Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
ill
a:- COMMUNITY DEVELOPMENT Permit #: ELC2011 -00338
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/21/2011
Parcel: 2S104CC07300
Jurisdiction: Tigard
Site address: 13482 SW ASCENSION DR
Project: CHOWN Subdivision: HILLSHIRE WOODS Lot: 92
Project Description: (2) branch circuits for range and warming tile.
Contractor: HI DEF ELECTRIC Owner: CHOWN, THOMAS H & BONNY JEAN
1110 NE 19TH CT 13482 SW ASCENSION DR
CANBY, OR 97013 TIGARD, OR 97223
PHONE: 503 - 891 -2231 PHONE:
FAX: 503 - 212 -5516
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/21/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/21/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 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 Utilit Noti ication Center. Those rules are set forth in OAR
952- 001 -0010 through • • • ` ••' 2- 001 - 0090 ay ob - ' . copy oi!• - . - • . 'rect questions to OUNC by Iling503.232.1987 or 1.800.332.2344.
\ \N A
Issued By: /�. LL._ _ J _
— � ? • ermitteeSignature:
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 " - _ . '- , ,. •
,
City of Tigard Received -
' 13125 SW Hall Blvd.. Tigard, OR 972 Plan Review
Other Permit
23 f c co \ % A C CS )
Er
Phone: 503.718.2439 Fax 503. 6c
Date/ :
Date/B
TIGARD : , Argiimi,,_,.. Permit No.: ,
11.- .-4 - a
Inspection Line: 503.639.4175 Date Ready/By: 10 See Page 2 for
Internet: www.tigard-or.gov \'
Notified/Method: EMI Supplemental Information
4`: - il I' '' ,,, ,,, ,5:1:;,k , ,,,,,4,S , ',2% , ,,', ,,,- peAN 116iftWATIW,M
TY - ' . „jyrt ‘, .„,
1=1 New construction g Addition/alteratiotrOta tiOW Please check all that apply (submit 2 sets of plans w/items checked below):
0 Demolition D Other: El Service or feeder 400 amps or more 0 Building over three stories.
where the available fault current 0 Marinas and boatyards.
t;,
tO S$It 410 Ain,': ' 1.1. , Z.: W.1,,414:ii exceeds 10.000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14.000 0 Commercial agricultural
14 1 - and 2-family dwelling 0 Commercial/industrial CI Accessory building amps for all other installations. buildings
0 Multi-family CI Master builder El Other: D Fire pump. ID Installation of 75 KVA or
!JO p. !.: erz6..ri' ,,,,,, .„,.,...0 , ,., ,.....„.,.., , w,,,,.. : :....w...,11 D Emergency system. larger separately derived system.
,,i,„...,„,..y....,,,,„..„,...7,,,,,.."„.,:,,,,-,,.......1..,.,,,i,,,,,m,,,,,,,::::,1„,,,i. ' fl Addition of new motor load of
.WOHP or mor , .X
I / 3 yg.2... 5 44) .5-c_e., ' / -, )/ca,- 0 Six or more residential units. occupancy.
Job no.: Job site address:
0 Recreational vehicle parks.
City/State/ZIP: ‘7 1 , 4 r _d og_ f -- 7 , 2 _ .a 7 0 Health facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg/apt. no.: . Project name: 0 Service or feeder 600 amps or more.
1,13 is* -:FO;$,C0p,ual,
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. addl 500 sq. ft. or portion 33.92 I
Tax map/parcel no.:
Limited energy, residential
75.00 2
kiXS''' ' ''' ' ' ' 6':i ' `' (with above sq. ft.)
Limited energy. multi-family
-1 12 0)/re a o 110/.7L R4°Oe residential (with above sq. ft.) 75.00 2
e )e N l 4 Services or feeders installation, alteration, and/or relocation
e? vt d /2-0 vo 1-1- - .fr eilorpr a 77( 6 i 4 " 200 amps or less 100.70 2
4*
i,-; .' :',' ''': VZ;:;.14:::ti W , 4 201 amps 10 400 amps 133.56 2
401 amps 10 600 amps 200.34 2
Name:
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 1
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, or exchange, according to ORS 447, 449, 670, and 701. 401 amps 10 599 amps ,. 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
'' ATPligAit ;71711C,.A1-,6":0:0170*A"4;g4.1,i*i:','AiiiE above service or feeder fee,
7.42 2
each branch circuit
Business name: g _ p ElL...--ik. B. Fee for branch circuits without
service or feeder fee, first
i 56.18 / 2
Contact name: branch circuit
/ Each adrEl branch circuit
i 7.42 / 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
Sign or outline lighting 67.84 2
14,1ta':!. ,.:'' : - ) . " 00:SitMal0:C.4..:.'' , ARIPTF:. ' , . Signal circuit(s) or limited-energy
,
panel. alteration, or extension. Page 2 2
Business name: - 1 - 11 - Der C fe c _..--/ r / c
Each additional inspection over allowable in any of the above
Address: ift 0 Ad t 1441 f T Additional inspection (1 hr inin) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: if , L v 0 le___ 1 7 o 13 Industrial plant (I lir min) 78.18/ hr
Phone: ( 3 ) /If 2 2- 3 1 I Fax: (5V 3 ) 2 f 2. - cr jig* Inspections for which no fee is
90.00/ hr
. specifically listed (1/2 hr min)
CCB Lie.: t 76 .6 ‘). Electrical Lic.: C Suprv. Lic.: o lft 515 4::,:s„
. --,
i I
•
Suprv. Electrician s • i t -, required: - Subtotal.
r
Plan review (25% of permit fee): ....---
Print name: C,./ ,
l a r e vI ce- i'-e144 Date: 6 _ 9_1 if State surcharge (12% of permit fee): . 7 6,3
TOTAL PERMIT FEE:
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.
innuilding\l'eriniisn.C-PermiiApp.doc 07/01/10 440-4615T( I I /05/COM/Wlill