Permit 111 CITY OF TIGARD ELECTRICAL PERMIT
.11 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00474
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/24/2011
Parcel: 2S112BA90361
Jurisdiction: Tigard
Site address: 7955 SW FANNO CREEK DR 2
Project: HENDERSON Subdivision:DNITA FIRS VILLAGE CONDO (PHASE Lot: 36
Project Description: (2) branch circuits for kitchen.
Contractor: WEST SIDE ELECTRIC CO INC Owner: HENDERSON, GWEN L
1834 SE 8TH AVE 7955 SW FANNO CR DR #2
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/24/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/24/2011 $7.63
Type of Use: MF 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 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 the rules or direct questions to OUNC by calling 503.232.1987 or 1,800.332.2344.
41111 111111.1 4101."
Issued By: Permittee Signature: o / 1 if�i:�
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.
Aug 23 2011 6:11PM West Side Electric 503 - 736 -0656 p.1
�? ii
Electrical Permit Applicatio R?'' 1_„1:. +11 1 It 1: I ,t il.\l.l
City of Tigard AUG 2 4 2011 Dae
, w 13125 S W Hall Blvd., Tigard, OR 97223 I ` � " � •
I B Plan Review Other Permit:
Phone: 503,639.4171 Fax: 543.598 qty ;�
Date/13
i 1 Inspection Line: 503.639.4175 ] I �� � J/ 1 Date Ready/By: Id See Page 2 for
Internet www.tigard- or.gov BUILDING DIVISION N Sapplementaltnfarmatioa
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❑ New construction Qf�► Addition/alteration/replacement please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition / ❑ Other. ❑ Service or feeder 400 amps camera ❑ Building ova duce stories.
x; itei it lt e ,,�k a �S'i 9 G '�' .. - - w +: ) rune y. s'tw'f " - � 1 �' r? ,i exceeds 10.000 available
amps at 150 current
to or CI Floali 8 Madding
."^„ t ' - p ', cu rts'� � .. «. , .��'.g GT .. 'l y.t� 1_;.. s •
❑ I- and 2-family dwelling ❑ Commercial/industrial le&9lc ground, or excceds 14,000 ❑ Commercial -use agricultunnl
❑ Accessory building amps for all other installations. buildings -
ri Multi-family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
cut s` "!"7e' ifl�.'. . (,+...ri` � , +• .:..; .' r,"1 id4a. ' V` . , ," ` ^,.' -id'' ❑ Emergency system. larger separately derived aystem.
� / � a tria .�.;. ulk ' ❑Addition of new motor load of ❑ "A" "E ", "1.2 - , "1 -3"
Job no.: 3- cylJVC Job site address: '7Q Ss- Si ' ,r. 100HPormore. occupancy.
/ tJ � ❑Six or more residential units- ❑Recreational vehicle parks.
City /State/ZIP: / 7 0� 9 7Z2 ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg./apt. no.: j Project name: h ,--J dfri G c-, ❑ Service or feeder 600 amps or more
y. ,+ K o , -, ,c ,WL F ;,, V d
Cross street/directions to job site: , + &ame . Vi 1N +i.m ' ;c � y & 11 o . ' ° ''t c „ I s'
bae `;;
F �• pea. r Total l
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: j Lot no.: 1,00D sq. ft. or less 168.54 4
Ea, add'I 500 sq. ft. or portion 33.92 1
Tax /parcel no.: Limited energy, residential
fa:.:3a:��'at '`3�':r' s- T (`r,F'I? .':lr •r y 0 '. h +': u : tl , r� l 1)� . t . iii a�, s , r,. S.t o� se 75.00 2
2 Limited energy, multi -family
t a stden "
;,�. � (., -.. „ .__,.� i +'�L.ti ��t ".... a.1i7 h`1�ih 4Y�-It �` (with above sq. ft}
:.... 1 r ? , 1 ,.l,.....�5, Li
/ residential (with above ft.) 75'00 2
C/ /64.)/4 ' Of dtCd�n , �2 �l sq-
J Services or feeders installation alteration, and/or relocation
200 amps or less 100.70 2
- Sir l. ,- .c= .. ,::::'..;.'.':..:.:':'1.: l .'.d 4 ut.0 , ,z ;, a ' „'Nna' , eel a 10 q:,.., , 201 amps to 400 amps 133.56 2
a
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: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps I 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
xs a ,&"' , # 14.4. ' • kiA ' v above service or feeder fee,
ire '. t , €z 5 b..i;,-vt r ' e : 't,. 4ti!,; '`c " , :.. «, i"i ; , t 'r. , ,': :41 1 :e ll each branch circuit 7.42 2
Business name: B. Fee for branch circuits withou /Q • sery ice or feeder fee, first / 56 j 2
Contact name: branch circuit 5-6,
Each add'1 branch circuit / 7.42 '7 V 4- 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder
67.84 2
'
Phone: ( ) f Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
,}y �ej Sign or outline lighting 67.84 2
l
(I , , r i .
d� 7 ~r - , F ' .�.'E 4Y fr' 1 uuW:ar�} . M l x . T.:.�. v,t? t)) .1S.. Si
a . -.�-� .�,.;,.,.��,��..;.- .'^5...� `H h . � si circuits) or Mmitod- energy
panel, alteration, or extension, _ Page 2 2
Business name: we st Side E 1 e C t r i e Co., Inc.
Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
Industrial hr min) - 66.25 / hr
City /State/ZiP: Portland /OR/97214
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 23 i - 1548 Fax: (503 ) 736-0677 Inspections for which no fee is 90.00 / hr
s.ecificatl listed Vi hr min �q
ere i .:y3' „ n N, ,.ro 7 "� Yisw „ate a �"I ft. "i .r 5 ,: 'O l.' .. ;My<�
CCB Lre.: 13 306 Electrical Llc.: 26-135c Suprv. Lic.: 4654-S , . <, �� sa � •; °. ,_.,.,�.,�„. -��i. < � . r , 1 .
r
Suprv. Electrician signature, required: '. ,� Subtotal:
Plan review (25 °l0 of permit fee): 63
Print Dame; Randall P' Roberts Dare: ' j)f( State surcharge (12% of permit fee): 7 43
- TOTAL PERMIT FEE: 1 /
Authorized signature:
This permit application expires ifs permit is net obtained witlsia 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per penal t.
1■auadin s\ELC- pinxiApp.doc 07/01/10 440- 4616T(I 1106 /COM/WEB