Permit 117 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00417
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/28/2011
Parcel: 2S112BC07900
Jurisdiction: Tigard
Site address: 8123 SW CAROLE CT
Project: Robson Subdivision: Lot:
Project Description: (4) branch circuits for kitchen remodel
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: ROBSON, SCOTT
PO BOX 3948 8123 SW CAROLE CT
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 971 - 563 -8211 PHONE: 503 - 430 -7547
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 07/28/2011 $78.44
Specifics:
Service or Feeder
1 ea 12% State Surcharge - 07/28/2011 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 OAR 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. /
Issued By: 7Cl ��- Permittee Signature: d /V iP�G77 -i�d^/
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 A ' lica 1E1 5,
.. ,
City of �' 0 V\ FOR O E1CG USE ONLY
ty f Tlg and 1 1` $ 6 2 Received
q I3 225 SW Hall Blvd., Tigard, OR 9722 u DatelB // 02 // Permit N oS iCad // -- c 2 • IN
i C Phone: 503.639.4171 Fax: 503.598.1960 F - f � ` es KBD Plan Review
Inspection Line: 503.639.4175 OA/ ( �' V, 6��� Date/By: Other PcrmiC
Ins 'It D
p V j DateRe
TIGA
• Internet: www.tigard- or_gov \�, `t, �� Jurla' ® See for
�S f °" ,`V Notified/Method: �( , SupplemPage °niat 2 Information
_ TYPE OF WORK t
❑New construction PLAN REVIEW
Add ition /alteration /replacement Please cheek all that apply (submit 2 sets of plans whims checked below):
❑ Demolition ❑ Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
CATEGORY OF CONSTRUCTION
where the available fault current 0 Marinas and boatyards.
exceeds 10,000 snips at �.l - and 2- family dwelling s 14,000 or ❑ Coxes Floating buildings
less to ground, or exceeds 14
g ❑ Commercial/industrial ❑Accessory building
❑ Commercial - use agricultural
❑ Mufti fatuity ❑ Master builder amps for all other installations. buildings.
❑ Other: 0 Fire pump. 0 Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION o Emergency system. larger separately derived system.
�
Job no.: 6/23 514 ❑Addition s nocw motor load of 1] " c c a c .
Job site address: J � C-7-- 104HP or snore. occupancy.
City/State/ZIP: p CI Six or more residential units. ❑ Recreational vehicle parks.
CAA0 L• E- 0 Health -care facilities. 0 suppl voltage for mare than
Suite/bldg./apt. no.: ) 0 Hazardous locations. 600 volts nominal.
Project name: 0 Service or feeder 600 amps or more.
Cross street/directions to job - ire: FEE SCHEDULE
Description 1 Qty. f Fee. I Total 1 •
New residential single- or multi - family dwelling unit. •
Subdivision:
Includes attached garage.
Lot no.: 1,000 sq. ft. or less /68.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 1 33.92 1
DESCRIPTION OF WORK Limited energy. residential 1
(with above sq. 0.) 67.84 2
r OK v v � i t u r _ I /`e/ f � Limited energy, multi- family
I ,, pY" t/VC� residential (with above sq. R.) 67.84 2
Services or feeders installation, alteration, and/or relocation
PROPERTY 04Y.VER 200 amps or less 1 00.70 2
TENANT ' 201 amps to 400 amps 2 33.56
`� 2
Name: �� SO /\ / S � O 77—
/ 401 amps to 600 amps
20034 2
Address: S 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State /ZIP. Temporary services or feeders installation, alteration, and/or
Phone: ( ) relocation
Fax: ( ) 200 amps or less
Owner installation: This installation is being made on property 201 amps to 400 amps 59.36
intended for sale, lease, rent, or exchange, ac to ORS 44 7, 449 and 701. 401 amps to 599 amps 125 08 2
Owner signature: 168.54 2
-
Date: Branch circuits - new alteration, or extension, der panel
CI APPLICANT A. Fee for branch circuits with
0 CONTACT PERSON above service or feeder fee
Business name: each branch circuit 3 7.42 .ZCo 2
B. Fee for branch circuits
Contact name: I without service or feeder fee,
Address: 1 first branch circuit
56.18 IS
Each add'/ branch circuit 7.42 2
City/Stalc(7_IP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) ( F: ; dwelling, service and/or feeder 67.84 2
E - mail: 1 ( ) t Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: Y
1� \� 1�� L J d Li Signal circuits) or limited -
Address: r 2 � energy panel, alteration, or
-J t? extension. Describe: Page 2 2
City/State/ZIP: tijibo , 'v'(vc D V, tin o7
Each additional inspection over allowable in an of the above
P :ne: (1.7() .51,3 :7---f ' Fax: (�`() Z�( r Per inspection 66.25
F
� / J C � Investigation per hour (1 hr min) 66. I
1 Lie.: E �? j��-� Electrical Lic.: - ( 0 0( ` y Iprv. Lic.: 51 67, 5 Industrial plantper hour
Soon'. Electrician signature, required: 1 r) t � ( 78,
_- ELECTRICAL PER1yIIT FEES
Print name: ( Subtotal: r �4
� �— ► y I� � Date: i 0 —2z 09 Plan review (25% of permit fee):
Authorized signature: State surcharge (12 % of permit fee):
Print name: TOTAL PERMIT FEE: g37 r J i.--- --
Date: This permit application expire% if a permit is riot obtained within 180
days after it has been accepted as complete.
r:5 tdinstm
acrtssEt.C- Pesm to
;tnpp.doe WO I/09 • Number of inspections allowed
440.4 st 5Tp tros /COMlWEB per permit.
Z'd 6t7£ L99Z£09 ou�oal� (Inoa10 0 -Id d09 O . L L 5Z Inc