Permit Ipq , , CITY OF TIGARD ELECTRICAL PERMIT
14 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00334
Date Issued: 06/17/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S134CC00400
Jurisdiction: Tigard
Site address: 12155 SW MERESTONE CT
Project: Love Subdivision: MERESTONE Lot: 3
Project Description: New 100 amp panel.
Contractor: DAY ELECTRIC LLC Owner: LOVE, WARREN
21757 S LANCE CT 12155 SW MERESTONE CT
BEAVERCREEK, OR 97004 TIGARD, OR 97223
PHONE: 503 - 997 -1454 PHONE:
FAX: 503 - 632 -3525
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/17/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/17/2011 $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 Code an all - -= her applicable law. All work will
be done in accordance n
a ce wit - .proved plans. This permit will expire if work is not started within 180 days of issue e, or if •rk is suspended for more the 180
days. ATT TION: Oregon la, --qui -s ou to follow the rules adopted by the Oregon Utility Notification ente'. hose ru are set forth in OAR
iii 952 -001- 10 through OAR 952-0;1-0090. y obtain a copy of the rules or direct questions to OUNC by calling 503.2 '.198 or 1.;100.332. 44.
Issu 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' � , II. t/ ��J Date: 7///
LICENSE NO. 9W/5
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.
t
Electrical Permit Applicat' �A/ED FO OF USE ONLY '
.... City of Tigard A� �P Received /� PermitNo.:E/ // eD35
v '"' 1 D ate /By: ((, `
13125 S W Hall Blvd Tigard, OR 97223 Plan Revi ��
1 . ' Phone: 503.718.2439 Fax: 503.598.9 1 7 2011 DateBv: Other Permit:
I 1 G A R C� Inspection Line: 503.639.4175 Date Ready/By: iu: FJ See Page 2 for
Internet: www.tigard-orgov Notified/Method: Supplemental Information
C TY OF TIGARD .OFWOR
K ' ' 'BUILDl ON , PLAN` W�
; iREVIE�" ,. . ,.
❑ New construction Addition/alteration / replace
NGp e nt . Please check all that apply (submit 2 sets of plans w /items checked below):
El Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
CONSTRUCTION' ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
r CATEGORY, �OF _ . . ?' 1
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.
Multi- family 0 Master builder 0 Other: 0 Fire pump. ❑ Installation of 75 KVA or
°JBSI
O TE ,INFORMATION ,AND LOCATION °` " . ' " ' ❑ Emergency system. larger separately derived system.
wr �., T!_ _.... 2'�'S4 e, ❑ Addition of new motor load of ❑ "A" "E" "I - 2" "l - ",
Job no.: Job site address: I' t'5 - SW Y eT more. c
❑ Six Six o or r moore residential units. ❑ Recreational vehicle parks.
City/State /ZIP: e-,, 0(a_ ❑ 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 more.
;' =FEE S �DU L E j s , -.= i .,
Cross street/directions to job site: Description I Qty. I Fee. 1 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 I
Limited energy, residential
`DESCRIPTION OF =WORK -x ` ' h ° f _ r, v 4 "ir - : ' , (� " a � r v� ti ' (with above sq. ft -) 75.00 2
ri. ., . , ,i - , .. :lA,i , z. - , ,i.'es 3ry ,t', r_, , f t _,= ,,, „ . A: , g. to , ,.i4
� Limited energy, multi- family
�1 �` Q
! `'•) [ b 0 ,g— \ 0.!\r ,\ l CS j ,, /L 4 W-. residential (with above sq. ft.)
75 00 2
�
� Services or feeders installation, alteration, and /or relocation
''1- ' L. 200 amps or less 1 100.70 100,1i) 2
ti ®TPROPER1Y O VNER,, ry : fi ❑,_TENANT 9' a/ ,? s , = 201 amps to 400 amps 133.56 2
Name: , 1/4. f ,I�� Y 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: S a_v.•-e_ g 4 , 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
201 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
above service or feeder fee each
® APPLICANT ", ❑ . G ONT ACT PERSON 7.42 2
. � .. _ .. branch c
Business name: B. Fee for branch circuits without
service or feeder fee, first branch 56.18 2
Contact name: circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modula 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: Q l �� panel, alteration, or extension. Page 2 2
l Each additional inspection over allowable in any of the above
Address: 2...t.---/ - —1 6—zt„Le._ C7 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: (�� Investigation (1 hr nun) 66.25/ hr
t7 ' 6 " •1/4 C '�� Z, 9 o. ` L t Industrial plant (1 hr min) 78.18/ lir
Phone: (s4-40-s) i c'p a t{ Sy Fax: (�3) (a 32 -�3 3 'f ' Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
CCB Lie.: )'$3 27) ) // Electrical Lie.: � -- " Suprv. Lie.: Lhat - S ELECTRICAL PERMIT FEES
Suprv. Electrician s required: a Z,/ �„ � �1 / �` �3 Subtotal: i O 1
�^ f Plan review (25% of permit fee):
Print name: O o I ' s l` .\ —rY y Date: ( I 1 y 1' \ State surcharge (12% of permit fee). 12 . e g
It TOTAL PERMIT FEE- //al , 7 g
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 \Pertnits\ELC- PemiitApp.doc 07 /01/10 440- 4615T(I1 /05 /COM/WEB