Permit CITY OF TIGARD EL ECTRICAL PERMIT •
•
II <'¢ COMMUNITY DEVELOPMENT
Perm #: ELC2011 -00374
•
TIGARD 13125 SW Hat Blvd., Tigard OR 97223 503.718.2439 Date issued: 07!06/2011
Parcel: 1S135DB04700
Jurisdiction: Tigard
Site address: 11435 SW 92ND AVE
Project: GAVETT Subdivision: Lot:
Project Description: (3) branch circuits for home remodel.
Contractor: WILLAMETTE ELECTRIC INC Owner: GAVETT, WESTON C & KERRY L
PO BOX 230547 11435 SW 92ND AVE
TIGARD, OR 97281 TIGARD, OR 97223
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 07/06/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/06/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OA' • 2- 001 -0090. You may obtain a copy of t e . irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
07/06/2011 WED 9:41 FAX 5036242938 Willamette Electric lj002 /002
Electrical Permit Application , FOR O U SE • ONLY •
�y Received
City of Tigard ,� 1� DateJB : /fit PermitNo.: r /r ',•71-
't 13125 S W Blvd., Tigard, OR 972 1, Plan Review
.... Phone: 501639.4171 Fax: 503 ,G,!r',f Y 1 r \ DateR3 : Other Permit:
TIGARD Inspection Line: 503.639 . '1 Date Ready/By: See Page 2 for
Internet: www.tigard \ t\ V �� Notified/Method: Supplemental Information
TYPE OT WORKG`' 0 s`Q 'PLAN REVIEW
❑ New construction J] Addition /alterati i 'hC pi�� Please check all that apply (submit 2 sets of plans w /nems checked below)
1 v. I ❑ Service or feeder 400 amps or more El Building over three stories.
❑ Demolition ❑Other: 11 � where the available fault current 0 Marinas and boatyards.
CATEGORY <OF. _CONUCTrON exceeds 10,000 amps at 150 volts or 10 Floating buildings.
g
less to ground, or exceeds 14,000
1- and 2-family dwelling Commercial /industrial ❑ Accessory building ❑ Commercial-use agricultural
Y g ❑ Y g amps for all other installations. buildings.
0 Multi- family ❑ Master builder ❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
' - IOI3 SITE .INFORMATION AND `LOC larger separately derived system.
. ❑ Emergency system
❑ Addi o new motor load of ❑ "A "F' , "1 -2' "1 -3
Job no.: _S y 2 Job site address: // e/ 5 %• ,, e ? ,,.r 4 I, e. 1 QOHP or more. occupancy,
i �' i ❑ Six or more residential units. ❑ Recreational vehicle parks.
C. ' ' ` "' ❑ Health -care facilities. ❑ Supply voltage for more than
City /State /ZIP: / 7 . _�
/ � � " l � ( �` ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: Project name: '/3 ., 2 ❑ Service or feeder 600 amps or more.
:_.:•....;: FEE .SCHEDULE .:
Cross street /directions to job site: K„;-' E Description I Qty. I Fee. I Total 1
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'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK . (with above sq. fl.)
Limited energy, multi - family
��'� ..f •:? ..`. •;, , -. , ': 2 t , / residential (with above sq. ft.) 75 • 2 • Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER • .. . • El TENANT 201 amps to 400 amps 133.56 2
401 amps to 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 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,
•
❑ APPLICANT . ❑ CONTACT PERSON 7.42 2
each branch circuit
Business name: 13, Fee for branch circuits without ;
service or feeder fee, first J 56.1 fit F ` 2
Contact name: branch circuit
Each add'l branch circuit 7.42 / l /./ 2
Address: Miscellaneous (service or feeder not included)
City /State /ZIP: Each manufactured or modular 67.84 2
I dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
111 Pump or irrigation circle 67.84 2
E -mail: 67.84 2
Sign or outline lighting ttng
67 '
Signal circuits) or limited- energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr -
City /State /ZIP: Tigard, OR 97281 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr • Phone: (503) 624 -3631 Fax: (503) 624 -2938 Inspections for which no fee is 90.00 / hr
specifically listed (%z hr min)
CCB Lic.: 75059 Electrical Lic.: 34 -283C _ Suprv. Lic.: 4226 -S ' 'El ECTRICA T
L,.PERNIX: FEES 1 , : .:': ; `::.:
T
--------
-------- Subtotal: �/ , O 2 -
Suprv. Electrician signature, required. u
Plan review (25% of permit fee):
Print name: David Fife Date: 7 ._. 6. State surcharge (12% of permit fee): f 4 e --
TOTAL PERMIT FEE: '77. (/
Authorized signatutc /-
'`hty This permit application expires if a permit is not obtained within 180
r'> • days after it has been accepted as complete.
/,, . ,.
Print name: . , / Date: 2— 6 + Number of inspections allowed per permit.
1: wBuilding 'Permits\ELC•PermitApp, 07/01/10 4404615T(1 1/05 /COM/WEB