Permit n CITY OF TIGARD ELECTRICAL PERMIT
'1 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00595
Date Issued: 10/26/2010
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Parcel: 2S103DB02800
Jurisdiction: Tigard
Site address: 11360 SW NOVA CT
Subdivision: GENESIS Lot: 4
Project: Walker
Project Description: (5) branch circuits for kitchen remodel
Owner: FEES
WALKER Quantity Description Date Amount
11360 SW NOVA CT
TIGARD, OR 97223 5 crt Branch Circuits 10/26/2010 $85.86
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 10/26/2010 $10.30
Electrical
Contractor:
S&A ELECTRIC, INC
PO BOX 218
BORING, OR 97009
PHONE: 503 -658 -5368
FAX: .6 03 - 2€ /7/O
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 R 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: OA/ /9 /9 / e f.9-770 h "
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 603.639.4175 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 I O R t)I rl( t. t •( ()Ni.‘
City of Tigard OCT 2 2 2010 Received DO
Datc/By. /Q `4 j /d '�r�� f Permit Noe iO S .
13125 SW Hall Blvd., Tigard, OR 9722 Ty OF TIGARD Plan Review
' DaldBy: Other Perin
Phone: 503.639.4171 Fax: 503.598.1
1 1 n R 1) Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready /By: Jw'�'� ® See Page 2 for
Iuteinet. www.tigard- ur.gov Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ddition/alteration /replacement please check all that apply (submit 1 sets of pions wiltems checked b.luw )
❑ Service or feeder 400 amps or m ore ❑ Budding over ihrcr stories
❑ Demolition ❑ Other: where the available fault cuncnt ❑ Marinas and bvattaru,
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
kss to ground, or exceeds 14,000 ❑ Commercial -use ugncuhuwl
IEC1 2- family dwelling ❑ Commercial /industrial ❑ Accessory building turps for all other installations buildings
❑ Multi - tinnily ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation 0175 KVA 01
JOB SITE INFORMATION AND LOCATION ❑ Lmergcnwy system. larger separateh dcnced s) stem
L ❑ Addition of new motor load of ❑ "A" 'l ° I - ?" 1
Job no.: i L Jo s ite address: 6,0 ' 1 } q 1P or more
cxutpanc)
3(, 3 SW 1VUU I 1 �� 1001
0 or more residential wars ❑ Recreational reticle parks
C ityiSlale/ZIP: • ,r7 t/1 c7'-q ❑ Health-care facilities ❑ Supply voltage for more Ihdn
` \ L� ) I ❑ Hazardous locations 600 volts nominal
Suite /bldg./apt. no.: Project name: ❑ Service or feeder 600 amps ur mom
FEE SCHEDULE
Cross slreeUdircctions to job silt: nesrrlptiva 1 Qtr. 1 Fee. 1 Tout 1 -
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 145.15 I
Ea. add'l 500 sq. (1. or portion 33.40 1
Fax map/parcel rio.' Limited cncrgy, residential
DESCRIPTION OF WORK (with above sq. a.) 75.00 2
Limited energy, multi•fancily 75.00 2
, )‹. I I-C_V J ", 111��'------ ---�JI t V V � J \ V ∎ 1tir „/'ti,t- + ` residential (with above sq. It.)
Services or feeders installation, alteration, mad/or relocation
200 amps or less 80 30 2 1
OPERTY OWNER I ❑ TENANT 201 amps to 400 amps 106.85
W U 1 LLcC� 401 amps s
s to 600 am 160.60 2 1
Name: ` P P
601 amps to 1,000 amps 240.60 2 I
Address: Over 1,000 amps or volts 454 65 2
City/State/ZIP: Temporary services or feeders installation, alteration, a nd /or
relocation i
Phone: ( ) j Fax: ( ) 200 amps or less 66.85 I -
201 amps to 400 amps 100.30 ' 1
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 133.75 2 j
Branch circuits - new, alteration extension, per panel
i Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 6.65 2
Business name: B. Fee for branch circuits 54 'IS ` � ��./
without service or feeder fee, �
Contact -
ontact name: 46 85
first brunch circuit
Address: Each add'I branch circui _ • 65 : i
Lit /StattlLlP: Miscellaneous (service or feeder no included)
Y Each manufactured or modular 90 90 2
Phone: ( ) Fax: : ( ) dwelling, service and/or feeder -1
I
Reconnect only 66 85
E-mail: Pump or irrigation circle 53 4U 1 - 2 j
CONTR Sign or outline lighting 53 40 i 2 .
I3usincss name .-A _ Signal circuit {s) or limited- f
��-�- R 1 L energy panel, alteration, or 1
Address: (_) ") _ C ,_;`\ extension. Describe. Page 2 2
C'ily /State % /,IP ± 7 c / / Y CJ r� 9 XL' / Each additional inspection over allowable in any of the abo e 1
,...,\ r...4 ...77 inspection 62 50
Phone: (e:,(.. :) ! ' (. I
�� ( 1 '-y L' I ti I l ' ((_5_,3) r ' L �u 17/ v Investigolion per hour (1 hr min) 62.50
CCI3 Lie.: j 4 030 f Electrical Lic.: 3�5'�� Suprv. Lic.: t163 ' Industrial plant per hour 73 75
J ELECTRICAL PERMIT FEES iS • WI
k ,
5 � �(L� � ectrician signature, reyuirc ? � �, �� 2� Subtotal: /- ' i
PERMIT f'
Print name: -„�
Date: Plan review (25% of permit fee).
,1,-,--, V-1 1U ZZ �` U State surcharge (12% of permit fee 11�
,. � ��
Authorized signature; \ '- ,\ I�, TOTA
� I. 1) ' - ''..s. - w r
777111 0 'nth perm application expires if a perarit is no .brained within 180
Print rint name: L > .H . -}-C l-} ri L v Date: 1 0.--2_2.—\ 0 days after it has been accepted as complete.
1 - • Number of inspections allowed per permit �/
1 ' 43u0dmgU'ermnslELC- permgA oc 05/23/06 440 -461 ST(I I/OS /COM/WED .ley y / r / l/
2/2'd 096I8ESEOS :01 0ILT92820S DIZIlD313 ti '8 S :WOdd dt7S :20 0102 -22 -100