Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00498
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/09/2011
. . Parcel: 2S 111 BD00310
Jurisdiction: Tigard
Site address: 14570 SW 100TH AVE
Project: ROMMEL Subdivision: PEMBROOK HEIGHTS Lot: 10
Project Description: Grounding for water service.
Contractor: CASEY'S PLUMBING Owner: ROMMEL LIVING TRUST
PO BOX 30075 14570 SW 100TH
PORTLAND, OR 97294 TIGARD, OR 97224
PHONE: 503 - 253 -0030 PHONE:
FAX: 503 - 262 -8251
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/09/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 09/09/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 • 2 :: -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: / ' Permittee Signature: (5 /9
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.
Sep 08 11 03:21p Case's Plumbing 5032628251 p.1
Electrical Permit Application i FOR OFFICE USE ONLY
City of Tigard g< _ DateJB : �'� �� Permit No.: F. • p - '/9 , eceive
l w q 13125 SW Hall Blvd., Tigard, OR 97223 - fi , Plan Review e i , i r
Phone: 503.718.2439 Fax: 503.598.1960 s Q, r�01 Other Permit: 0 /01/T/11* Date/B : 00 , �y/
T I G ARD Inspection Line: 503.639 c G P 0 Dale Ready/By: ions: El See Page 2 for
Internet www.tigard or.gov Jt - "Nbtiied/Method: Supplemental Information
TYPE OF WORK r .,5 ° Ur l rv7`, X0°4 PLAN REVIEW
�' \ �'
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction �' Addition /alteration/replacement_
\J` W.'. ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
...g
Multi - family ❑Master builder ❑ Other: ❑Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system_
❑ Addition of new motor load of ❑ "A ", "E , `1 -2 ", "l -3 ",
Job no.: Job site address: ` 1 10011P or more. occupancy.
�• Ci � .k---) t (31)30, V.Ik A _ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: nsA (� 1 �,, �� Qa4 ❑ Health-care facilities. ❑ Supply voltage for more than
X 1 ❑ Hazardous locations. 600 volts nominal_
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
job site: FEE SCHEDULE
Cross street/directions to
J Description i Qty. I Pee. I Toml i
New residential single- or multi- family dwelling unit.
( 1e_- ceSd Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Tax map /parcel no.: Ea. add'l 500 sq. ft. or portion 33.92 I
Limited energy, residential 75,00 2
DESCRIPTION OF WORK (with above sq. ft)
( r Limited energy, multi - family 75.00 2
_ c t/ l�_ • UCek V.�L?vr\11'(�CC? residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less J 100.70 MO ° 2
, ej7PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
3 401 amps to 600 amps 200.34 2
Name: v ‘..._ A \ \_c>.rr rMc�<"'(\"...—S 601 amps to 1,000 amps 301.04 2
Address: � - � ( nz Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
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 to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
above service or feeder fee
IEP , ,
❑ CONTACT PERSON 7.42 2
each branch circuit ■ Business name: M� vc J Ef (� B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: C" , branch circuit
J Each add'i branch circuit 7.42 2
Address: "D. 0 . 1 j t:X 'D, C 1 Miscellaneous (service or feeder not included)
Ci City/State/ZIP: � ( Each manufactured or m
ty �(iy' \ -' G . I G r �- \ ^ l I 4. 67 - 84 2
dwelling, service and/or feeder
Phone' ~ %--1 Fax: Reconnect only 67.84 2
�) 5 ( L.P.. `� �� Pump or irrigation circle 67.84 2
E -mail: _Y"'", - f•) _ C.a. je• PLi..trVll';t r A , C C% i A. Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: P •e- C C - c ,Th E- (Ec_-- >t v- _ e� panel, alteration, or extension. Page 2 2
1 Each additional inspection over allowable in any of the above
Address: --P, G ! `C_ ; ,X _ _ 1 `� Additional inspection (1 hr min) 66.25/ hr
Investigation (i hr min) 66.25/ hr
City /State/ZIP: r- `t Ckv-1 ( 1 , �? C --- l ' c _� Industrial plant (1 hr min) 78.18/ hr
Phone: ) (_0 Lk - ._ G5 ^ Fax: ( ) � (f.:,. • 6 C Inspections for which no fee is 90.00 / hr
specifically listed (14 hr min)
CCB Lie.:1 LA---1k ')C:\ �i ci. lectrical Lie.: _�, 2 (-• Suprv. Lic.: / l ELECTRICAL PERMIT FEES •
Suprv. Electrician signature, required: 7/ iyx /0///15 Subtotal: IC.� e
71;
I Plan review (25% of permit fee):
Print name: R / Date: ! State surcharge (12 %ofpermit fee): c ) $'
Authorized signature:'v�'(\ L iv` i 1 t 11�� t i TOTAL PERMIT FEE: i, r
I �k e - '
�` (L ki Thi permit a pplication expires if a permit is not obtained within ISO
days after it has been accepted as complete
Print name: ) CCU Lk_ e cc `f k t= Date: • Number of inspections allowed per permit.
1: 1BuildinglPermitslELC- PennitApp.dec 07/01/10 440-4615T(II105 /COMIWEB