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Permit CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2011 -00388 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/14/2011 Parcel: 2S104AC07100 Jurisdiction: Tigard Site address: 12633 SW MORNING HILL DR Project: Kolling Subdivision: Lot: Project Description: (3) branch circuits for furnace, A/C and exterior GFCI. Contractor: WEST SIDE ELECTRIC CO INC Owner: KOLLING, GERARD W 1834 SE 8TH AVE 12633 SW MORNING HILL DR PORTLAND, OR 97214 TIGARD, OR 97223 PHONE: 503 - 231 -1548 PHONE: 503 - 524 -0314 FAX: 503 - 736 -0677 FEES Quantity Description Date Amount 3 crt Branch Circuits wo /Purchase 07/14/2011 $71.02 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/14/2011 $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 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. i, O ,9-/°/° G � �. L. jam° i✓ Issued By: L l/1� /�= �� 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. Jul 12 2011 6 :12PM West Side Electric 503 - 736 -0656 p.1 Electrical Permit Application ` R EC EIVE 1 _ I.( /R. 1>l'1 Ft r. I Sr- ii\1'.\ City of Tigard 13125 SW Hall Blvd., Tigard, OR 97223 ::11����' Re�ei,.ea � /� p Dace : T :er. ?emit , ` /'o -+O iF .4171 Fax: 503.598.1960 D Review Phone: 503.639 Oth Penn - c JUL 1`3 20 1 1 ���jge pp - a i ;; Inspection Lie: 503.639.4175 Date Ready/By: See Page 2 for Internet: www tigard or gov N :fied,Mahod: is Y A 11 , ' .• , aJ , pple Sumental InfprmttttOa r , 5`Sr ` f1w7�' « x� §r19 ar �F. -.. t S -�,? �xRl'�'Ax.0 � '(�i}I+lk t;! raax-', - 6i �. � a u� fA.3,.. �' A '�1 b ':1";:':4".-''' .'. �2�`in 3 l . r. a &'s���C�k n." iSd;YC� .a '• m�.t�i, t��r .`4�?...... L Tliu.cit .e. �u'9'ib�'�lri�':K �iy �.♦J,�, �Yi�. rc r...•+. = � Slat wl.�.. -w wc�warS s �" + .�ti�^�. r- • n. Please check all that a I . New construction IA Addition/alterat r rep acement apply (submit sets oF Plans wnretrss checked below): .r Demolition ❑ Service or feeder 400 amps or more ❑ Building over three curries. i� ; x? ., t , , K where the available fault current ❑ Marinas and � ; o q" r �=� a+ ' �,�.,, ra. r k .^ 7 r _ boatyards. c; `" . :4, ^ ' ` k �:t'_ 4-t .;,i' • }, . "''`w su {s >y i b , a i `t t exceeds 10, ,��, �,�t,la,Y�S xs,, , _..[:- n' 4'• t 000 ernes at ISO volts or ❑ Floating buildings. I 1 - and 2-family leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural y dwelling ❑ Commercial /industrial El Accessory building IE Multi- amps for all other installations. buildings_ Multi-family ❑ Master builder ID Other: ❑ Fire pump. Installation of 75 [:VA or •'�� ...:tE ' . +Ellis t�fi�i:l .., 1 . ofr"»ss�rn}n�.�j,':�s, Ft r, ,- >�;�P�S1�W.. '�,' ''"'�Ki� � }' a:.�l. ❑ mergencY system larger separately derived system, ❑Addition of new motor load of ❑ "A ", "2 ", - 1 -2'•, "1 -3 ", I nb no.:15 Job site address: I Z (o 33 56" Mor,.i2 !/4 Dr. 100HP or more, Recreational /� ❑Six or more residential units. ❑ Recreational vehicle parks. ' ity /State /ZIP: TI ter e, D2 Q 7 Z Z3 • O Health-care facilities. ❑ Supply voltage for more than '• uite/bld /8 . no.: // / �� ❑ Hazardous locations P + 600 volts nominal. g- pt - Project name: /Cry j //,', 1, Cop y p ` ❑ Service er feeder 600 amps or more � ross streetldirections to job site: `'+ ® ®� I , New residential single- or multi- family dwelling unit. Includes attached garage. '.ubdivision: L no.: 1,000 sq. ft or less 168.54 - n I ex map/parcel no Ea.. add'l 500 sq. ft. or portion 33. �In ��q , x ,. : ;z .: w w s r a� Limited energy, 0;1& . : rig s ! •1 7 1,, ^:'sC : ,Im. 4 4 1 ::i.... ,.ts iiii with above a residential •. ft. III 75.00 © /^ / , Limited energy, multi- family I , (.. U /44 c� ' ' e '�C/'l Oi' 6F(. residential with above • . ft . 75.00 I Services or feeders installation alteration and/or relocation 200 amps or less Ell 100.70 _ : *..µye .' ' t.. .. _ 'e '' t k 9 i �� '"°'r� c ' 1 `�z 4 a 201 amps 50 400 am Ps , , 11 , R �c,:..�iirr { - :._.^.�K k� irY ..,!,11 P ps ]33.5b © 401 amps to 600 amps _ 200.34 _ nine, 601 amps to 1,000 amps — 301.04 - ' ddress: Over 1,000 amps or volts gm 552, _ ' icy /State /ZIP Temporary services or feeders installation, alteration, and/or relocation I 200 tunes or less 59.36 ''hone: ( ) Fax: ( ) _ _© I I . er installation: This installation is being made on property that I own which is not 201 amps m 400 amps 125.08 - 40! amps to 599 amps ]68.54 wrier r s for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. _ B ,• , .. tx :t „ . t , > � •, � ._ g :1' t * signature: Date A. Fee for branch circuits with �„ s 99 3 t' . a ;7 a rr : xewt1 . or feeder fee, 9`> ."... s .'...:' .:§(,ltri t , in.,'<. " , ` � :e?t +�tG above service each branch circuit 7.42 111 witless name: B. Fee for branch circuits wig/tow service or feeder fee, first 56.18, I a' Ill ontact name: branch circuit I . Each add'l branch circuit FM 7,42 ni ddress: Miscellaneous service or feeder sot included I ity /State/ZIP: Each manufactured or modular . 67 � © dweilin_. service an4/or feeder 'hone: ( ) Fax:: ( ) Reconnect only - IIM 67 84 -© Pump or irrigation circle ME 67,84 - ' LIMY £'i l i'i w t' , y Y ' vtrv","�ra u ' ii r,.,` -,. t Sign or outline lighting 67 � © , ii. I+ii rI,/,.7 '. ; s ,m s z .. ,' r't..J„�ty . :. # .,, :. I} f i rlx,,., Yt,.•..; X > Si circuit(s) or limited- energy . 'tusiaess West Side Electric CO. Inc- • - el, alteration, or extension, _- Each additional ins coon over allowable is an of the above I. ddress: 1834 SE 8th Ave. Additional inspection (1 hr min) _ 66.251 hr -- Investigation tY Portland / Investigation {l hr min) 66.25i ' i /State/ZIP: Industrial plant (1 hr min) ' 78.18i hr _ IIII !'•0• : (503) 231 -1548 Fax: (503) 736 -0677 ' Inspections for which no fee is I - s • ificall • listed Yx hr min 11. 40,00r hr � . i CB Lic.: 13306 Electrical Lie.: 2 6-135c Suprv. Lie,: 4 + " " '" k u, I. '�� Subtotal: �ll� uprv. Electrician signature, required: Plan review (25% of permit fee): P rint name: Randall F Robe Date: 7 fJ // ' State surcharge (12*% of permit fee): IMMIM TOTAL PERMIT FEE; [ • uthorized signature: Thin ermit application expires if a P PP P permit is not obtained within 150 days after it has been accepted as tompkte. ' int name: Date: • Number of inspections allowed per permit. I:I: ldinglPenwutELC- Perm,tAVPdoc 0710 Ill 0 440- 4615T1I1 /05MOMAVES •