g16CI ( ) dwelling.service and'or feeder 67.84 2
Fax:
r.�+ y` ! Remimect only I 67.34 j-I.V 4 2
E-maLL (J- 1 c..i f, 9!90-l-ko .,,a 1. C•UM Pump or irrigation circle 67.34 , 2
CONTRACTOR Sign or outline lighting 67.34 1 2
Business naive: Signal circuit(s)or limited-cumin. See 1
panel.alteration-orenension. Page 2 ' 2
Address: Each additional inspection over allowable in and of the above
Additional impectino(1 hr min) I 66.25!hi i
CityrState!ZlP: Incestigrtion(1hrmin) I 66.25/hr
Phone:( ) I Fax:( ) industrial plant(I hr min) 78.1&'hr ;
Inspections for which no fee is
CCE Lie.: Electrical Lie.: I Suprv.Lie.: specifically Q.C�'lhr
callvlisted r'ihrminy
Super.Electrician signature,required: EL ECTRIC AL PERMIT PEPS
subtotal: 6-7• $4
Print name: I Date: Plan review(25%of permit fee):
State surcharge(12%of permit Cee): T. 11
Authorized sigiature: TOTAL PERMIT FEE: -15;......9 -75'..it
Print Thb penult application expires Ifs permit is not oh1 d within 180
Cint nante: Date' do's after it has been aceepied as complete.
^ Number of inspections allowed per permit
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