Permit CITY OF TIGARD ELECTRICAL PERMIT
1 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00186
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/08/2011
Parcel: 1 S134BD00300
Jurisdiction: TIGARD
Site address: 11455 SW HAZELWOOD LP
Project: INGLE Subdivision: ENGLEWOOD NO. 2 Lot: 91
Project Description: (1) branch circuit for furnace.
Contractor: SIMPSON ELECTRICAL CONSTRUCTION Owner: INGLE, TIM
2145 NE MCDONALD LN # C 11455 SW HAZELWOOD LP
MCMINNVILLE, OR 97128 TIGARD, OR 97223
PHONE: 503 - 472 -2530 PHONE:
FAX: 503 - 435 -0157
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/08/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/08/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 1 • . pted by the Oregon Utility Notification Center. Those rules are f t forth in OAR
952- 001 -0010 through OA' • - 001 -0090. Yob may o • - ..,.y of the rules o direct questions to OUNC by calling 503.232.1987 or 1.800. .2344.
1
Issued By: , <— Permittee Signature:
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 A
FOR OFFICE USE ONLY
.-
City of Tigard DR - L ;31F/ilf -/P
...,. .. ..
1 , 13125 SW Hall Blvd, Tigard, Olt 97223
Phone: 5016394171 Fax 503.598.1960-. , , .. Waill1.111111111111. OtherPesaait
'\' Inspection. Line: 503.639.4175 kl OF I IGARD Date Rgad
„ hamlet uww-tigard'or-gor BUIL ING DIVISION Nathedfaieth°± IfflalliEggEEl
.,-otglocwosit:.__ • :. 7 :..-.........-•-:: ' 7. ' '. .---: -,- ;'..":f• - -;:i.":: : :' , _ ',.' .. 7';':'1;f: -- - - -rtliltilltVitgl ' ''.' '. -- ' '-- ' --. '
0 New construction PE A,chrdiontaltmatio a/replacement Plesse die e:alithatapply (soinnit a seta ofplaas Teams clacked below):
0 'Demolition . 0 Other: - 1 °Service or 400 amps or more 0 &aiding OVer line statcs-
wbcic de available fault camas 0 Marinas and boanyards.
--.....• . , _ • - •
: : 2 :-: : :: -'. -.: -::-... :::..: . ,. • - . -- -. . • . =ends 10000 arms at 150 veils Or 0 needing buildings .
less to genaxi, or exceeds 14, Cammerced•ose
1- and 2-family dwollbag D Commeatrmdositial 0 AZOnneri building aropsfor an caber ieStail 00 0 agricultural MiUdings.
• E Multi-family 0 Master builder I 0 Other: 0 mw pump., Li braallatina of 75 KVA or
' . ' • • . - ' - ..."•: . • – - ' ' 4146 tOditreti:? - :: '.: ' ; -; '• CIED sigl
'11 - larger seganately derived system.
EIAddnaan of rim =armload of 11:1"A", - E", -1-2".-1,-3-.
100HP tw more. occupancy.
Job no.: I Job site address: ttf-i SO SI j H L
0 Six or more reifuleomal" units 0 Remeatienal vehicle parks_
Ci: ' , a r 41, i le...91.2.31-
/State171P 011ealih-ease facilities_
allazardoos locations. ° Supply lioltage firr mom than
tY
600 volts nominaL
SuiteibldgJapt no.: Project name: , , z5 1:13amiee or beder 600 maps ornate.
:-. :;:-: ,:i.: Pt& Selitailltr:' -.:•. -: • '
Cross strecthfireelions ro job site: lo.riusko I ow. I pen I Taw I .
Includes attached garage.
Subcilvision: - 1 Lot no.: L000 sq. it wires 168.54 4
Ea, add1500 nit orportion 3302 1
Tax map/parcel no.: • . .
Limited energy, residenfial
75.00 ' 2
. 104eittiiiiiiii • WOiliC= :;;::::::: 1 : : :`:;• : ** - ''' - : . 1 - ' i . ( abmesq- ft.)
cnergy, malthanaly
r . „, 75.00 2
C
ircu'. -Co -Coe tuel icc- residential (with above sq. it.) .
Services or feeders bistallotion inorthis- relocation
200 amps or ion W0.70 2
,.7, 1-L:11Plii)*I4ClitljPitptER .-'-: -- :.j . ,. V ,'-'-•••-••.: : -,.. 0 ..lomeorx --::....-:,:*:,-- 201 aniFslo 400 amps 133.56 2
/tune 401 amps to 600 amps -' 20034 2
:
601 snips tI3 1,000 amps - ' 301.04 2
.
Addreas: • - Over I.000 amps orvalis - 55226 2
Temporary services or _feeders installation, alterartIon, and/or
My/State/21P:
relocation
Phone: ( ) I Fax: (1 ) 200 amps or less
5936 , I
201 ps to
Owner instdlation: This installation is being made On property that I own which is not
1 am 400 amps 125 08 2 401 amps to 599 amps 16854 _ 2
intended for sale, lease, tent, or exchange, according to ORS 447, 449, 670, and 701.
Branch dreads- new, alb:rat or extession, per panel
Owner signaturc DM= _ A Fee for branch circuits with
. - above service or feeder fee,
;:.,..;.:::: ...::.-.,.:-.-,.......,., - :;1• . 130;14111t - : , - • -'. :...r ...: - ... ' 1. -.'7.-.1 i Eitottir■ket POISON each bunch _ . 742 2
Business nem= I E. Fee fa branch circuits witiawa
service or feeder fCe. Fust
Contact name: bum& circuit ( 5618 56 I. 2
L . Each addl branch circuit 742 2
Addresx • • - . Nfmcdianeons (service or feeder not Int:hided)
Each ma:miaow:rector nuochilar 2
City/StaterZIP:
. . .5 -,.., service nralfor feeder 67.84
Phone: ( ) I Fax: ) Recotmect only 67,4 2 .
Pump or irrigation circle 67.84 2
E-mail:
Sign or anti= lighting 67.84 2
.
'.,.: • -. - . -- '.-- : '-''-'''•• :::::';;•••,' :- :"::....:: ;f:-COMERACrOlt ".''. •::-.!:.*•:: '-':..''.- -....'. ,-.; •.':-. :-.--.:: ! - .- Signal circlit(S)or limited-energy
l, it or ottesSirm. . Paget 2.
BUSilICSS WM: 5; C P
Si PS)11 lc c...4r: c a i (.0.115-1 pane
44 c hoi Each addidantil inspection ever allowable in any of the shove
Addrcal I 4 5 i i 6 McDon. LI I-, si4 C% Additional inspeninn (1 ha min) 1 6625/hr .
Investigation (I lir min) 6625/hr
C itY/S t ate": alit_ Oroof i: l ir , 4A 97 Industrialclant (1 hr min) ...
78.18/hr
i RI= 5 ) 1 435— 0151 lospeetions for which no fee is
90_00/ hr
' specifically listed Ch hr min)
ca Ucz ( 3 3ES I Electfical Lic.: ' I . S I %Pry- L�. 9:493S - '-_- '-_ - :FEES..
1.•
Suprv. Electrician signature, required: 16 r
Subtotal: sr, (At
planicvicw (25% of permit Its): .,--
Print nail= ge r, (54 I natc: ' is it i Slate snrchurge (12% of pamir fc* a 6 7 ti..
TOTAL PEILMIT FEE:
Authorized signature:
This want approestion MONS ifs permit is not obtained - windmill°
days after it has lbeen accepted as complete.
Print name; Date-. - Number of iovectiems salaried. pcs
— ' -
ViDeadigsVernits;ELC-PeenkApp.dse 0702AO 440-46i_ST(11COMIWEB
L d L9 LO leo!.iloal3 uosdws ett:LO l,L ao idv