Permit CITY OF TIGARD ELECTRICAL PERMIT
` COMMUNITY DEVELOPMENT Permit #: ELC2011 -00547
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718.2439 Date Issued: 10(05(2011
Parcel: 2S103CB03300
Jurisdiction: Tigard
Site address: 12365 SW MARION ST
Project: DUTZ Subdivision: WILLAMETTE NO 2 Lot: 38
Project Description: Panel replacement and (1) branch circuit for hot tub
Contractor: CONDUIT ELECTRIC Owner: DUTZ, CAMERON P & LISA Z
19461 SW 89TH AVE 12365 SW MARION ST
TUALATIN, OR 97062 TIGARD, OR 97223
PHONE: 503 - 692 -1428 PHONE:
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/05/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 10/05/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/05/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 •r direct questions to OUNC by calling 503 232 1987 or 1.800 332 2344 OPP
i
Issued By: — — = ,� Permittee Signature:
4110:0 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.
From:CONDUIT ELECTRIC 5036923652 10/04/2011 15.11 #945 P.001/002
Electrical Permit Application t ., z z h FO&OFFi@E JSE ONLY: ,, , f- ; - ,
City -- �K .'u.., h: -" , ..- '�- .>:r... r..nw w�u_�� �,V -_z..7 .a?"� ,Y �.. wry t--t-xs
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13125 Tigard Date/By , Armin Pe No . H
13125 SW W Hall Blvd.. Tigard, OR 97223 Plan Review
Phone 503.639.4171 Fax: 503 593 1960 " + Other Permit
Inspection Line 503 639 4175 iJiT F I )11L`.B'. adylBy imiy 2 Sec Page 2 for
Internet' www cr ngatd or us j ` �. cthod ..---..6, Su Supplemental Information
TYPE OF WORK ' ` PLAN REVIEW
❑ New construction [gAddition /alteration /re c:4) ' ° Please check all that apply
❑ Demolition ❑ Other ❑Scrnce 225 amps, comm'I ❑Hazardous location
(� ❑ Service over 320 amps - rating ❑ Bulldog over 10,000 sq. ft.,
CATEGORY OF CONSTRUCTION v��` , of I - and 2 - family dwellings 4 or moi new residential
1 1 -and 2- family dwelling A O.1 "` � S B stem units in one structure
❑ Commercial, industrial ❑ Fl �V ❑ ❑ y
L a °°u Du 600 vo lts nominal
nps or more
❑ Multi - family ❑ Master builder ❑ �Y
JOB SITE INFORMATION AND LOCA `g. ❑Occupant load over 99 persons ❑Manufactured g over three stones ❑ Feeders. 400 am structures or
p ❑Egress /lighting plan P a
Job no.: //5'1/ Job site address / 5 Sr iy) 'mg ar4 $` T, ❑Heallb - care facility ❑Other -- --- - --
.-�-- Submit _r_ sets of plans with any of the above,
( City /State /ZIP: / I 'L-b CPL. q 7-2." , The above ate not applicable to temporary consltuction service •
Suite /bldg. /apt no.: T Project name: . DC.gt L FEE* SCHEDULE Description l Qrs. 1 Fee. 1 Total I "
Cross street /directions to job site: New residential single or multi family dwelling unit.
Includes attached garage.
1.000 sq ft or less 145.15 4
Subdivision: Lot no.: , Ea. add'I 500 sq ft. or portion 33.40 1
' — Limited energy, residential I 75.00 2
Tax map /parcel no : Limited energy non - residential r 75.00 2
DESCRIPTION � O g F ' WORK Each manufactured or modular
' $ t. I L+ 14—tor Q CA etc—i .1 V - d s ervice and /or feeder 90 90. - 2
— - Services or feeders installation, alteratioi (y>vl/o rreloca on
200 amps or less _ / I 0 1 /11)4 2
Cie PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 106 85 2
401 amps to 600 amps 160.60 2
Name: C 4 1� vTZ 601 amps to 1,000 amps l 240 60 _ 2
Address: 5_ Over 1.000 amps or volts 454 65 2
Reconnect only I 66.85 2 I
City /State /Z1P: Temporary services or feeders installation, alteration, and /or
($ 3 52,14.-- f ( ) I relocation
Fax - --
Phone:
200 amps or less I I 66 85 1
Owner installation: This installation is being made on property that i own which is not 201 amps to 400 amps 100 30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701 401 amps to 600 amps 133.15 2
Owner signature Date: _____ I Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT ❑ CONTACT PERSON A Fee for blanch circuits wrdt
,F7 e a — service or feeder fee, each 1 q X, 2
Business name: branch circuit
B Fce for branch circuits
Contact name: iwiirhnur service or feeder fee, 46.85 „I 2
Address: each branch circuit
Each add'1 branch circuit 6 2
City /State /ZIP: Miscellaneous (service or feeder not inc.! ‘:led)
Pump or irrigation cliche 53.40 2
Phone, ( ) Fax: ( ) Sign or outline lighting 53.40 2
E -mail: Signal encuil(s) or limited-
_ CONTRACTOR energy panel, alteration, or
Business name NI ®L.s L'e c._1 _-� extension Describe • Page 2 2
/� : : �' ' K. `� 9 ` it (/ Each additional inspection over allowable in any of the above
l P F9 Pet inspection 62.50
City /State /Z1P: / Zl41. -477 Pi ®tZ 9 investigation per hour (I hr min) 62.50
_
Phone (5 ( Q i q L- t ce2.. 8 l Fax: (503 Ca 1 Q 2-- 3 co 52_ lndustnaI plant per hour 73 75 �^
111 iti � -- ELECTRICAL PERMIT FEES
`��
CCB Lic.• /0 (is? Electrical Lie.: ,26 C v
Supry Lie.. — y � -
(y��® Subtotal / U vh
Suprv. Electrician signature, required' c) —r `------- Plan review (25% of permit fee)
/ _ S , Q t / State surcharge (8% of permit fee) /). / , _ • r'�, 7
Print name: v� ?ate �_ Date: / �
— TOTAL PERMIT FEE A, , 0
Authorized signature: 9 . - 7 ? --- This - permit application expires if a permit is not obtained within 180
Print name' �'p- F r �), Date: I
�/ days after it has been accepted as complete
7 C1 - ' fee methodolntry set by - fri-Count, Building Iodine) Sets-ice Board
--' -- -_ tt' Numhci of inspections per permit allowed
1 •nuddine Perm, +'LLC- PernutApp doc 1 '_•03 4.10 - 46151(1042 COxt.\\9 15