Permit CITY OF TIGARD ELECTRICAL PERMIT
� COMMUNITY DEVELOPMENT Permit #: ELC2011 -00184
TIGAR.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04(07(2011
Parcel: 1 S136AD02301
Jurisdiction: Tigard
Site address: 10500 SW 71ST AVE
Project: Holm Subdivision: VILLA RIDGE Lot: 3
Project Description: Electrical reconnect only.
Contractor: Owner: HOLM, MELINDA
8743 N CRAWFORD ST
PORTLAND, OR 97203
PHONE:
PHONE: 503 - 956 -4673
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/07/2011 $67.84
Specifics:
1 ea 12% State Surcharge - 04/07/2011 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 - ... • - 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. • ENTION: Ore.•n - requ' es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -0' -0010 through OAR ' , 2- 00 -0'= s You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Iss ed By: � � ` ��� ! Permittee Signature: x
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.
Electrical Permit Application FOR OFFICE USE ONLY
4 61 City of Tigard Date /B : 7 it 411111 Permit No.: 4 ', __i cli
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t g Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit:
TI G A R D Inspection Line: 503.639.4175 Date Ready/By: Ions: H See Page 2 for
Internet: www.tigard - or.gov Notified/Method: Supplemental Information
El New construction El Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition t Other: where the available fault current ❑ Marinas and boatyards.
;;. - x exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑Commercial -use agricultural
W and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
g , ❑ Emer system. larger separately derived system.
ll ' t - t t - 1 ; ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
Job no.: Job site address: /0 500 V V
7 5� 100HP or more. occupancy
, ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: tl a r d � � g 7 Z L. ❑ ❑ Health -care facilities. ❑ Supply voltage for more than
J Hazardous locations 600 volts nominal
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: '5(,(/ 06 k Description I Qty i Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. 11. or less 168.54 4
3( , v) 2 U R..9 3/(46- L iced ne y, ft. or portion 33.92 1
Tax map/parcel no 1lJ Limited energy, residential
idential
v . a' as r 75.00 2
1 t' ' r - ! a IN, 41k,-,10,0 (with above sq. ft.)
Limited energy, multi - family 75.00 2
Nit J R e La nv , ` J e / e c 4 rI ca / %� € 4 Q residential (with abovesq.ft.)
f v �YJ Services or feeders installation, alteration, and /or relocation
' /` 1/10 USe
200 amps or less 100.70 2
`, .",r ., f . ` ` .� ,', 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 161\ Ala I (rii 601 amps to 1,000 amps 301.04 2
Address: $7L{3 v. cA 4 J - Over 1,000 amps or volts 552.26 2
i
ty for � � � � � Temporary services or feeders installation, alteration, and /or
City/State/ZIP: G relocation
Phone: ( 5 q6( -‘16, I Fax: ( 6jo3) ZZ 5-43 71 (LG a (Ai) 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 I own which is not
intended for sale, lease, rent, o �cchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
'�}` Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
- i °� 4 43 ; above service or feeder fee 7 42 2
• ` � . . • • ) each branch c
Business name: N A_ B. Fee for branch circuits without
f U t service or feeder fee, first 56.18 2
Contact name: A ( ; to et u /4 I )I4 1 branch circuit
I Each add'I branch circuit 7.42 2
Address: 374-(3 / t ( 1 , ,( fl (,(/> tI . Miscellaneous (service or feeder not included)
-, Each manufactured or modular
6., City /State /ZIP: (10,, L8 110 3
dwelling, service and /or feeder 67.84 2
Phone: (
t3 ) ' '6e - /CO 73 I Fax: : (SO 3 ) Z,S 63M Reconnect only l 67.84 47, Vi 2
Pump or irrigation circle 67.84 2
E - mail: it tNICL00 Ci) 40 414/ , Caw) Sign or outline lighting 67.84 2
V` °' ,.,?T''" l} ti -zY. t' Signal circuits) or limited- energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP:
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) ." Fax: ( ) Inspections for which no fee is 90.00 / hr
� s.ecificall listed '/2 hr mm
CCB Lic.: ElGefrical Lic.: Suprv. Lic.: 3 ' ° ` � -
-° .. U ilit `':At'.�t =
Subtotal: l
Suprv. Electrician signature required:
Plan review (25% of permit fee): __....----
Print name: i ' Date: State surcharge (12% of permit fee): q.
/ TOTAL PERMIT FEE: 76 , /
Authorized signature': This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: / Date: • Number of inspections allowed per permit
I:\ Building \Permits\ELC- PermitApp.doe 07/01/10 440- 4615T(t I /05 /COM/WEB