Permit ro CITY OF TIGAR® ELECTRICAL PERMIT
= � COMMUNITY DEVELOPMENT Permit #: ELC2010 -00256
TEGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 05/26/2010
Parcel: 2S 102 B D00600
Jurisdiction: Tigard
Site address: 12725 SW PACIFIC HWY
Subdivision: Lot: 0
Project: Adrangi
Project Description: (7) branch circuits due to dry rot repair work.
Owner: FEES
ADRANGI, FARID Quantity Description Date Amount
4289 ORCHARD WAY
LAKE OSWEGO, OR 97035 7 crt Branch Circuits 05/26/2010 $100.70
wo /Purchase Service or
PHONE: 503 - 719 -2174 Feeder
1 ea 12% State Surcharge - 05/26/2010 $12.08
Electrical
Contractor:
SIMPLY SHOCKING LLC
15118 S WOODGLEN WAY
OREGON CITY, OR 97045
PHONE: 503 - 880 -8649
FAX:
Type of Use: COM
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. ATTEN3.LOW reg . requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-001 through OAR 952 -001 • %I. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246 - _ • . or 1.800.33 44.
Is ued By: 1 _ /` �� Signature: ii �.
iu .►._I / Permittee
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' C'40 41919--5 Date:
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.
•
E R ECEIVED ,
Electrical Permit Applicatio® —.),,(),:,(1.-.,,s,4),,;_, l
City of Tigard Received .-' / permit No.: —•
131 Hall Blvd., Tigard, OR 97223 ' MAY 2 6 2010 Plan Review
�� � , � IU OD � s �
- Phone: 503.639.4171 Fax: 503.598.1960
Date/By: Other Permit:
T I c A Ii 3 Inspection Line: 503.639.4175 CITY
BUILDING DIVISI Dat R eadyBy: runs: la See Page 2 for
Internet www.tigard or.gov OF TIGARD Notified/M Supplemental Information
i ,,, - -,, . T:YPE OF WORK - O " ' :PLAN REVIEW
❑ New construction ® Addition /alteration/replacement . Please check all that apply (submit 2 sets of plans w /items checked below): 4
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
i -.�" exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
-a . CATEGORY °OF CONSTRUCTION . Tess to ground, or exceeds 14,000 ❑Commercial -use
agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
r. ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION; AND LOCATION, ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 12725 SW Pacific Hwy 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard, OR 97223
❑ Health-care facilities. 0 Supply voltage for more than
' / ` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: AVim) YOQ.1 IJf u I/ OQ-1I, ❑ Service or feeder 600 amps or more.
. FEE SCHEDULE_
Cross street/directions to job site: Description 1 qtr. I Fee. I Total 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 •
DESCRIPTION OF WORK ,,,, (with above sq. ft.) 67.84 2
Limited energy, multi - family 67.84 2
rewire of dryrot/damage repair area residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT s 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name:
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
n 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 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
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 1 56.18 5 I 2
Contact name: branch circuit .
Each add'I branch circuit T 7.42 yy,, 2 ,
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: /State /ZIP: Each manufactured or modular 67.84 2
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: Simply Shocking LLC panel, alteration, or extension. Page 2 2
• Each additional inspection over allowable in any of the above
Address: 15118 S Woodglen Way Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Oregon City, OR 97045 Investigation (I hr min) 66.25/ hr •
Industrial plant (I hr min) • 78.18/ hr
Phone: (503) 880 8649 Fax: ( ) Inspections for which no fee is 90.00 / hr
specifically listed (% hr min) •CCB Lic.: 189419 I (Ph I El • L C576 it,,1 Suprv. Lic.: 3853s t t I ip , = ELECTRICAL PERMIT FEES '
Subtotal: /00 • '70
Suprv. Electrician signature, required:
--,..„> Plan review (25% of permit fee): - Ef)—
Print name: Steve L Morris Date: 5 -25-10 State surcharge (12% of permit fee): / ;1. • D 0
TOTAL PERMIT FEE: // 9 .7g
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Jason B h Date: 5 - - * Number of inspections allowed per permit. '