Permit r CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00646
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/16/2011
Parcel: 2S 112DB00200
Jurisdiction: Tigard
Site address: 15255 SW 72ND AVE
Project: Pittman & Brooks Subdivision: FANNO CREEK ACRE TRACTS Lot: 45
Project Description: (6) branch circuits for TI
Contractor: WILLAMETTE ELECTRIC INC Owner: BROOKS & PITTMAN RENTALS
PO BOX 230547 15255 SW 72ND AVE
TIGARD, OR 97281 PORTLAND, OR 97224
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 -624 -2938
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 11/16/2011 $93.28
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/16/2011 $11.19
Type of Use: COM 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 i : s �, 1 -00.0. 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: ' r Permittee Signature: 4/1 e /e1�%�l//✓
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 MON 8:35 FAX 5036242938 Willamette Electric 1 002/002
Electrical Permit A 1 pplicatioRECEIVED TOR OFF ICE US1~ ONLY
Date/B Received oar- �at
City of Tigard ReI : �/ /4P // �i /` Per
13125 SW Hall Blvd., Tigard, OR 9722NnV 14 2011 Plan Review
Phone: 503.639.4171 Fax: 503.598 1960 Date/13y: Other Permit:
TI GARU Inspection Line: 503,639.4175 CITY OF TIGARD Dale Rcady/3y: Iris. � El See Page 2 for
Internet: www.tigard- or.gov BUILDING DIVISION Notifted/Method: Supplemental Information
TYPE OF WORK PLAN REVIEW
N ew construction Please check all that apply (submit 2 sets of plans w /items checked below):
❑ 2rAddition /alteration /replacement )
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts of ❑ Floating buildings. •
•
•
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ i- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
0 Multi - family ❑ Master builder ❑ Other: ❑ fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION
ID Emergency system. larger separately derived system.
. ❑ Addition of new motor load of ❑ "A ", "E ", "1 - ", "1 - ",
Job n0,: 7..r/ site address: /3� 2 )` S L .4 a/l.. f IOOFIPormore, occupancy.
❑ Six or more residential units. 0 Recreational vehicle parks.
City /State /ZIP: 7-, ca ❑ Health -care facilities. ❑ Supply voltage for more than
r� % r) ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Pi/», d / r 4 s ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description D I Qty. I 1'cc. I Total 1^
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'I 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
Tr residential (with above sq. R.)
Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 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
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation
Phone: ( ) Fax: ( ) ' 200 amps or Icss 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 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
❑ APPLICANT ❑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
/ 56.18 S6 '' 2
Contact name: branch circuit
Each add'l branch circuit S 7.42 3 7 r� 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
CONTRACTOR Sign or outline lighting 67,84 2
Signal circuit(s) or limited-energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City /State /ZIP; Tigard, OR 97281 Industrial plant (I hr min) 78.181 hr
Pho ,'(503) 624 -3631 Fax: (503) 624 -2938 Inspections for which no fee is 90.00 / hr
ILK V-' J = specifically listed CA hr min)
CB Li e. : 75059 El Li e. : 34 - 283C 1 Suprv, Lic.: 4226 - '' � ELECTRICAL PERMIT FEES
_ g
Suprv. Electrician signature, requ'
Subtotal: (t
Plan review (25% of permit fee):
Print name: David Fife Date: / /_ /�! ,6 State surcharge (12% of permit fee): J f 9
TOTAL PERMIT FEE: /0% y1
Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: * Number of inspections allowed per permit.
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