Permit 1 CITY OF TIGAR ELECTRICAL PERMIT
`7 2 p COMMUNITY DEVELO Permrcu ELC2011 -00605
Date Issued 10/28/2011
TIGARD 13125 SW Hall Blvd, Tigard OR 97223 503 718 2439
Parcel 2S110DD10000
Jurisdiction Tigard
Site address 15735 SW HIGHLAND CT
Project GAINES Subdivision SUMMERFIELD NO 6 Lot 316
Project Description Panel replacement
Contractor WILLAMETTE ELECTRIC INC Owner GAINES, DAVID & VIRGINIA
PO BOX 230547 15735 SE HIGHLAND CT
TIGARD, OR 97281 TIGARD, OR 97224
PHONE 503 - 624 -3631 PHONE
FAX 503- 624 -2938
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/28/2011 $100 70
Specifics amps or less
1 ea 12% State Surcharge - 10/28/2011 $1208
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 160
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 - -- Permittee Signature
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
10/26/2011 WED 15- 51 FAX 5036242938 Willamette Electric [(002/002
Electrical Permit Appli eEIVED "FOR OrrICE1 ESE ONLY -` .
City of Tigard Received 0 Permit No ,� { i �i r
y 13125 SW Hall Blvd , Tigard,(( *24 6 2611 Plan Review ems- -�
111 ' 2 _ Phone 503 639 4171 Fax 503'598 1960 Date/By Other Permit
TIGARD Inspection Line 503 639 41 Date Ready /Oy lens &I See Page 2 for
Internet www tigafd -or go TY OF TIGA Notified/Method 1 - Supplemental Information
: ve : I. I.
e WORK PLAN REVIEW .
❑ New construction 11 Addition /alteration/replacement Please cheek all that apply (submit 2 sets of plans wn checked below)
❑ Service or feeder 400 amps or more ❑ Bedding over three stones
❑Demolition El 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
0 l- 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived system
0 Addition ofneu motor load of ❑ "p ", °E", "1- 2 ", "i -3 ",
Job no - 7 f rW ,. � Job site address 2 S t— // ! U / ) h IOOHP or more occupancy
/ � / ,s / ///��� /G rn c ❑ Six or more residential units ❑ Recreational vehicle parks
City /State /ZIP CY / r9 / '7� ��/ ❑Hcaleb -care facilities ID Supply voltage for more than
/ / / ❑Hazardous loesuons 600 voltsnominal
Suite /bldg (apt no Project name /,_ e 1 /5 Y' S ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross stieet/ditections to job site Desolation I Qty I Fee I total I e
New residential single -or niulti-family dwelling unit
Includes attached garage.
Subdivision I Lot no 1,000 sq ft or less 16854 4
Ea add'I 500 sq ft or portion 33 I
Tax map /parcel no Limited energy, resldentlal
_ with above s R 75 00 2
DESCRIPTION OF WORK ( 9 )
Limited energy, multi- family 7500 2
2 m - , ,ve R e /. e 4 e n t , f / residential (with above sq R )
Services or feeders installation, alteration, and/or relocation
4 200 amps or less i 10070 f0),'7a 2
❑ PROPERTY OWNER 1 ❑ TENANT f!`9 201 amps to 400 amps 13356 2
l( 401 amps to 600 amps 20034 2
Name: ; it II ' ((( ii' llI
A ft /�S �i - A /.c . to 9 601 amps to 1,000 amps 301 04 2
Address (ef W 1 b Over 1,000 amps or volts 55226 2
� :� v
Cr /State /ZIP _ C ation, and /or
fY /� Q71 Fax ( ) 0 \ 1 ' relocation
/- ' 200 amps or less 5936 1
Phone.( ) Fax
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 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
El APPLICANT . ❑ CONTACT PERSON abovescrvice or feeder fee, 742 2
each branch circuit -
— -
Business name B Fee for branch circuits wit/rout
service or feeder fee, first 56 18 2
Contact name branch circuit -
Each add'I branch circuit 7 42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP Each manufactured or modular 6784 2
dwelling, service and /or feeder
• Phone ( ) Fax - ( ) R rlut rity ���7 %d'.�4t
E Pump or irrigation circle 6784 2
-
Signor outline lighting 67 84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name Willamette Electric Inc. panel, alteration, or extension Page 2 2
Each additional inspection over allowable in any of the above
Address P.O. Box 230547 Additional inspection (1 hr min) 66 25/hr
City /State /ZIP Tigard, OR 97281
- Investigation (I hr mm) 66261 hr
Industrial plant (1 hr min) 78 18/ hr
Phone' (503) 624 -3631 Fax (503) 624.2938 Inspections for which no fee is 9000/ hr
specifically listed (K hr min)
CCB Lic 75059 04/ Electrical Lie 34 -283C Supn Lie 4226 -S ELECTRICAL PERMIT FEES
l c -- Subtotal � 47, 76
Supra Electrician signature, requtrecE -- — o
Plan review (25% of permit fee) r .
/o�z Print name. David Fife Date. // State surcharge (12% of permit fee) r ‘.
Authorized signature TOTAL PERMIT FEE
This permit application expires ifs permit is note a ,ed wt
Print name Date days after it has been accepted as complete. '/
. Number of inspections allowed per permit /
I Malabog\PermdtELCBCimitApp doe 07 /01 /10 4404615T(11 /os /COM/WEB