Permit 11 a H CITY OF TIGARD ELECTRICAL PERMIT
1" • COMMUNITY DEVELOPMENT Permit #: ELC2011 -00135
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/15/2011
Parcel: 2S103CB02900
Jurisdiction: Tigard
Site address: 12245 SW MARION ST
Project: Subdivision: Lot: 0
Project Description: Panel replacement
Contractor: OREGON ELECTRIC CONSTRUCTION INC. Owner: JOHNSON, H DALE AND
1709 SE 3RD AVE GRACE V TRUSTEES
PORTLAND, OR 97124 12245 SW MARION
TIGARD, OR 97223
PHONE: 503 - 234 -9900 PHONE:
FAX: 503 - 535 -2763
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/15/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/15/2011 $12.08
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit i .. - • 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 ' accordance h ap• •ved 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: Orego , aw r • ires you to follow the rules adopted by the Oregon - Nobi i *enter. Those rules are set forth in OAR
952 - -0010 through OA' •5: - 00.09r. You may obtain a copy of the rules or direct questions to • NC by • ^ •• •87 or 1.800.33 344.
A. '/ / A/ "furl
Is - ed By: ` Perm ittee Si • • . ture: i
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' fa t 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.
Electrical Permit Application ' I OR 01 I I( I I �1: (I \1.1
i 1 of Ti and R ®� ��_ _ a p // 4 el S
`.r I Permit No.:
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Date/B , Other Permit:
-r1, , , }, D Inspection Line: 503.639.4175 Data Ready/By: /irk 0 See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental Information
❑ New construction ® Addition/alteration/replacement Please chuck all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current 0 Marinas and boatyards
'� i exceeds 10,000 a sat I50 volts or
mp ❑Ploatirrgbuildings.
„ :. t . ' 6i( less to ground, or exceeds 14,000 Q Commercial -use agricultural 1- and 2 - family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings. grtcultural
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. Cl Installation of 75 KVA or
❑Emergency system larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1 -2" "1_3 ,
Job no.: 79167 Job site address: 12245 SW MARION ST looter or more. occupancy,
❑ Six or more residential units. ❑ Recreational vehicle parr,
City/State/ZIP: TIGARD OR 97223 O 1. ❑ Health -care facilities [] Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: MiecRIOPMCITENTAL ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Description Qty: Fee. Total . ,,..
New residential single - or multi - family dwelling unit.
Includes attached garage.
Subdivision: L no.: 1,000 sq. ft. or less 168.54 4
Ea. add'! 500 sq. ft, or portion 33.92 1
Tax map parcel no.:
Limited energy, residential 75.00 2
(with above sq. ft.)
Limited energy, multi -family
REPLACE FUSE BOX WITH BREAKER PANEL. JOB #79167 residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100,70 100.70 2
201 amps to 400 amps 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: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
made on property 201 amps to 400 amps 125.08 2
Owner installation: This installation is being p perry that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit _
- Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 _ 2
Pump or irrigation circle 67.84 2
E -
Sign or outline lighting 67.84 2
Business name: OREGON
Signal circuits) or limited energy
ELECTRIC GROUP panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1709 SE 3" AVE Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/ State /ZIP: PORTLAND OR 97214 Industrial Omit (ibrmin) 78.18/ hr
Phone: (503) 234 -9900 Fax: (503) 535 -2763 Inspections for which no fee is
90.00/ hr
- ifi . listed h hr min
CCB Lie.: 203 Electrical Lie.: 26 -95C Suprv. Lie,: 454' a1
Suprv. Electrician signature, require ". $' W14 �� '\4 -- Subtotal: 100
Plan review (25% of permit fee):
k'. rTR .rFrFfi.4lalau(Na11g1(t►g • Dat : 3 - 4 - 1 State surcharge (12 %of permit fee): 12.08
1 1Y 14 . g ,t\I VR.... r
Authorized signature: TOTAL PERMIT FEE: 112.78
This permit appneadon expires if a permit Is not obtained within 180
days after It has been accepted as complete.
Print name: RICK MCELLIOTT Date: 3 -14-11 * Nu of inspections allowed per permit
I :rBwIdiegtPermua\V/C PermitApp.doc 07/01/10 440- t6t5T(uro5 /COM/WEB