Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00693
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/08/2011
Parcel: 2S109AB03700
Jurisdiction: Tigard
Site address: 14256 SW 133RD AVE
Project: Strba Subdivision: THREE MOUNTAINS ESTATES Lot: 30
Project Description: (2) branch circuits for heat pump and furnace.
Contractor: WEST SIDE ELECTRIC CO INC Owner: STRBA, JAROSLAV P &
1834 SE 8TH AVE STRBA - CECHOVA, KATRINA
PORTLAND, OR 97214 14256 SW 133RD AVE
TIGARD, OR 97223
PHONE: 503 - 579 -1497
HONE: 503 - 231 -1548
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 12/08/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/08/2011 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 952- 001 -0090. You may obtain a co• • •e rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344. s
Issued By: Permittee Signature: — ^ .fiiLL���ly
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.
2011-12-06 18:08 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
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(RECEIVED „.,,,,„„,,.,„„. 1 . - ` , 1.01.1.1
City of Tigard n hi, ... iirma
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Cl.0 C 7 2011 rmit No_ !!'",, • - ri....i 1/ —.006 9
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13125 S'W Hall Blvd.. Tigard, OR 972.ws-
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Phone: 503 639.4171 Fax: 503,598.1960 Effaill.1111. Other Permit i 7.,.. „_.„, • _ _ • tt ,
,•„.., Inspection Line: 503.639.41 75 CITY OF TIGARD Date Ready/By: e See Page 2 for
IntCT7let: WOvW.ligard-or.g0V , Notified/Method: Supplemental in m
foration
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. ''''.''ttti.t*0100:;::''''': :.;'.' ...'.; -: 1 ,, .' f:: , ,.
0 New construction I:4 Addition/alteration/replacement Please check all that ;poly (submit j sets anions w/items Chucked balmy
0 Service or feeder 400 amps or more El Building over three mode,.
E Demolition 0 Other:
where the available fault current 0 marinm and boatyards.
il.0•;; . itii ''::: ;.'.:::;: ', exceeds 10.000 amps at 150 v„its or Li Floating b
.
less t ground, or exceeds 14,000 I] Conuncreial-nse agncultunil
rx I- and 2-family dwelling 0 Commercial/industrial 0 Accessoly building amps for all other inarallmions. buildings.
CI Multi-family D Master builder n Other: 13 Fire pump, 0 Installation 0175 KVA Or
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Si ii ,5-.;:e. ;' i sitz7,, , e 6,,Y: w ft ,
Motor load of 17 !!l 5'5‘en'.
Job no.: Is Ezle Job site address: / y2_56- S tt,..) 6i) r / ..c. 100HP ur more. occupancy
ID Sly or more residential units, 0 Recreational vehicle parks.
-- ,
City/State/ZIP: / 4 , i ,. -d 0 9 77 Z X MI lealth-care facilities. 0 Supply voltage for more than
7 7 0 Harartions locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: Stf /C/ 6 1 0 &MCC Or feeder 600 OMD8 Of Mom
...'.. •,._,... ..;FErSCIlltitit'l!'''.1?:::i.:!;.'..1•:'
Cross street/directions to job site; _____.
fhtfliption .., f Qty. I F. t Total I '.
New residential single- or multi-family dwelling unit
-
includes attached garage.
—
Subdivision: Lot 1,000 Sq ft. or less 168.54 4
Ea add'4500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
IN 75.11 2,
'2 .::,: 6iit'. ..;•1:':n;;;; A L imited (with above S • ft:
energy, multi-film iy
75.00 2
EWA infinfi 2 ''-// q C - residential (with above sq. it )
_Services or feedert InStallation, alteration, and/or relocation
200 amps (It less 100.70
;1••3. 201 amps Moo amps 133.56
401 amps to 600 amps 200.34
Name:
601 amps to 1.000 amps 301.04
Address:
Over 1,000 amps or volts 552.26
Teviripotary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) i Fax' ( )
I • 200 amps or less
201 amps to 400 am ps 59.36
125.08
Owner installation: This installation is being made on property that I Own which is not -
401 sin to 599 am 168.54 2
intended for sal; lease, rent, or exchange, actx)rding to ORS 447, 449, 670, and 701.
Branch circuits - newailleration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
—
" • • • .• - • - .,.. -9,••:.•,.:...: ahnve service ur fee,der tee,
W CANT' W
k T . 1 , :' , : ,. .'''.?:' , ;tikiVONTAtti:::!.:. , .1;.%:'e.:Jv,?; 7A2 2
R. Fee for branch circuits withow
Business name:
. ,&
service or feeder fee, first
5 sz
I branch circuit ( 6.1g 2
Contact name:
•
FAel add'I branch circuit I 7.42 1 9 2: 2
Address:
MiStellaneous_(ienlice or feeder not included)
Each filand3CUITed Or modular
City/State/ZIP:
_ dwelling, service and/or feeder 6784 2
Roconncct only 67.84 2
Phone:( )
TiFTx: : ( )
Pump or irrigation circle 67 84 2
E-mail:
, . .. Sign or outline lighting 67.84 2
a.,.. il7 si circuit(s) or li
Panel, aberatiOn, or extension. Page 2 2
Business name: West Side Electric Co. Inc.
Each additional inspection over allowa in any of the shove
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
. _
----___.
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Portland/OR/97214
Industrial plant (1 hi min) 78.18/ hr
Phone:( 503) 231 Fax: (503) 736 inspections tbr which no fee is
90.00/ hr
.ocifical listed Iihr min
COB Lie.: 13306 Ekekrieal Lic.: 2 6 - 13 5 C SLIMY- Lie.: 4 65 4 - s '_,.;',...'? .. t:
Suprv, Electrician signature, required: i, Z.A4‘ 1 I I °F. - 4111=1 Plan review (25% of per f 63 -.-4-.)
Print name: Randall F Roberts Date: / 2 7 // state surcharge (12% of pernut fee): 7
TOTAL PERMIT FEE: — 7 / Eti_.
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:
. i • Number of inspections allowed per pennii.
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