Permit III CITY OF TIGARD ELECTRICAL PERMIT
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1 1 11 . :• • COMMUNITY DEVELOPMENT Permit #: ELC2010 -00561
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/12/2010
Parcel: 1 S 136AA01002
Jurisdiction: Tigard
Site address: 10270 SW 70TH AVE
Subdivision: Lot: 0
Project: Tuski
Project Description: (1) 200 amp or less panel change.
Owner: FEES
TUSKI, JOSH Quantity Description Date Amount
10270 SW 70TH AVE.
TIGARD, OR 1 ea Services or Feeders - 200 10/12/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 10/12/2010 $12.08
Electrical
Contractor:
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 -231 -1548
FAX: 503 - 736 -0677
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 OAR 952- 001 -0100. You may obtain a copy of the rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
Issued By: / - " Permittee Signature: O" 1/' 1. PL /( 7e,ii
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.
Oct 08 2010 5:20PM West Side Electric 503 - 736 -0656 p.2
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Electrical Permit Application R "' ((, , ;
pp l i . i is u .
City of Ti OCT 1 2 2 010 °ems /t' /2 /s - 4, Permit No. -u'.20/o - o 'se / •
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
It Phone: 503.639.4171 Fax: 503.598.1960 Date/By:
_ dBv: Other Permit:
1 - ; ,; , , Inspection Line: 503.639.4175 CITY O T 3A,RD beta Read B See Page 2 far
Internet: www.tiga d- or.gov B 1 , , a 6y Notified/Metho �( ] Si...' uppena lnformatko
f4 ;f' = m''14..kt i4A -, A _�. ':a?r... °'cWrt,' :i+t f�,•e41d f w . ::r "_'a' � .�r_ 74 c ;m S, _T ti e _.. �` h�, i. !.S .. Fl ,, _ . 5 i . -. : +1. ,t^ r . 1. ! 1::5 ':.-,.4 a` ``• `• -
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❑ New construction pil Additionfalteration/replacement Please cheek all that apply (submit 3, sets of plans w /iteins checked below):
Demolition Other. 0Service feeder 400 amps ormme 0 Building over three stories.
0 � 1 m i i ;r:'.5?.um'�e? •:' r Q • *-- arc _..s•: ; . i i where the available fault current 0 Marinas and boaryards.
Fiz !I .} f i '', 9 ` 7f : � ; _ .761, '- ; r- ;Rs4tl `, ':!t3 --Z ;e exceeds 10, 000 amps at 150 volts or ❑Flo buildings
.. , ._..,:_Iii .- . - fll.!`-.....sin7 -tr, li:.., .�1n77tt'.fK' .'r'i: -.. ",,, - _•deal: - i5';. `..; acing bw rag s
less to ground, or exceeds 14.000 ❑ Cotmnerd dose agricultural 1 -and 2- family dwelling ❑ Commercialhndustrial ❑Acc building amps for all other installations. buildings. Mull fa mily ❑Master builder ❑Other ❑ Fire pump. ❑ Installation of 73 KVA or
k�,.;:... �vn 3✓ !emu i°e
. `�.,,W e, t x een'5gPncY system. larger separately derived system.
I •(" r . _:: i:.,, 7 ` K , . t . , , .E r 2 ?2. ft ii Y xi.:-- ❑ Addition ofuew motor load of
Job no.,337� Job si/ 7 0 /' / Js+t/ ) 7 - O 10014P or more. occupancy.
te ress: f
❑ Six or more residential unity. o Recreational vehicle parks.
cityistate/ZIP: T. 041 L `'' 7Z Z ? 1:1 Healthcare facilitics. El Supply voltage far more than
❑ Hazardous locatitms. 600 volts nominal.
Suite/b ldg.lapt. no.: Project name: rojA To. i i/ ❑ Setviee or feeder 600 =rim morn.
.' i;;10 rcv,4 1-1 ITI7i Matti %'1K'i 3riii%
Cross street/directions to job site: Descriptiea I Ora. I Pee I Total L
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'l 500 sq. ft or portion 33.92 1
Tax map/parcel no..
Limited energy, residential , • 0
q.�rt .
... . _ ,[, . .. i:::G' : ' ? T. 'f� r . r 'hS����: C 75.00 2
el.. ,. 11Xi".�,Y k% SF� � � • �: ;�.�, $1.•,-".s!' . .;2 ;� �. F, b t'i.y. ; yc'•'! ^ �ti a,ti u::.. ; �-�.<: (with 8t7WeaQ. ft.}
Limited energy, multi- family
Ra / CA4it residential (with above sex. ft) 75.00 2
Services or feeders installadon, alteration, and/or relocation
200 amps or less /- 100.70 400 2
s y1 7 'r (i . ,''. •`aa, :, 'i .' r_ !:i. - C �-` - . . . 9 : s: :.�•.:. _ .:4 2°i s to 400
. K� . •:, :' . , .. ` r . . ! h _ Scv( 'r . <, .,...j, � R� � '; ;. --- - , . ;1. „ .. ,�:u;; ",�.:;� ;.. amp eeupe 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:
relocation
Temporary services or feeders 1 estailadon, alteration, and/or
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 125.08 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 ex tension, per panel
Owner signature: . Date: A. Fee for branch circuits with
... r� - -•. , :,, y .r•• v service or feeder fee,
-�'a 3F`!•..i..•rN�TIe�. •+'fit 4k> S^. ,.,•:N:'� "id'li}n'.�- !F,''d! -U. �x>r • 7.42 2
.ea _ - each trail circuit
Business Mime B. Fee for branch circuits without
service or feeder fee, first
Contact name: • branch circuit 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Ci /StatefZlP: Each manufactured or modular
tY dwelling, service and/or feeder 67.84 2
Phone: ( ) , Fax: : ( ) Reconnect only 67.84 2
E-mail: or irrigation circle 67.84 2
H, - .�. s,." - of r .. , M Sign or outline lighting 67.84 2
I' ,tl ::., , :i,<__a y 'ay :t . - ;�F�: 7Z% :,'.1iir..,.[.:,vS•, , , . ..,n . ,.,.,?1.,
a 65 Si eiiCuit(s) or limited- energy
Business name: West Side Electric nc.
panel, �aattoalinstection. Pap 2
Co., r Each additional inspection over allowable in any y of the above_
Address: 183 4 SE 8th Ave . . Additional inspection (I hr min) 6625/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Portland /OR/97214 Industrial plant (Ihrmin) 78.18 /hr
Pho :(503) 231 -1548 Fax: (503)2-'3.6 - 0677 J+n pt0dons for which no fee is 90.00 / br
l ✓ iftcalf listed Sys hr min)
VCB Lic.• 13 3 0 6 4 ctrical Lic: 26 � 5 C Suprv. Lie.: 4 6 5 4 - S ;::- ' c:- r: '= } t ��;; " m ; ° �:seit" iF:f
Suprv. Electrician signature, required: y s4 � i Subtotal: /GO �v
Pla review (25% of fee):
Print name: Randall F Roberts Date: / / / //0 State surcharge (12% •af permit fee): 1 / Z /
Authorized signature: TOTAL PERMIT FEE: ii Z 7 V
LLB permit application expires if a permit is net obtained within 180
days miter it bas been accepted as complete.
Print name: Date: a Number of inspections allowed par permit.
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