Permit a CITY OF TIGARD ELECTRICAL PERMIT
1111 0 COMMUNITY DEVELOPMENT Permit #: ELC2010 00512
T
[G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 09/21/2010
Parcel: 2S104CD08501
Jurisdiction: Tigard
Site address: 13520 SW ESSEX DR
Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 84
Project: McKay
Project Description: (2) branch circuits for hot tub and GFI outlet.
Owner: FEES
MCKAY, BRACKEN & MARCY Quantity Description Date Amount
13520 SW ESSEX DR
TIGARD, OR 97223 2 crt Branch Circuits 09/21/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 09/21/2010 $7.63
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $71.23
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 wit
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 OAR 952- 001 -0100. You may obtain a co. of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: _ -- 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' 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.
Electrical Permit Application FOR OFFICE USE ONL
I 7 City of Tigard C R eceiv e d PermitNo.: — tl
13125 SW Hall Blvd., Tigard. OR 97 r 010 '.
V 1 0 ��
Phone: 503.639.4171 Fax: 503.598.1960 '\ N. t Plea
Other Permit:
I c n t: l� Inspection Line: 503.639.4175 ,
- 65 See page 2 for
Internet www.tigard- ar.gov { �� 0 , - , • i r Supplemental Information
TYPE . OF WORK C , `t ,\ ,, PLAN REVIEW
(
❑ New construction Addition/alterationA ment Please check an that apply (rnbmit 2 sets of plans Nrtems checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: vrhere the available faith current 0 Math= and boatyards.
CATEGORY :OF CONSTRUCTION =cads 10.000 amps at 150 volts or ❑ Floating buildings.
building an to gro o e exceeds 14, ❑ Commercial-use buildings. agricultural l
K.1- and 2- family dwelling ❑ CommerciaVindustrial ❑ Accessory mg an for an other installations. brlding
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","1-2", 9-3 ",
Job no.: Job site address: ) 35 c $'W eSS2X I OoIiP or more.
❑Six or more residential 1111i/S. ❑ Recreational vehicle parks.
City /State/ZIP: i Jae) ❑ Healthcare facilities. ❑ Supply voltage for more than
KdCY ❑ }hazardous location& 600 oohs nominal.
Suite/bldg. /apt no.: ✓ 1 Project name: //1 ► C I/l.0` ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qt,. 1 Fee. 1 • het,, l •
• • • New residential single-or-multi-family dwelling unit •
Includes attached garage.
Subdivision: • lot no.: 1,000 sq. R. or kss 168.54 I 4
Ea add'1500 sq. R orportion 33.92 , 1
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. IL) 75.00 2
U �LL ]] �{ - Limited energy. multi family 75.00 i 2
Cl o - u b F ( Ci C td 1 `5 residential (with above sq. R)
r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 1 2
❑ PROPERTY OWNER 1 0 TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 20034 I 2
60I amps to 1,000 amps 301.04 1 2
Address: Over 1,000 amps or volts 55226 I 2
City/State/ZEE': /StatclZtp: Tesmporary services or feeders iaataiation, alteration, and/or
tY relocation
l
a mps or less 59.36 1
Phone: ( ) 1 Fax:( ) 200 ., 59
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.0E 2
eat
intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 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 fox 7.42 2
each branch circuit
Business name: B. Fee for branch circuits whew
service or feeder fee, first 56.18 s‘ 3 2
Contact name: branch circuit
Each midi branch circuit , 7.42 '7. (f.2 2
Address: Miseellaneous (service or feeder not included)
City/State/ZIP:
Each manufactured tnodeelesr 67.84 2
tY dwelling, service and/or feeder
Phone: ( ) J Fax: : ( ) Rerormect 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: S. { C • panel, alteration, or extension. _ Page 2 2
'vl �' See E l e ! 1 e• A •15�ert.lc e .^ Each additional inspection over allowable in any of the above
Address: -.A 14 e m!. Den r. (J L el Ste C Additional inspection (1 hr min) 6625/ hr
Investigation (1 hr min) 6625/ hr
City/State/DP: f) G f,,r1 j; 1 I., I a. 9,7 12 Industrial plant (1 hr min) 78.1 S/ hr
h Inspections for which no free is
: C ) 472- 2 5 Fax: (93)435-015-7 specifically listed (A hr min) 90.00/ br
cce Lie,.: 1 33 3 -( I Electrical Lie.: 3_ s c 1 Suprv. .: grA 3 S .. ELECIRICAL PERMIT FEES
(0 3 6 v
Suprv. Electrician signature, required: . Plan review (25% of permit fee): r
Print name: li C' .. I Date: q (1i / State surcharge (12% of permit fee): 9.43
r•to n r (-15r),-,
TOTAL PERMIT FEE: -7 t, 2. 3
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it has been accepted as cora pktr..
Print name! I Date: • Number of inspections allowed per permit.
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