Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00645
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S104BA06400
Jurisdiction: Tigard
Site address: 13863 SW NORTHVIEW DR
Project: SULLIVAN Subdivision: CASTLE HILL NO.2 Lot: 97
Project Description: Altering (4) kitchen circuits.
Contractor: PRECISION NW ELECTRICAL Owner: SULLIVAN, PATRICK J & DENISE L
12020 SE ANNA CT 13863 SW NORTHVIEW DR
DAMASCUS, OR 97009 TIGARD, OR 97223
PHONE: 503 - 413 -9870 PHONE:
FAX: 503 - 594 -2873
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 11/16/2011 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/16/2011 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 • 2- 001 -0090. You ma - • • . of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: `_h Permittee Signature: ► ,CZ1
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.
11/14/2011 20:59 FAX 5035942873 PRECISION Nut 12002/002
Electrical Permit Application .1..9.1: (writ h l 5h' (), .A. •
City of Tigard Received � ,r/
1111 Oatem : r i Ill Permit No.: 0Z i i _iyi i r
13125 SW Hull Blvd., Tigard, • ' Plan
' .. Phone: 503.718.2439 F;,4 11:x �
60 Dala Other Permit:
1. 1e.; .\ t ;) Inspection Line; 503.639.4 t,'-.. ` le %\\ Dale Randy/By: Mc �, fa See Page 2 for
Internet: www.tigard- nr.gpv 1 Notifed/Method: [yfv Supplemental Information
_ TYPE OF'WO • lv� 10 PLAN REVIEW .
0 New construction 'Additiotl/al : � q5T : meat Please check all that apply (submit j sets of plans w /items Checked below):
r� l , ❑ Service or feeder 400 amps or more El Building over three stones.
El Demolition ❑ Other: ‘0,0 where the available Iuult current ❑ Marinas and boalyarcls,
CATEGORY OFONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating h
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
Wi- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fin pump. ❑ installation of 75 KVA or
JOB sue INFORMATION AND LOCATION ['Emergency system, larger separately derived system,
._ ❑Addition of n e w motor L o r d of El "A" "1:' , "1 -2" "1 -3"
Job no.: Job site address: / S �`t, /1 / V�l� // / / 1 0011? or more. occupancy.
'r' `�' ✓ �v" Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP_ -r ,spolli O vt, c, Z/. - T ❑ health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.; Project name : p..•;•fs 4 % . 1.50 t1 5 VPt�4 _❑Servtee or feeder KO amps or more.
FEE Cross street /directions to job Site: 1-- nmertntinn SCHEDULE
I aa i eee. I Tonal I •
New residential single- or multi - family dwelling unit.
m Includes attached garage.
Subdivision; i.ot no,: 1.010 sq. ft. or less 168.54 4
— Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
_ .. A C -aC,"C V 4Arte4 J residential (with above sq. ft.) 75.00 2
Services or feeders installation. alteration, and/or relocation
200 amps or less ' 100.70 2
. 0 PROPERTY OWNER . -I ❑ TENANT 201 amps to 400 amps Y. 133.56 2
Name: 401 amps to 600 amps 200.34 2
• ,_, ,_ 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; ( ) 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 401 amps l0 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, er panel
Owner signature: _ Date: A. Pm for branch circuits with
[] APPLICANT I ❑ CONTACT PERSON _J above service or feeder fee 7,42 2
each branch circuit
Business name; II. Fee for branch circuits without
service or feeder fee, f rat 56.18 .. 2
Contact name: branch circuit
Each add'l branch circuit 7.42 5 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 M
panel, Business name: Vy�Ast apj *)o.1 SlC,t i "f C.444. Each a dds ion, l I extension. Page 2 2
Each additi inspection over allowable in any of the above _
Address; Se PtWati,J a. `(...ft— Additional inspection (1 hr .min) 66,25/ hr
r w investigation (1 hr min) 66,25/ hr
City/State/ZIP:
Atvv gate LJV v t Q t+ � � •� Industrial plant (1 hr min) : 78.18/ hr _
Phone: ( q ) 443 - ' 0 Fax; (sot ) C 4--- J inspections for which no fee is 90.00 / hr
specifically listed (h: hr min) -
CCB Lie.; ItotaS i t Electrical Lie.: (,%J % Suprv. Lic.: tr (DS ELECTRICAL PERMIT FEES
Supra_ Electrician signature, required Subtotal:, L1
_ - \�Lr+ Plan review (25% of permit fee): —
t'rint name: vA 1 } r l �p Date: (1- 6-201, _ State surcharge (12% of permit fee): , '1/ _
Authorized signature: TOTAL. PERMIT rnot �>�rL 8, LAtukt This permit application expires It permit ls not obtained within 180
Print name: ii R isAe , 0 Date: tit , - ) 4 5 - Z • ki days alter it has been accepted as comple 7 ,
Number of inspections allowed per permit. 7
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