Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC201 1 -00682
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/06/2011
Parcel: 2S 103AA03500
Jurisdiction: Tigard
Site address: 10490 SW CLYDESDALE PL
Project: Bhat Subdivision: CLYDESDALE Lot: 15
Project Description: Replace electrical panel
Contractor: ATLAS ELECTRICAL CONTRACTORS Owner: BHAT, VISWESH
4403 SE ROETHE RD 10490 SW CLYDESDALE PL
MILWAUKIE, OR 96267 TIGARD, OR 97223
PHONE: 503 - 659 -2212 PHONE:
FAX: 503 - 659 -4944
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/06/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/06/2011 $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. ATTENTIO■• Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -00 • through OA' • 2-O01-''9' You may obtain a copy of the rules or direct questions to OUNC by calling 51 . .1987 or 1.800.332.23'4.
Issued = ee--/f l' ib� �'l O Permittee Signa .1' ' ��i �� f
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' -` > r77- 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.
Dec. 2. 2011 10:46AM Atlas Electrical Contractors Inc No. 7411 P. 1/2
Electlrieal elr l mit Application 41)1S) FOR OFFICE tiSE ONLY .
City of Tigard � Received �� /...496 8-
City g 9� 0 pale/6 : �� / c -� Pcnn i
'I 13125 SW Hall Blvd., Tigard, 0 .`. jt` 1 ��
Plan Review
Phone: 503.718.2439 Fax: 503.';1:. 4 60 'Q { � e.DateB ; Other Permit:
frc;,lttU Inspection Line; 503,639,4175 �` l G� S DataReadyBy: l¢ris: la See Page 2 for
Internet: WWW,tigard Or.gov Q G , ` NolifiediMethOd: Supplemental Information
TYPE OF WOR 1 \ -, PLAN REVIEW
`S •
❑ New construction ® Addition/alteratiot‘ ement Please cheek all [hat apply (submit a sets of plans w /items checked below):
❑ 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 or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other Installations, buildings,
❑ Multi- family ❑ Master builder ❑ Other: I;]Pire pump. ❑ Installation of75 KVA or
JOB SITE INFORMATION AN10 LOCATION ❑ Emergency system, larger separately derived system. • ❑ Addition of new molar load of 12 "A ", "E ", "l 2 ",'I - ",
Job no.: 20597 Job site address: 10490 SW CLYDESDALE PL 100HP or more, occupancy.
_ ❑ Six or more residential units. ❑ Recreational vehicle parka.
City /State /ZIP: PORTLAND, OREGON 97223 ❑ Health - care facilities. ❑ Supply voltage for more than
—
❑ Hazardous locations, 600 volts nominal.
Suite/bldg,/apt, no.: Project name: VISWESH BRAT /FIDELITY CI Service or feeder 600 amps or snore.
- FEE SCHEDULE
Cross street/directions to job site: " neretipuon I Qtr. I Fee. I Total I •
' New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot n0.: 1,000 sq. 0. or less • 168.54 4
- Ea. add'I 500 sq. R, or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION or WORK • .. • . (with above sq. it.) 75.00 2
Limited energy, multi - family
INSTALL NEW 200AMP ELECTRICAL PANEL TO REPLACE DEFECTIVE residential (with above sq. 11.) 75,00 2
Services or feeders Installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY OWNER I ` ❑ '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
City/State/ZIP: Temporary services ar feeders installation, alteration, and /or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
201 amps to 400 amps 1 25,01 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 549 amps 16s,54 2
intended for sale, lease, rent, or exchange, according to OIiS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I •
above service or feeder fee,
® CONTACT PERSON each branch circuit 7.42 2
Business name: SEE BELOW 13, Fee for branch circuits without
service or feeder fee. Rai 56.18 2
Contact name: branch circuit
Each add'1 branch circuit 7.42 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
E - mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 ' 2
CONTRACTOR • Signal circuit(s) or limited - energy
Business name: ATLAS ELECTRICAL CONTRACTORS panel, alteration, or extension. Page 2 2
- Each additional inspection over allowable its any of the above
Address: 4403 SE ROETI-IE RI) Additional inspection (l hr min) 66.25/hr
City /State /ZIP: MILWAUKIE, OR 97267 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 659 -2212 Fax: (503) 659 -2212 ]nspections for which no fee is
specifically listed 0•5 hr min) 90,00 / hr
PERMIT FEES
CC I ic- 1532 4!4 t3 Electrical Lic.: 3.2C a'{ • uprv, Lic -: 5009S ' ELECTRICAL'
1I: / /
Suprv_ Electrician signature, required: _ /DI/ 1 1 3 Subtotal: 100.70
`� �+= Plan review (25% of pclmil fee):
Print name: TY W SHEPERSKY \ Date: 12/2/11 State surcharge (12% of permit fee): 12.08 v *
�I TOTAL PERMIT FEE; 112.78
Authorized signature: l t/ t Thls permit uppltcdtlon expires if p permit is em Oblpincd within Igo
Print name: TY P✓ SIIEPEiG Y / / /ttt///tt1 days after i, ha$ been accepted us cOmplete.
Bate: 12/2/11
1 ' Number of inspections allowed per permit.
t; 1IlutIdIng \PermitAELC- PermiIApp.doo 07/01/10 4404615T(r1 /05 /COM/WEO