Permit u CITY OF TIGARD ELECTRICAL PERMIT
s
a COMMUNITY DEVELOPMENT Permit #: ELC2010 -00250
T[GARIa 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/21/2010
Parcel: 2S104AD00100
Jurisdiction: Tigard
Site address: 12600 SW 128TH AVE
Subdivision: BELLWOOD Lot: 14
Project: Bode
Project Description: Replace (1) 200 amp service
Owner: FEES
BODE Quantity Description Date Amount
12600 SW 128TH
TIGARD, OR 97223 1 ea Services or Feeders - 200 05/21/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 05/21/2010 $12.08
Electrical
Contractor:
WINNER ELECTRIC INC
5950 SW PROSPERITY PK
TUALATIN, OR 97062
PHONE: 503 - 638 -5028
FAX: 503 - 638 -4242
Type of Use: SF
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. 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 o ; R • 2 -00 -8100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
1
Issued By: /I ' V ° � - 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' - > 4U L ∎ - - Date: v — Z( � 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.
t �1ry i n ,9t i X �ITO " C 1 !. iY 4 .' l I .;
Electrical Permit Applicatio® - ren i �,�, ,�,� `^,'� � 1 r i , 'I 0R O 1 I ' I iSI'O I r ,', 'P I ,''
�ECE�ED Received .,a �, . I I w. ; it N �.,. ,
'li 1` 1 1'i'.� Ir k Rece 4
City of Tigard ,� a� / c 4 Perm
ermo.' 7
L DateB r GC.0 ��Q �� ;;;,..7 50
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
'1 C iut , Phone: 503.639.4171 Fax: 503.598.1960M AY 2 9.i. Date/B : Other Permit:
i I v A R D' inspection Line: 503.639 .40 Date Ready/By: 121 See Page 2 for
vol Internet: ernet: www.tigard - or.gov Notified/Method: IN in Supplemental Information
• CITY OF Ti 1 RD
TYPE OF `I qEDING DIVISION PLAN REVIEW'
❑ New construction ddition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items 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.
L� 1 -an 2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
y g ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire Pump. ❑ Installation of 75 KVA or
. . •' JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "E" "I -2" "1 -3"
Job no.: Job site address: /-. (� ) 5(,J /2 e ms' AVL , 00HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: .�� CL /d OR_ q-7 .....2 3 ❑ Health-care facilities. ❑ Supply voltage for more than
f ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 5Cde.. ❑ Service or feeder 600 amps or more.
' ' SCHEDULE ,
Cross street/directions to job site: Description 1 Qty. I F 1 T 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 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.: Limited energy, residential
0.84 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family 67.84 2
72 266— 7 1 /� residential (with above sq. ft.)
.673z4-66— ! Services or feeders installation, alteration, and/or relocation
200 amps or less / 100.70 /a), -70 2
ROPERTY: OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
x 401 amps to 600 amps 200.34 2
A6-
�
Name: /6 L� E — 601 amps to 1,000 amps 301.04 2
/
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
ty relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
' .CONTRACTOR • • Signal circuit(s) or limited- energy
Business name: panel, alteration, or extension. Page 2 _ 2
i/
//l/7 e - el�'I C- .�'7 C Each additional inspection over allowable in any of the above
Address:
S1 S 5ou 46cK 5 iL ?r pen kzJ 66.25/ hr
Additional inspection (1 hr min)
City/State /ZIP: 7 069 /J / / investigation (1 hr min) 66.25/ hr
litl, / 'n V 2 / 'a ✓� / C industrial plant (1 hr min) 78.18 / hr
Phone: (57)3) (n3a'_ 5 Fax: ( 5)3) 60,3g- , q y2 Inspections for which no fee is
90.00/ hr
specifically listed (%Z hr min)
CCB Lic.: /0714.,/ Electrical Lic.:3y /53L Suprv. Lic.: a17 a 5 s . ELECTRICAL PERMIT ,FEES
Suprv. Electrician signature, required: ti Subtotal: /( ?
Plan review (25% of permit fee): /--�;
Print name: J8 e) is.) ALL_ Date: 6.� 2.19— /o State surcharge (12% of permit fee): /.2.61/
TOTAL PERMIT FEE: ii 2. 7 S'
Authorized signature: This permit application expires if a permit is not obtained within 180 tl/
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
1:\ Building \Permits\ELC- PermitApp.doc 10/01/09 440- 4615T(11 /05 /COM/WEB