Permit ill �� CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2010 -00367
1GARD, 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 07/20/2010
T
Parcel: 2S103DC04700
Jurisdiction: Tigard
Site address: 13855 SW 114TH AVE
Subdivision: VIEWMOUNT Lot: 35
Project: Vaternick
Project Description: (5) branch circuits for bath remodel.
Owner: FEES
VATERNICK FAMILY TRUST Quantity Description Date Amount
13855 SW 114TH AVE 5 crt Branch Circuits 07/20/2010 $85.86
TIGARD, OR 97223 wo /Purchase Service or
PHONE: 503 - 639 -9661 Feeder
1 ea 12% State Surcharge - 07/20/2010 $10.30
Electrical
Contractor:
YOUNG ELECTRIC LLC
PO BOX 91364
PORTLAND, OR 97291
PHONE: 503 - 706 -9867
FAX:
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $96.16
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 0 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 246.6699 or 11.800.332.2344. //
Issued By: / - Permittee Signature: ON /9 / C / /6"/
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 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.
Jul 15 10 05:14p Premier Plumb ., i1 Inc 503 - 469 -8715 p.1
J o
Electrical Permit Application ��, c \''') r^OR OFl•It I 1 O 1',
City of Tigard � � 1 � G ° : � , 7 Zd i : i � .. Permit No.: �LC� - V /O — ® 0.3. 7
13125 SW Hall Blvd., Tigard, OR 97223 Tt Review
Phone: 503.639.4171 Fax: 503.598.1960 , O `� � 6\ Date/By: 011�rPermn. EC' �� /�6
Inspection Line: 503.639.4175 \ Date Ready/By: orr is: / / E See Page 2 for
T't , , R. , Internet: www.tigard- or.gov C \% �N` Notified/Method: 1 t G Supplemental Information
TYPE OF WORK $ PLAN REVIEW
❑ New construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wlitem3 chocked 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
ES 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of /5 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E" "1 -2" more. "1 -3"
r �� 100HP or mo.
Job no.: - -�- . Job site address: / 76 r7 3 f1 ,/ 7' ❑ Six or more residential units 0 Recreational vehicle parks.
�
City /State/ZIP: / - G � 7) 4 J 7a,?-.?,1 _ ❑ ❑ Health -care facilities. Hazardous locations. 0 Supply voltage for more than
600 volts nominal.
Suite/bldg.lapt no.: Project name: j//?/' ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dcucrittion 1 Qty. 1 Pm I Total I '
New residential single- or multi- family dwelling unit
Includes attached garage -
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with sq. ft.) 75.00 2
ait
Limited energy, multi- family 75.00 2
r- c t/i ' l i. ,--e t„ -, Ile// t residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or Tess 100.70 2
0 PROPERTY OWNER 1 ❑ TENANT 201 amps to 400 amps 133.56 2
/� � C/� �� 401 amps to 600 amps 200.34 2
Name: �/ 601 amps to 1,000 amps 301.04 2
Address: S' q---"-/ E Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, ra
llation, altetion, and/or
City /State /ZIP:
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 10 400 amps 125.08 2
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: J d ,-„fJ - C: - .2 ��,2.) L / B. Fee for branch circuits without
'C, service ur feeder fee, first / 56.18 2
Contact name: r . , branch circuit
� Each add'l branch circuit G. 7.42 5 2
/ �
Address: � ?/ Miscellaneous (service or feeder n induded)
Each manufactured or modular
/V / /
City/State/ZIP: r l / / dwelling, service and/or feeder 67.84 2
Phone: (4'J 7dl 986 '2 Fax: : ( ) Reconnect only 67.84 2
E -mail' 1` Pump or irrigation circle 67.84 2
✓ Sign or outline lighting 67.84 2
• CONTRACTOR Signal circuit(s) or limited-energy
Business name: --:-- / / panel, alteration, or extension. _ Page 2 2
dL/y` 9 l ` c{/�'�� Each additional inspection over allowable in any of the above
Address: �5� /
�r � / Additional inspection (1 hr min) 66.25/ hr
� 9 -^I� / Investigation (1 hr min) 66.25/ hr
City /State /ZIP: 7 /
Industrial plant (1 hr min) 78.18) hr
Phone: ( e .,..76 -- r ,,, Fax: ( ) inspections for which no fee is
s pecifically listed (% hr min) �! hr
VC13Lic.: f �: 4 lectrical Lic.: C f Suprv. Lic � PERMIT FEES
3s E LECTRICAL PER
Subtotal: < 9 ' fl prv. Elect� s , required: t( f � / / /(�
// Plan review (25% of permit fee):
Print name: L� t :/L� r /fs,�,/t Date: �✓ �� State surcharge (12% of permit fee): _
TOTAL PERMIT FEE: �/
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as compkte.
Print name: Date: , Number of inspections allowed per permit.
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