Permit CITY OF TIGARD ELECTRICAL PERMIT
•
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00633
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/08/2011
Parcel: 2S112CB06800
Jurisdiction: Tigard
Site address: 15443 SW 81ST AVE
Project: DeSellier Subdivision: ASHFORD OAKS NO.2 Lot: 82
Project Description: Lighting for interior remodel.
Contractor: PRAIRIE ELECTRIC INC Owner: DESELLIER, GRETCHEN G
6000 NE 88TH ST 15443 SW 81ST AVE
VANCOUVER, WA 98665 TIGARD, OR 97224
PHONE: 800 - 573 -2750 PHONE: 503-684-4078
FAX: 360 - 573 -9866
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 11/08/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/08/2011 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 952- 001 -0090. You may obtain a • of th- - = 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.
11/08/2011 12:42 FAX 360 573 9866 Prairie Electric Inc. 010 01/00 2
Electrical Permit Application 0. 0 rAtAe l OR OF�:IC'C Iar oNCY
City of Tigard 0G
sa g O`` Received JJ _ Permit No,:
" 13125 SW Hall Blvd., Ti ard, OR 9722
P
III PII
Phone: 503.718.2439 Fax: 503.598.1960 .*\ � GP �t !/ Rcview Other Permit:
Inspection Line: 501639.4175
ftGA1D C � � ♦�� Date Ready/By: Y= ®See for
Internet: Www.tlgard Or.gov 0 N. Notified/Method: Supplemental ental Information
t : � F ": ` i ala i TM7" . M7 n, t l � .t ems' zwi W. al w e,. ;. -c V, .".t� e. t .I," ' t . �°i k'r. � _ •
... ni :E. r a:} �`. _ter" hhc 4.� 1ite, �Ittr4 -..-,z l 3.e_v E h .... i T•'v. , 3.w. n „a': oar : u i 'a." . e�. . .
Please check all that apply (submit 1 sets of plans w /items checked below):
❑New construction ®Addition /alteration /re c acement
❑ Demolition ❑ Other: t current ❑ Service or feeder 400 amps or more ❑ Building over three stories.
, « Demolition * µ e m a mr r y h r x 4 � , where the available fault Marinas and boatyards.
l y r ., ,.e t� • d o . om% exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
,�. ...4" .ac:l: ': �. '; ; .. a�. x '' h '.r 7 " : . ::.,..:.. , - • x5 . - less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Eg 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
}I, alCa * c .e; } `a �r gg a
E l
system. larger separately derived system.
v E 1 i . = !tit ° p ai .. ,�+^"' y s`11r 2 , 8 tt 3 � ,' f7 : q ❑ Addition of new motor load of
Job no.: SRO Job site address: 15443 SW 81 AVENUE 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.: I Project name: CREATIVE HOME REMODELING ❑ Service or feeder 600 amps or more
Cross street/directions to job site: Description x ""N of RIM
Description Qty. Pee. Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: 1 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 l
Limited energy residential
v ?c r ar�r r 75.00 2
-.' y,, ...:414 ii" . � 3 ^ 0 ,1-.4 �a tG^ o .4r4 - , (with above sq. ft.) .
Li energy, multi - family 75.00 2
CIRCUIT WORK FOR INTERIOR RECEPTACLE, LIGHTS residential (with above sq. ft.)
Services or feeders Installation, alteration, and/or relocation
200 amps or less 100.70 2
p _ '341'.. 1 „� T 201 amps to 400 amps 133.56 2
5 e t1 ° a.1 /'+, ',�'a.' "4` 4 s r I itt f d
.C,^":' ; wC +�... .......W r . -..... .. ... �._". .
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
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 snips 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 extension, per panel
Owner signature: Date: A. Fee for branch circuits with
a 1 + i s 5 ' rs 4 " ' �i E ��'„' above service or feeder fee,
3
t-:,.... _ ,' .i, � ' lw' k:(' l Me i ,.1-. -. 1 l � 1, ' ' y ' each branch circuit 7.42 2
Business name: PRAIRIE ELECTRIC, INC. B. Fee for branch circuits without �,////� l
service or feeder fee, first = 56.18 I/1 , (g 2
Contact name: ANITA PASO branch circuit //
TH Each add'] branch circuit 7 7.42 51-,10 2
Address: 6000 NE 88 STREET Miscellaneous (service or feeder not included)
City /State /ZIP: VANCOUVER, WA 98665 Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: (360) 573.2750 I Fax: : (360) 573.9866 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: anttap @prairlelectric.com Sign or oudine li htin 67.84 ' 2
- arat0'e4 .` j J t `- -e +I s A. " h aG " . k sue p G . , ' :' ` "'', ., n,. - g g
,L � -,n�c � S circuit(s) orl energy
Business name: PRAIRIE ELECTRIC, INC. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 6000 NE 88" STREET Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: VANCOUVER, WA 98665 Investigation (1 hr min) 66.25! hr
Industrial plant (1 hr min) 78.18 / hr
Phone: (360) 573.2750 I Fax: (360) 573.9866 Inspections for which no fee is
s.-cificall listed i/ hr min) 90.00/ hr
CCB Lie.: 60178 357,3 Electrical ii,: 37491C 17 Su Irv. Li 0 �A, r : 35625 1 , .. ry.. �.. e' � n> �u �;, . =a 0 ,
Suprv. Electrician signature, require.. `• Subtotal: i ,
s Plan review (25% of permit fee):
Print name: BILL HALBERG 1
Date: 11 v .e State surcharge (12% of permit fee): r Al -/
p
Authorized signature: •
TOTAL PERMIT FEE: 10' ' ; le 14.
This permit application expires if a permit is not o . med within 180
Print name: days after it has been accepted as complete.
Date. * Number of inspections allowed per permit.
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