Permit 0 //7/ * /6 / Irtk ce
CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit #: ELC2011 -00300
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/03/2011
Parcel: 2S110DD06700
Jurisdiction: Tigard
Site address: 10535 SW GREENLEAF TER
Project: Thompson Subdivision: SUMMERFIELD NO 5 Lot: 292
Project Description: (1) branch circuit for bathroom switch. 6/14/11, reprinted permit to include panel replacement.
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: THOMPSON, LELA M
PO BOX 3948 10535 SW GREENLEAF TER
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/03/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/03/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 06/15/2011 $100.70
amps or less
Type of Const: 12 12% State Surcharge - 06/15/2011 $12.08
Occupancy Grp: Electrical
Total $175.70
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 OAR 952 - 001 -0090. You may obta y of • u es o . irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: s
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.
CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00300
Date Issued: 06/03/2011
'TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110DD06700
Jurisdiction: Tigard
Site address: 10535 SW GREENLEAF TER
Project: Thompson Subdivision: SUMMERFIELD NO 5 Lot: 292
Project Description: (1) branch circuit for bathroom switch
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: THOMPSON, LELA M
PO BOX 3948 10535 SW GREENLEAF TER
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 971- 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/03/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/03/2011 $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 the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 9 ' r i -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: "t7 /5 G / 7704
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 Fermi t .Application H L FOR OFFICE USE ONLY
City of Ti , ed / P entlitNo.:
JUN 1 Date/ay: 'II // 8JJ- �r �ijlf �
13125 SW Flal 11? I vd. Ti OR 972 23 2 '-• ' Plan Recei v R
t 2 . Phone: 503.639.4171 Fax: 503.598.1960 Other Permit
Dare fB y :
7 I G rt R O Inspection Line: 503.639.4175 CITY OFT! - Date Ready/By: burn: CI See Pace 2 for
Internet www.ti ard or.gov BUILtt t f�I , lr r Notified/Method: '7770 '7770 I Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction at Addition/alteration /replacement Please check all that apply ( submit } sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition
❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
151 and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family _ D Master builder ❑ Other: Q Fire pump. ❑ Installation of 75 KVA or
JOB :iT I' E INFORMATION AND LOCATION
El Emergency system. larger separately derived system
❑ Addition of new motor load of ❑ "v', "E, "1 -2 l -3
Job no.: Job site address: I '51.4 Gl(41ePE TAT: ix or or more. occupancy.
Q Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Cl HimIth - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 crofts nominal.
Suite/bldg. /apt no.: Project name: Cl Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dardprlon I Qtr. I rm. I Tail I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 168.54 4
Subdivision: (Lot no.: Ea. add'l 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
67.84 2
DES IPTION OF WORK (whit above sg.1t.)
n � �� n Limi energy, multi -family 67.84 2
` tom' U P( r,Qt, ! ma y �� a residential (with above sq. ti) j
Services or feeders installation, alteration, and/or relocation
Ee. CIA 11 *1 e LC, 2D 11 Eb3oa 200 amps or less I 100.70 10 2
❑ PROPERTY (DINNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This in:itallation is being made on property that [ own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 _ 2
Owner signature: Date: Branch circuits - new, alteration, or extension, Qer panel
A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: - - B. Fee for branch circuits
— without service or feeder fee,
Contact name: first branch circuit 56' 18 2
Address: Each add'1 branch circuit 7.42 _ 2
Miscellaneous (service or feeder_ not included)
City/State/ZIP: Each manufactured or modular
' dwelling, service and/or feeder , 67.84 2
Phone: ( ) Fax : ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
f� / - n r r Signal circuit(s) or limited-
Business name:
P t ko ... cz L u l E (-C�f el i energy panel, alteration, or
Address: I o s 9 L4 f3 extension. Describe: Page 2 2
City /State/ZIP: ii t' r "yaw_ lj_ 0 4--)7 O Each additional inspection over allowable in any of the above
Per inspection 6625
Phone: (T7 () 313 1::-Z-1 �. � I Fax: ( '5) 7f'( 0 (3c1 C1 Investigation per hour (1 hr min) 66.25
CCB Lie.: 4%)1•2.)j5 -L j Electrical Lic.: -( Suprv. Lie.: 51 0 5 Industrial plant per hour , 78.18
ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: f �,1� Subtotal: _ ,(`Q jQ
Print name: 0 _22 0 9 Plan review (25% of permit fee):
e J� � � �� Date:
State surcharge (12% of permit fee): I ). 0 g
Authorized signature: TOTAL PERMIT FEE: 11 a.'7
Print name: Date:
This permit application expires if a permit is not obtained within
' days aver it has been accepted as complete.
• Number of inspections allowed per permit.
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Electrical Fermi l A licatio�i E l l/ _
p� FOR OFFECE USE ONLY
of Tigard Received /0 / Permit No.
I2, 13125 SW Hall Blvd., Tigard, OR 97223' 1I N .3 2011 Plan Pla �/ ' � 6 4020 0 d
,• , L
Phone: 503.639.4171 Fax: 503.598.196 D Datt Review ew Other Pcnnit � a2d // 00/70Z4
TIGAR Inspection Line 503.639.4175 CITY OF ��^ �D Dale Ready/By:
Jur; f-t / ' „ I RI See Pagc 2 for
Internet: www.:igard or.gov C OF t tp c Notified/Method: �� L(S Supplemental Information
- n 1 1t ro+ n n�. e
TYPE OF "' dRKi l40 Ut fl lr1 'ION PLAN REVIEW
❑ New Construction Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
LI Service or eder amps or snore ❑ Building over three stories.
❑ Demolition E Other:
- where the available fault current ❑ Marinas and boatyards.
C.d,TEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for aft other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
0 Addilion of new mOtor least of
Job no.: Jo : site address: 10555 ' .J r,er ( or or more. occupancy.
�� `�I 0 Six or more residential units. ❑ Recreational vehicle parks.
• City/State /ZIP: It 0 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: oaeriptiun I Qtv. I Fm I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 168.54 4
Tax map /parcel no.: Ea. add'I 500 sq. ft_ or portion 33.92 I
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ft.)
I C S}! ' ` V- �} n � C t C ` a ki � . T./%-)
' Limited residential energy, (with above ii C4 .4) Cl +"1`r W ✓W,� !'H, residential (with above sq. ft.) 67.84 2
y;�,,,,.� Services or feeders instillation, alteration, and/or relocation
" �M - 200 amps or less 100.70 2
.0" OM NER , ❑ TENANT 201 amps to 400 amps 133.56 2
Name: ""17.1^ . Titan P5 401 amps to 600 amps 200.34 2
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
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rant, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT A Fce for branch circuits with
APPLIGAN
❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee,
first branch circuit 56.18 5(0. 2
Address: Each add'I branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 1
dwelling, service and/or feeder
67.84 1 2
Phone: ( ) Fax: • I
1 ( ) Reconnect only 67.84 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: P 1" to �� c t •�' f ol I � Signal panel, or limited -
L energy panel, alteration, or
Address: T o 3 Z.9 '48 extension. Describe: Page 2 2
City /State/ZIP: 1/0 f,,.' r e... n h ` D . r o 7 0 Each additional inspection over allowable in any of the above
/ r � f Per inspection 66.25
Ph e: (an 51, O p t � t I 1 Fax: (r J ' 1349 �i
(O 1
l/ Investigation per hour (lhr 66.25
OV I ie.: j l�r -�' Electrical Lic.: -c ` Suprv. Lie.: t cp. 5 Industrial plant per hour 78.18 t ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: E Subtotal: 542. (
Print name: / l )p A / ts : 1 Date: 1 D _22 09 Plan review (25 % of permit fee):
State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: ca, a 97, ; i--
Print name: Date: This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
' Number of inspections allowed per permit.
1: t0vndi neYtrmitst7LC- peemirnpp uvoun> 440.16ISTt1 I ro5/cotwwm
Z . d 617EI99Z£09 ou }oeld pain aid d99:0i, 11, ZO unf