Permit IN CITY OF TIGARD ELECTRICAL PERMIT
II COMMUNITY DEVELOPMENT Permit #: ELC2011 -00588
Date Issued: 10/21/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel 2S109DA14800
Jurisdiction: Tigard
Site address: 15294 SW SUMMERVIEW DR
Project: Arlington Heights No. 3, Lot 64 Subdivision: ARLINGTON HEIGHTS NO 3 Lot: 67
Project Description: Install circuit for possible future solar photovoltaic system.
Contractor: HILLSBORO ELECTRIC LLC Owner: DELMORE, JIM
21185 NW EVERGREEN PKWY #110 15294 SW SUMMERVIEW DRIVE
HILLSBORO, OR 97124 TIGARD, OR 97224
PHONE. 503 - 687 -7577
HONE. 503 - 439 -9666
FAX' 503 - 601 -3680
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 10/21/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/21/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
Required Items and Reports (Conditions)
This permit is ed su. - to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will
be done i accordance with a.•rove. = •ns This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days TENTION Oregon law - -quire .0 to follow the rules adopted by the Oregon Utility Notificati.. Center Those rules are set forth in OAR
952 -00 -0010 thr.ugh OAR 952 -00 090 may obtain a copy of the rules or direct questions to OUNC by -<;::.- . 32 1987 or 1 800 33 2344
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Issu d By: I' Sign. /i . /. <' At% l�� J
/ L P erm i ttee _ ,I— it
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' i I ,' 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.
I )
Electrical Permit Applicati i, roRZO.FFICe USe LV •
City of Tigard Rece Date /B ived . (Q Permit No. l - (5 ,55b'
° 13125 SW Hall Blvd., Tigard, OR 972 C I 2 2� 11 Plan Revlew �/
_ - Phone: 503 718.2439 Fax: 503 598 19 0 Date /B Other Permit I(�40,0`r.0(.2lSO
T I G A R D Inspection Line: 503 639.4175 CITY p ;� Date Ready /By. Ions. 1a See Page 2 for
- Internet www.tigard - or.gov C T ITY OF I IGAfRD Notified /Method Supplemental Information
TYPE OF
g NG IDi °Vi sluuN PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below)
❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: where the available fault current ❑ Mannas 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
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ Installation of 75 KVA or
❑ Emergency system larger separately derived system
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: 7888 Job site address: 15294 SW Summerview Dr 100HP or more occupancy
❑ Six or more residential units. ❑ Recreational vehicle parks
City/State /ZIP: Tigard, OR 97224 ❑ Health -care facilities ❑ Supply voltage for more than
❑ Hazardous locations 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Stonebridge #1438 ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq ft or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi -family 75.00 2
x
r C S k c� R�,`�✓ [.( �t residential (with above sq. ft.)
vi Services or feeders installation, alteration, and/or relocation
1-624--.. 200 amps or less 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
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: ( ) 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
tY _ dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Hillsboro Electric, LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 21185 NW Evergreen Parkway #110 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: Hillsboro, OR 97124 investigation (1 hr min) 66.25/ hr
Industnal plant (1 hr min) 78.18/ hr
Phone: 503 439 -9666 F ax: (503 601 - 3680 Inspections for which no fee is
Phone: ( 503) ( ) f h f 90.00 / hr
specifically listed ('A hr min)
CCB Lie.: 134481 Electrical Lie.: 34 -499C Suprv. Lie.: 46625 ELECTRICAL PERMIT FEES
r' �. Subtotal: 56.18
Suprv. Electrician signature, required: / p A , o
Plan review (25% of permit fee):
Print name. Paul A Ellis Date: 10/20/11 State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE. 62.92
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit
1 \Buddme \Permits \FLC- Perm,tApp doe 07/01/10 44046 15T(1 1 /05 /COM /WEB