Permit CITY OF TIGARD ELECTRICAL PERMIT
1 .'• � * COMMUNITY DEVELOPMENT Permit #: ELC2011 -00166
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/31/2011
Parcel: 2S103CC10100
Jurisdiction: Tigard
Site address: 12125 SW WHISTLERS LN
Project: SMITH Subdivision: Lot: 0
Project Description: (3) branch circuits.
Contractor: MCCOY ELECTRIC CO INC Owner: SMITH
2014 SE 9TH AVE 12125 SW WHISTLER'S LN
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 03/31/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/31/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 throu e • . R 952-001-0090j.. - - .. • • of the r • • ' -ct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. s
f
Issued By - ' -- -- s-1- Permittee Signature:
c OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Mar. 30. 2011 4:18PM McCoy Electric Co, No. 4108 P, 1
Electrical .Permit application 10R off R'l. II II i
City of Tigard Received 3
! Date/B : 1/ L . ,
61 13125 SW Hall Blvd., Tigard, OR 97223 plan Review
' C Phone: 501639 4171 Fax: 503.598.1960 Date/B : Other Permit:
l It;Altll
Inspection Line: 503.639.4175 1)a(eReady/By: ® se P.ge 2tor
Internet: www.ligard- or.gov Notified/Method: FEAM Supplemental Information
't YPE, O0.WORK BLA)!f'REVxEVy . ,
Please check all that apply (submit a sets otplans wlitems checked below):
❑ New construction ❑ Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
[] Demolition ❑ Other: where the available tbult current ❑ Marinas and boatyards.
CAT GOI1Y OF CONSrRUCTYON exceeds 10,000 rap$ at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 ❑ Commercial - use agricultural
O 1 - and 2 dwelling ❑ Comtnerciallindustrial ❑ Accessory building amps for oil other installations. buildings.
d Multi- family ❑ Master builder Q Other: ❑Thopump CIlnstaliation • JOB INFOItMt�TIQN AND LOCATION ❑Emergenaysystem, larger separately derived system.
. . , . ; ❑ Addition ofnew motor load of ❑ "A" "E ", "1- 2 ", "l -3 ",
Job no- :1)5311 Job site address: 19, L 25 5() U)h,i 5 er 100HP or more. occupancy.
eatlon
❑Six ormore residential units. ❑ Recreational vehicle parka.
City/State/ZIP; It 5ard o R (I~1 , l 3 El Health-care facilities_ 1:1 Supply voltage for more than
ry / S[ate/ZIP:
❑ l locations. 600 volts nominal.
Suite/bldg. /apt, no.: Project name: fl i't's ❑ Service or feeder 600 amps or more.
job site: ' '. , , FEE'SCC Oty. LE
Cross street/directions to
1 heserlpRon I Qty. I Foe. I Total I
New residential single or multt4amity dwelling unit.
Includes attached garage.
Subdivision: ).ot no.: 1,000 sq. R. or less 168.54 4
Tax map /parcel no -: Ea, add'l500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
I IESCRI?TION , OF .WOT;K . (with above sq. R.)
re raf i Oi ' - C rj j r t I f Limited residential (with multi-family 75.00 17
%) /1 residcntie! (with above sq. ft.)
Services or feeders ins tall alion and/o_ r relocation
200 amps or less 100,70 _ 2
❑ PROPERTY OWNER ❑ , TENANT 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 VAS 552.26 2
Ci / StatdZIP: Temporary services or feeders Installation, al feral ion, and /or
relocation
Phone: ( ) I pax. ( ) 200 amps or less — 59.36 1
20I amps to 400 amps 125.08 2
Owner installation: This installation is being made on property 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, per panel
Owner signature: Date; A. Fee for branch circuits with
D APPLIC above service or feeder fee,
AN ❑ CONTACT' PERSON each branch circuit 7.42 2
Business name: • B. Pee for branch circuits wllhour
service or feeder tbe. first I 56.18 S tu , 6 2
Contact name: branch circuit _ CI
- Each add'! branch circuit Q 7.42 (4, td 2
Address: Miscellaneous (service or feeder not included)
Each manu or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Pax: : ( ) Reconnect only 67.04 2
Pump or irrigation circle 67.84 2
B -mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy
t r ` , ( J 1 e ( j
L
Business name: panel, alteration, or extension. Page 2
Q V � r11 / Each additional Inspection over allow ahle in any of the above
Address: G � 4 ve , Additional inspection (1 hr min) 66.25/hr ,
City / Statc/ZIP: 'or 1 GGn d OK, q V Investigation (1 hr min) 66.25/ hr
q Industrial plant (1hrmin) 78.18/hr
Phone: f l,) z , /l Fax: 2 ' 1 1. 234 Inspections for which no fee is 90.00 / hr
specifically listed (Yr hr min)
CCB Lie.: • r SUpry.) c.: . 1 1
� ELECiitICAL'PERMIT-FEES
Supr v �avra► �' Plan review (25 /o o Subtotal: (k$
. Electrician signature, required: of permit fee): .
Print name: „1 - 4,14 , 1e 6 p H Date: .'t) , it State surcharge (12% of permit fee):
r � TOTAL PERMIT FEE: ` i s
Authorized signature: This permit applicehon expires ita permit Is not obtained within Igo
Print name: Date: days after it has been accepted as complete.
N um b er of inspections allowed per permit.
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