Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00697
TLGAR:D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/13/2011
Parcel: 25111 DC04200
Jurisdiction: Tigard
Site address: 15635 SW ALDERBROOK DR
Project: COTE Subdivision: SUMMERFIELD NO.7 Lot: 357
Project Description: Panel replacement and (2) branch circuits.
Contractor: RED'S ELECTRIC CO INC Owner: COTE, OLIVER PAUL
6336 SE 107TH AVE 15635 SW ALDERBROOK DR
PORTLAND, OR 97266 TIGARD, OR 97224
PHONE: 503 - 233 -6467 PHONE:
FAX: 503 - 233 - 1281
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/13/2011 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 12/13/2011 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/13/2011 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 ob :: - - rules • ct questions to OUNC by calling 503 232.1987 or 1.800.332.2344.
/ I
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.
Dec. 12. 2011 3:45PM No. 0186 P. 1
Electrical Permit Applicat - ---- FOR orFICC ON IS
Cl Recoivcd permit No _
III - `J Of Tigard
Re e iv
y 13125 SW Hall Blvd.,'I'i ara, oR 9722 1 2 2
g 1 plan Review Other Penni!.
Phone: 503.718,2439 Fax: 503.598.180 Oate/H
TJ (.Attu Inspection Line; 503.639.4175 Date Ready/13y: ® See Page 2 for
Internet; vulva• tigard or.gov CITY OF TIGA Notifled/Melhod Supplemental Information
,. - ._.... _ N(3Di. ISICN...,_ _. ...7.. . -.
❑ New construction Addition/alteration/replacement all plus w/items checked below).
■ ScIvice or feeder 400 amps or more
❑ Demolition U Other: where Ike available fault current ■ Marinas and boatyards.
_ :... '7--.'...1 • ;caF , GARY: QF . CONSTR'(TC'Y'IQN -`. . less to ground, Of exceeds 14,000 0 Commercial-use agricultural
I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other inatallatiOnS, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ■ Fire pump, ■ Installation of 75 KV. A or
...... • - , .. 0 Emergency system. larger separately derived system.
. ,- - Jam SITE• INFORI LQCATION'. %L.:. . -: • � �
Job no.: to 71-/140 '
Job site address: I (5' t1tgrb rdokr ■ ■ Recreational vehicle parks.
City /Stare /ZIP: ' Dr • ■ ■ Supply voltage for more than ■ Hazardous locations. 600 volts nominal,
Suite /bldg. /apt, no.: Project name; ■ Service or feeder 600 `
Cross street/directions to job site:
Ne\V residential single- or multi-ramify dwelling unit.
Includes attached garage.
Subdivision: Lot no.; 1,000 sq, ft. or •
-- Ea. :. , t
Tax map /parcel Ito.: Limited energy. portion Si
' Limited energy, multi-family 75.00 2
paJr\e..k Ck\aincit).. / 0-1F 4 residential (win, abOVO SQ. ft.)
Servkes or feeders installation, Altera ion, and/or relocation
00 amps or less 100.70 I • +
Q OPETlT_'Y OWNER ❑ T ' - _ 201 amps to 400 amps 133.56
ENAi�1T - =
401 amps to 600 amps 200.34 2
Name: �` \_ 0_," - 052A 601 amps to 1,000 amps 301.04 2
Address; over 1,000 amps or volts 552.26 2
Temporary services or feeders tnstallaliocn, alreration, and /or
C1Iy /Sta1G /ZIP: rC10 Atip m
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1 --I 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 I 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
:.. .._. .. • - - feeder - - •- • � - above service or ee fee, 2
:ArpY ICANT ❑CONTACT ;P EIRSON each branch circuit a2 , �
Business name: B. Fee for branch circuits without
service or feeder fee, first 56,18 2
Contact name:
branch circuit
Each add'I branch circuit I 7.42 , J 2
Address: Miscellaneous (service or Role r not included)
Each manufactured or modular 67.84
City /State /ZIP: dwelling. service and/or feeder
Phone: ( ) pax: : ( ) Reconnect only 67,84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
ON`YItACTOIi = Signal circuit(s) or limited-energy
Business name: panel, alteration, or oxtension. Page 2 2
e r 3 — t C Each additional inspection over allowable in any of the above ,
Address: t o ' 74 (t, r ' (j Q14 RV-E' Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66,25/ hr
City /State /ZIP: • la O ie._ — - Industrial plant (1 hr min) 78.18/hr
Phone: Gea ) D z 3 -( ct 6,2 Fax: ( p'� ) 3 — y4 Inspections for which no fee is 90 / hr
vv cifically listed (/: hr min)
CCI3 Lic.: L/3 Electrical Lie.: . w }0-- Suprv. Lie.:
ELECTItUCACkERM1T. FEES - . i -
Subtotal: /ask 1(5: S=
Suprv. Electrician signature, required:
_Plan review (25% of permit fee):
Print name: ; ( F- �X 1- (' Date; State surcharge (12% of permit fee); / a , '
t TOTAL PERMIT FEE: 1a ,
Authorized signature: This permit application aspires If a permit is nor ob wi{bin:1BB
days aver it has been accepted as c 1
• 0 'l , 0
Print name: Date; d Number of inspections allowedperpermib.
I: 1Duildinlpermifi \GLC- PermiiApp.doc 07/01/10 440- 4615T(u /OS /C01I/WEB