Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00639
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 A; /9- Date Issued: 11/10/2011
Parcel: 25111 CA03100
Jurisdiction: Tigard
Site address: 9485 SW SUMMERFIELD DR
Project: HOFFMAN Subdivision: SUMMERFIELD NO.7 Lot: 378
Project Description: Panel replacement. 2/23/12, reprinted to add (1) feeder & (1) branch circuit.
Contractor: CASEY'S PLUMBING Owner: HOFFMAN, DONALD E & SUSAN T
PO BOX 30075 9485 SW SUMMERFIELD DR
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 11/10/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 11/10/2011 $12.08
Type of Use: SF • • • ' • Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 02/23/2012 $100.70
amps or less
Type of Const: 1 crt Branch Circuits w /Purchase 02/23/2012 $7.42
Occupancy Grp: Service or Feeder
0 ea 12% State Surcharge - 02/23/2012 $12.98
Electrical
Total $233.88
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 a • • _ 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. ATT ION: Oregon .w r ' s u to follow the rules adopted ' by the Oregon Utility Notifi = • Center. T(rose rules are set forth in OAR
952- 001 -00 0 thro gh OAR 952 -0' 090. u ay obtain a copy of the rules or direct questions to OUNC by 2.1987 or 1.800.332'2344.
t
Issued BK Permittee Signa (
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.
CITY OF TIGARD ELECTRICAL PERMIT
II — COMMUNITY DEVELOPMENT Permit #: ELC2011 -00639
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/10/2011
Parcel: 25111 CA03100
Jurisdiction: Tigard
Site address: 9485 SW SUMMERFIELD DR
Project: HOFFMAN Subdivision: SUMMERFIELD NO.7 Lot: 378
Project Description: Panel replacement.
Contractor: CASEY'S PLUMBING Owner: HOFFMAN, DONALD E & SUSAN T
PO BOX 30075 9485 SW SUMMERFIELD DR
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 11/10/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 11/10/2011 $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 O.: 52- 001 -0090. You may obtain a co•y of -s or direct questions to OUNC by calling 503.232.1987 or 1.800 332.2344. '"
A
Issued By: Permittee Signature: �a ( .
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.
Feb 23 12 01:35p Casey' Plumbing 5032628251 p.1
Electrical Permit Application I ' FOR OFFICE I:SE ONI.Y
9 I Received
City of Tigard e Date/B , t Permit No.: ° /l -Q'' •
r 13125 SW Hall Blvd., Tigard, OR 97223 FEB 2 20 ����
Review
Phone: 503.718.2439 Fax: 503.598.}4¢9, _ 12
Pl an Date/Br. Other Permit: Z' 1 G A K D Inspection Line: 503. 639.4175 l•i I Y OF Date ReadyB}•: morn: B See Page 2 for
Internet: www,tigard -or.gov BIJll p re. T�Gq;� Notifed/Method Supplemental Information
-�, w r /t
TYPE OF WORK D r ✓I TN PLAN REVIEW
•
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction ' Addition/alterationlreplacement
❑ Demolition ❑Other. ❑ Service or feeder 400 amps or more ❑ Building over three stories
wberc the mailable fault carman ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
2 dwelling less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
1- and 2
y g ❑ Commercial/industrial ❑ Accessory building amps for au other installations. buildings
Multi- family 0 Master builder ❑ Other:
0 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 ", "1 -3 ",
Job no.: Job site address: q �} g.6 3l �� 1 eta 1 ix or or more Recreational 4 ❑ Six or more residential units. CI Recreational vehicle parks.
City/State/ZIP: - n ❑ Health -care facilities. ❑ Supply voltage for more than
Ci
ty �l J t CA-- Qa ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: 12 Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ne:e„n
pra
I Q ty. I Fen 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
Fa. 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.)
po Limited energy, multi- family 75.00 2
t:1CJI V) 9.Q..✓ M •1v . c � o .. ak\ —O7 residential (with above sq. R.) -
Services or feeders installation, alteration, and/or relocation
CQrie cr.,-t- Ian ,S 200 amps or less 1 100.70 /60, 10 2
4 ROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
^ 401 amps to 600 amps 200.34 2
Name: {
„ rna A 601 amps to 1 ,000 amps 301.04 2
Address: 0i 1-k% 4S N.13 5tArcv e,B clot Over 1,000 amps or volts 552.26 2
City/State/ZIP: ��� t� Temporary services or feeders installation, alteration, and/or
cv t ��+2 07 Q„,4
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
-r APPLICANT I ❑ CONTACT PERSON above service or feeder fee, f 7.42 ? . ��' 2
each branch circuit
Business name: f\'t j ''-S f t:,„." ( B. Fee for branch circuits without
service or feeder fee, that
56.18 2
Contact name: 1-2 ■ �, `� branch circuit
ad
r �-� Each d'! branch circuit 7.42 2
Address: l-'- C , l �j LX • VC 1 S Miscellaneous (service or feeder not included)
City/State/ZIP: ^� n Each manufactured or modular
Pc„.- �G + "�,Li.1 \ Cl , C E- ' T\ De) 4 dwelling, service and/or feeder 67.84 2
Phone: .2J) u: (, k3 _ cii si3?.., J Fax:: ('3_33 a ua -a, .6 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: [` r t -Z - \•cLG C.I. C Cl_S e'IS pt,w ;'ll ". / l ' C O v Sign outline lighting 67.84 2
CONTRACTOR
_ Signal circuit(s) or limited Business name: M.e C ' -&Sf E (E V l.� panel. alteration, or extension. Page 2 2
� Each additional inspection over allowable in any of the above
Address: - G ` •� G X _c:, Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/ hr
e,, - / c Z G` c`
1 `
1 c, G` Industrial plant (1 hr min) 78.18/ ltr
Phone: ( 3) ( t . 4 ._ 4 ?., Fax: (-_ ,. ( c,.. ' � . Inspections for which no fee is
specifically listed (:4hrmin) 90.00/ hr
CCB Lic.: 1 t..k---\ no, 9 Electrical Lic.: Ly� 5 Suprv- Lic.: /5� ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: /..l% �"' Subtotal: /Oft /X
Plan review (25% of permit fee):
Print name: ii. V- � il l �v t 1 ( _ -`` ` - Date: _ I State surcharge (12% of permit fee): /A. 9
Authorized signature:; ( Vtk ` TOTAL PERMIT FEE: /A f , /0
�'� .` This permit application expires ifs permit is not obtained within t
Print name: T■A ,'. CCU after it has been accepted as complete.
��-� E - £ I Da te: a air JD._ ' Number of inspections allowed per permit.
1: 1BuirdmalPcmhalELC-PermirApp.doe 07/01/10 +l0 1615T(11r4I5/C01UtVEB
Nov 10 11 04:18p Casey's Plumbing 5032628251 p.1
Electrical Permit Application FOR OFFI USE ONLY`
City of Tigard V-41C) DaReceived t y,
y + e/ Date!$ B lr Permit No.: •--> ..L li
13125 SW Hall Blvd., Tigard, OR ".4? •t CBJ Plan Review
' e�
Phone: 503.718.2439 Fax: 503.5';.'': Q0\ Other Permit:
TLGA R D Inspection Line: 503.639.4175 ``II 1 O 1. ^tn Date Ready/By: ® See Page 2 for
Internet, www_[igardor.gov �OV 1 Notified /Method: Supplemental Information
TYPE OF WORK Ov % `SV., PLAN REVIEW
ta`� • a,:.n Please check all that apply (submit 2 sets of plans w /items checked below):
El New construction gl'' Addition /alterat
El Demolition 0 Other: �V1t I ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
7 2 . 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ 'A ", "E ", "t -2 ", "l -3 ",
Job no.: Job site address: ° LA (`- (\ ' \- IOOHP or more. occupancy.
l - ____ ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ,, -. . � , ❑ Health - care facilities. ❑ Supply voltage for more titan
` �' ' ' ❑Hazardous locations_ 600 molts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: FEE SCHEDULE
Deuription 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
Tax map /parcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. tt.)
Limited energy, multi - family
J
%`�\ --� ∎�.� _ ",:`� ^ \ residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less il 100.70 /040d 2
la PROPERTY OWNER ❑ TENANT 201 amps to 400 amps I33.56 2
Name:
•„..__,,c,..,---.., ,` 401 amps to 600 amps 200.34 2
'`\ , , �` �� -•' 601 amps to 1,000 amps 301.04 2
Address: L;
..:�. .i - N -' , , . = \ , ; .` \=-' \ Over 1,000 amps or volts 552.26 2
City /State /ZIP: --- •,\ �,\ :„._;N_ , ` �1--- ..11,-, `; Temporary services or feeders installation, alteration, and /or
1 relocation
Phone: ( � -,`:-; ------=\::, r LI 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 125.08 2
intended for sale, Iease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Branch circuits — new, alteration, or extension, per panel
Date: A. Fee for branch circuits with . APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7 42 2
( each branch circuit
Business name: Me- i `.. , ` B. Fee for branch circuits without
t service or feeder fee, first
Contact name: h L branch circus 56.18 2
J Each add' I branch circuit 7.42 2
Address:
C {� C x LG'` Miscellaneous (service or feeder not included)
City/State/ZIP: I Each manufactured or modular
�v 6.1,.--\ Gl- t G �"— C�� �1 t F dwetlin2, service and/or feeder 67.84 2
Phone: ) U LA Q t 'I-?___, ' Fax: : ((5 Q L._0 .. -6 t Reconnect only 67.84 2
E- mail: C N *- c�.c.A- 6) C'CC JF_•IS PI_GI -1 t' C CC,iI� Pump or irrigation circle 67.84 2
r� , Sion or outline lighting 67.84 2
CONTRACTOR
Signal circuit(s) or limited -energy
Business name: i L , panel, alteration, or extension_ Paget 2
�� C t�G } L t � Each additional inspection over allowable in any of the above
Address: )
� " Additional inspection 1 hr min 66.25/ hr
City /State/ZIP: t Investigation (1 hr min) 66.25/ hr
r
C � - - 7 - `C \1 - C 1 C CI --1 Q 1 L
Industrial plant (I hr min) 78.18/hr
Phone: (�- 3 .D i_1 --<,''..S --- J Fax: j-, ) , v , J ` j
l _ Inspections for which no fee is
j specifically listed ( hr min) 80.00 / hr
CCB Lie_: 1 � QC‘ I Electrical Lic.: �y : c-,. I Suprv. Lic.: l _s- ELECTRICAL PERMIT FEES
' ''- 1\
Suprv_ Electrician signature, required: //,'.:1•-r--, 8 `,, Subtotal: l (3p -
' -,' Plan review (25% of permit fee):
Print name: 1 ` (- -1 I Date: r . S tate surcharge (12 /o of permit fee): 0 , 0
1 �'
1• i t, l
TOTAL PERMIT FEE //, , /f
Authorized signature :;�,t c till r "-- /r
� t This permit application expires if a permit is not obtained within 180
_
<:t--' k . Date' days after has been accepted as complete.
Print name: 1 CCU. ,
�LL • Number of inspections a llowed per permit.
1:\ 8uilding1Perniism ..c- PcrnrtApp,doc mot/to 410- 4615T(]1 /0$ /COhS/1L'Ea