Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2014-00558
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/29/2014
Parcel: 2S110AD90001
Jurisdiction: Tigard
Site address: 14820 SW 109TH AVE
Project: Fannie Mae Subdivision: CANTERBURY WOODS CONDO Lot: 1
Project Description: Electrical reconnect only
Contractor: NOT REQUIRED Owner: FANNIE MAE C/O REEKIE PROPERTIES LLC
9830 SW MCKENZIE ST
TIGARD, OR 97223
PHONE: PHONE: 503-639-1600
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 09/29/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 09/29/2014 $8.14
Electrical
Type of Use: MF
Class of Work: ALT
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. ATTENTIO ! =_ . law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001• rough OAR 952-4.1-''••. Y•u may obtain a copy of the rules or direct questions to OUNC by calling 51 .1987 or 1.800.332.2344.
Issue, By: ■ ��i/as` . Permittee Sig =cure: /' /1?342,"
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.
Electrical Permit ApplicatRIECEIVED FOR OFFICE USE ONi.l
ReceivedC�/ -et 5
City of Tigard Date/B : J Permit No.: 5--g
. • 13125 SW Hall Blvd.,Tigard,OR 97gpD 2 9 2014 Plan Review
g Phone: 503.718.2439 Fax: 503.59 D81e/B : Other Permit:
[ 1 c A R[) Inspection Line: 503.639.4175 ` Date Ready/By: : 0 See Page 2 for
Internet: www.tigard-or.gov
CITY OF TI(fARD Notified/Method: Supplemental Information
❑ New construction ❑Addition/alteration/replacement Please check all that apply(submita sets of plans w/items checked below):
❑ Demolition ® Other: reconnect
0 Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION, exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A" "E "1-2""1-3"
Job no.: Job site address: 14820 SW 109th Ave 100HP or more. occupancy.
❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP:Tigard,OR 97224 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
Cross street/directions to job site:Hwy 99 to Canterbury Description Qty. Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision:Canterbury Woods Condominiums Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft or portion 33.92 1
Tax map/parcel no.:R1034222 Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2
Limited energy,multi-family 75.00 2
electrical reconnect inspection residential(with above sq.ft.)
Reaewralble Eat ❑ See Page 2 _
Services or feeders installation,alteration,and/or relocation
® PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: Fannie Mae C/O Reekie Properties LLC 401 amps to 600 amps 200.34 2
Address:9830 SW McKenzie St 601 amps to 1,000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
ity/State/ZIP:Tigard,OR 97223
Temporary services or feeders installation,alteration,and/or
Phone:(503)639-1600 Fax:(503)213-2013 relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 1 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,alteratio n,or extensio n,per panel _
❑ APPLICANT ® CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
Business name:Reekie Properties LLC each branch circuit 7.42 2
B.Fee for branch circuits without
Contact name:Sue service or feeder fee,first 56.18 2
branch circuit
Address:9830 SW McKenzie St Each add'l branch circuit 7.42 2
City/State/ZIP:Tigard,OR 97223 Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:(503)746-9763 Fax: :(503)213-6083 dwelling,service and/or feeder
Reconnect only i4ji 67.84 (.o i•)Stf' 2
E-mail:sue.w®reekleproperties.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Business name: Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any of the above
City/State/ZIP Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
Phone:( ) Fax:( ) Industrial plant(1 hr min) 78.18/hr .
Inspections for which no fee is 90,00/hr
CCB Lie.: Electrical Lie.: Suprv.Lic.: s.- ificall listed '/c hr min
Suprv.Electrician signature,required: Subtotal:
Print name: :-1--44-1 gC�^lei! Date: Plan review(25%of permit fee):
C State surcharge(12%of permit fee): 8.14
Authorized signature: TOTAL PERMIT FEE: 75.98
This permit/,/ application expires if a permit is not obtained within Igo
Print name: Date9/��/if: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I:\Building\Permits\ELC_PermitApp_ELR_ERE.doc Rev 05/21/2013 440-46151(11/05/COM/WEB