Permit CITY OF TIGARD ELECTRICAL PERMIT
' 3' • COMMUNITY DEVELOPMENT Permit#: ELC201500833
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015
Parcel: 1 S136AA00303
Jurisdiction: Tigard
Site address: 10280 SW 69TH AVE
Project: Williamson Subdivision: 2007-031 PARTITION PLAT Lot: 2
Project Description: Change 200amp service from overhead to underground.(Shop-Meter#1941090)
Contractor: POWER LINE ELECTRIC INC Owner: WILLIAMSON, KRISTOPHER
8403 SE SHERRETT ST 10280 SW 69TH AVE
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 971-645-3807 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/14/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 10/14/2015 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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. ATTEN :': • -.on law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0015 through OAR •52-0• -II'0. You may obtain a copy of the rules or direct questions to OUNC by calling 5\033..232.1 \f I . .2
Issued ijr: C-441L.. Permittee Signature: J `►O\OG
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 ApplicJ11 1CFIV><i') FOR 01-1-1(.1: I SL ON
Received 10 EtC Ay�--(�,33
City of Tigard Re eBv Permit Na
13125 SW Hall Blvd..Tigard.OR i 3 ZO 5 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/13 Other Pemut.
l.1 ti\R l t Inspection Line: 503.639.4175 / s{�j�** Date ReadyiBy: Jun, Er See Page 2 for
Internet: wtivw'.tigard-or.gov �� OF �VAI\L Notified/Method. Supplemental Information
Agtaum DIVISION PLAN REVIEW
❑ New construction Addition/alterationireplacement
Please check all that apply.(submit 2 sets of plans ss'nems checked below).
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: 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
Cal-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
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A E I-?","I-3",
I oP or more occupancy.Job no.: Job site address: OZ L Nt,\ C\ k e- ❑Six or more residential
amts. ❑Recreational vehicle parks.
City/State/ZIP: "Tt at3 l d� 0 Health-care facilities 0 Supply voltage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
FEE SCHEDULE
Cross streetidirections to job site: Deseri.tion 1. Fee. Total
New residential single-or multi-family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1.000 sq.ft or less 168.54 14
Ea add•I 500 sq.ft.or portion 33.92 1
Tax mar parcel no.: /o,136 AA. 00 303 Limited energy.residential
DESCRIPTION OF WORK (with above sq.ft) 75A0 _
/ t tp (� Limited energy,multi-family 75 00
C o se j_ Z MA? SC<■i■ Cevxv, (Ne.\ :s[X 1,,o residential(with above sq ft l
�J n �-t tit Renewable Energy ❑ See Page 2
\� ( oinv./� ->C�t-,CC (slfv/- ) h1 1 iyaf07 0 Services or feeders installation,alteration,and/or relocation
PROPERTY OWNER ❑ TENANT 200 amps or less f 100 70 /06,70
Name: ` V \ 201 amps to 400 amps 133.56
i714C �1�1� cti ;c� 401 amps to 600 amps 200.34 2
Address: rj l� ,<;\4 t^ .vi, 601 amps to 1.000 amps 301.04 2
Over 1,000 amps or volts 552 26 2
City/State/ZIP:"C- ,/&! Temporary services or feeders installation,alteration,and/or
f:....) relocation
Phone:( ) Fax:( )
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 os 2
intended for sale.lease.rent-or exchange.according to ORS 447.449.670.and 701. 1 401 amps to 599 amps 168.54
Owner signature: Date: 1 Branch circuits-new,alteration,or extension,per panel
APPLICANT 1 ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee.
Business name: Npw� �Nt, ' A � L each branch circuit 7'42
1 \ B.Fee for branch circuits without
Contact name: �U�` S '\ service or feeder fee,first
36.18
branch circuit 2
Address: ti,10is <-3, S\xe_«ekk , Each add'I branch circuit I 7.42 2
Miscellaneous(service or feeder not included)
City-State./I I : -0,s.\101 OW,--- CA .) Each manufactured or modular 67 84
Phone:(Cr4 ) 643._-?�.r d Fax: :( )
dwelling.service and or feeder
l Reconnect only to 84
Email: Yt)WCC\-v.vAc 4A c.gZ-Ce ca\(tr�-C-c�'1v , Pump or irrigation circle , 67.84
CONTRACTOR Sign or outline lighting 67.84 _
Business name: lOs `;,K T�Gkx,c. - - Signal circuit(s)or limited-energy See
panel.alteration,or extension Page 2 2
Address: VDU- `-. (e - Each additional inspection over allowable in any of the abose
City!Stalc-ZIP:
Pa( ,rd 0 T�
Additional g ut I hrimi(I hr mm) 66 25/'hr
Investigation i I hr min) 66.25%hr
Phone:(RCA 1 61„6_34i201 Fax: I ) Industrial plant(I hr min) 78.18'hr
1 I Inspections for which no fee is
90 00,hr
CCB Lic.:0'5a 06 Electrical Lie.: Cs., \pe j Suprv.Lie.:5 305 5 specifically listed(',Ihrmin)
ELECTRICAL PERMIT FEES
Suprv. Electrician signature.required: I �r _ Subtotal: /66, "7 6
Print name: I I I - r 4' G�K ate:( \IA,1 s Plan review(25%of permit fee):
L 1 State surcharge(12.0 of permit fee): / -0 Vi
Authorized signatur-. - \ a,c) , e� TOTAL.PERMIT FEE: //3. . 7
` r This permit application expires if a permit is not obtained within 18o
Print name: �x1���,n,� V 0\0sea:SN Date: GC_-Sc,.1L\ 1s days after it has been accepted as complete.
• Number of inspections allowed per perm
I BuildinipPennits'ELC_PennuApp_ELR_ERE dos Rev 05;21,2013 440-3615T(I 1/05/COM(WEB