Permit „, „ CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00094
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/16/2011
Parcel: 1S134CA07000
Jurisdiction: Tigard
Site address: 11720 SW BURLCREST DR
Project: WOLF Subdivision: BURLWOOD NO. 2 Lot: 10
Project Description: Panel replacement.
Contractor: WEST SIDE ELECTRIC CO INC Owner: WOLF, RAMEY LEE &
1834 SE 8TH AVE WOLF, CHARLES E
PORTLAND, OR 97214 11720 SW BURLCREST DR
TIGARD, OR 97223
PHONE: 503 -231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/16/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 02/16/2011 $12.08
Type of Use: SF Electrical
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 OA' •52 -001 -0090. You may obtain a copv of the rules or direct questions to OUNC by calling 50987 or 1.800.332.2344. c
/ 1
Issued By: Permittee Signature: iG
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 the next available inspection date.
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.
Feb 14 2011 5:50PM West Side Electric 503-736-0656 p . 2
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Electrical Permit Application-C9, r F M 11
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City of Tigard Da ,,, B , ' i mg Pemiit No.: '777 t • _. , A L •
1,1_, le!- • 13125 SW Hall Blvd., Tigard, OR 917433 .1 5 2011 Plan Review
er rnij
- Phone: 503.639.4171 Fax: 503.598. DataB :: OthPer
, p I 1 Inspection Line: 503.639.4175 r ,, Tv „, . .„. Bate Ready/By: Juris: El See Page 2 for
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Internet: www.tigard-or.gov 0 ‘. I , y
. r t ;CARD NotifiedfMethod.: Supplemental Information
(;;ZIKRURFIrFtgrif,•;.;.M 1 . - 1W4W,MiAtineiM0.0:gaiReg :2
0 New construction OAdditionfalteration/replacement Please check all that apply (submit a sets of plans w/items checked below):
0 Service or feeder 400 amps or more CI Building over three stones,
o Demolition 0 Other: where 'ire available fault current 0 Marinas and boatyards.
Milf, . 6 , Apgrlipnta , 1 ..,..4,..„...,,,,,,,,.,,,..„,,,„.. exceeds 10,000 amps at 150 volts or 0 Floating buildings
loss to ground or exceeds 14,000 0 Commercial-use agricultural
1- and 2-family dwelling 0 CommerciaVindustrial 0 Accessory building
all other f
Multi-family 0 Master builder 0 Other: arnps or installations. buildings
0 Fire pump. '
0 Installation of 75 KVA or
■C';',V" , t" ',": ', y 0 Emergency system. larger separately derived system.
o:,k" 11 ._ .._ :: i - q.:' igioaeir:.... •;, 0 Addition of new motor load of 0 - A'', "E". - 1-2". "1-3",
Job no.: 3 S q 1S I Job site address: // 720 5} &x-/erv 0 1),-. 1.00HP or mare.
Six or mom residential units. 0 occupancy.
Recreational vehicle parks.
City/State/ZIP: ,r # ,-1/400( / 9 22 2_4 0 Health-care cilities. 0 Supply voltage for more than
:) 0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt. no.: I Project name: i (47,4 i f- „I):2'y 0 Service or feel:ler 600 amps or more
4, x 1. `'f''': e 1 : - : AiN::.-gW.::,.T,OMA
Cross street/directions to job site: : 0,1 • . I. Ov Total
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 so. ft. or less 168.54 4
Ea add'l 500 sq. ft. Of portion 33.92 i
Tax map/parcel no.: Limited energy, residential —
) '.'; M74 '''... '44 ' ( ,. 77 1 77 . :: ” :020 4 Ail :... :i i , ' 1R' (wi above w. ft) 75.00 2
Limited energy, multi-family
75.00 2
Pgit./ ( e 'An 9,e_ res (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
. 200 amps or less / 100.70 /00 " 2
nato 7 - -...„;,, "' 4 01t.5geD.7,LIAP 20) amps to 400 amps 133.56 2
tii 4 :' '..,: 'tg:IT ViTiiit4Pi•'' :"-reIl. i'i'islr r --
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'
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 - I
201 amps to 400 amps 125.08 2
Owner Installation: This installation is being made on property that 1 own which is not
401 amps to 599 arnps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branc circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
1
,,,,,,, : , .1 1,, 3.?,1; :.7 ,, ..„ rt :/ 40 ,i1..•,:l ika, ..,...',:4::•;i' - '.., ." . 7,,.: '',..;,,5!j, above service or feeder fee
iin./..ct,I. ' ,,, b circui ' 7.42 2
B. Fee for branch circuits without
Business name:
service or feeder fee, first
56.18 2
Contact name: • branch circuit
Each addll branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) [Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
.,:42,• a, ..,;,..:1•••• • Signal circuit(s) or limited energy
1 2
_panel, alteration, or extension. Page 2
Business name: West Side Electric Co., Inc. Eath additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State/ZIP: portland/OR/97214 Industrial plant ( I hr min) 78.131, hr
Phone: ( 5 03) 2 31 B Fax:(503 736 - 0677 Inspections for which no fee is
90.00/ hr
specifically listed (yi hr min) .
CCB Lie.: 13306 Electrical Lic.: 26 Suprv. Lie.: 46 54
-f-
Subtotal: _/(.) O ''
Suprv. Electrician signature, required: ,,,,e..„....Z,../ Plan review (25% of permit fee):
Print name: Randall F Roberts Date: State surcharge (12% of permit fee): 1 I i og
TOTAL PERMIT FEE:
Authorized signature: This permit application expires if a permit is not obtained within ISO
days after it has been accepted as complete.
Print name: Date: . Number of inspections allowed per permit.
VII ail ding',Aermits)ELC-PermitApp doc 07/01 /10 440 46I5T( ii /OS/COM/WEB
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