Permit rr . ' CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2011 -00312
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/08/2011
• Parcel: 2S103BCO5200
Jurisdiction: Tigard
Site address: 12155 SW TIPPITT PL
Project: Subdivision: TIPPITT PLACE Lot: 2
Project Description: New 100 amp panel
Contractor: WILSONVILLE ELECTRIC INC Owner: BOWDOIN, JONATHAN T &
PO BOX 845 KATHERINE J
WILSONVILLE, OR 97070 23532 SW STONEHAVEN ST
SHERWOOD, OR 97140
PHONE: 503 - 638 -5353 PHONE:
FAX: 503 - 638 -8804
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/08/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/08/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 r applicable I- All work will
be done in ac :. - . ith appro -• plans. This permit will expire if work is not started within 180 days of issuan•' -, or if is suspendee • ore the 1:0
days. ATT 'TION: Orego I . requ res • to follow the rules adopted by the Oregon Utility Notification C -•ter. • ose rules ar= - forth in • {R
952- 001 -00 0 through OAR 95 r 001 -00•• Y- ay obtain a copy of the les or direct questions to OUNC by calling 503. - : or 1.800.332.2344
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Issued B 1 Permittee Signature: , ,td Ar �/
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:
CON / , a . : TOR INSTAL , • TION ONLY
SIGNATURE OF SUPR. ELEC' .S-_ , i t "' / .4111? Date: 6 0
ice',. j
LICENSE NO. 3 g�
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all 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
CI of Ti and l 2011
Received / -
• •", `J g Date/B l _ Permit No.: 04-- c 5/
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° 13 125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503 5 9v TIGARD Date/B : Other Permit:
TI GARD Inspection Line: 503.639 4175 NG D IVISION Date Ready /By: luris: ® See Page 2 for
Internet: www.tigard or.gov i3UILDi Notified/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
['New construction 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 El Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY 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 all other installations. buildings.
r ❑ ' Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "I -3 ",
r I00HP or more. occupancy.
Job no.: Job site address:
/.5 s cd . if- p A PL. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: %—r-, p ❑ Health -care facilities. ❑Supply voltage for more than
w� ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Pr&ject name: - A ) ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
( At i i o p P 61 J residential (with above sq. ft.)
�1 Services or feeders installation, alteration, and /or relocation
200 amps or less
if 100.70 /d.' - 70
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
c 401 amps to 600 amps 200.34 ' 2
Na 9
't%. > `, ``r ill fJ f / 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) 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 1 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
❑ APPLICANT 1:1 CONTACT PERSON 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'I 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 - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name:pp ` panel, alteration, or extension. Page 2 2
l� I L - 4. / S D VI 1.1 e-n € (lie, C. � � -. Each additional inspection over allowable in any of the above
]D ® Address: � 8 D j Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: 1 �j � Investigation (1 hr min) 66.25/ hr
to � C 5 /J a ddd��� A �/ 1�
t.- Industrial � ' 7L j7 Industrial plant (I hr min) 78.18/ hr
Phone:, 3) '' ' Fax: g' ' Inspections for which no fee is
, i2� ✓�J specifically listed (%: hr min) 90.00 / hr
CCB Lic.: 7 4 M16 -- rE Mru e. 'v. Lic. s ELECTRICAL PERMIT FEES
Suprv. Electrt an ? i L. :•, re.. re ri _ ' ? /o � "' 3 Subtotal: /V O. 96 't l Plan review (25% of permit fee):
Print name: r . � �_ Date' r • State surcharge (12% of permit fee): / at
, •
/ r
TOTAL PERMIT FEE: / -75,
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
Number of inspections allowed per permit.