Permit CITY OF TIGARD ELECTRICAL PERMIT
` 2 COMMUNITY DEVELOPMENT Permit #: ELC2012 00032
TIGARD. 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 2S 104AC00900
Jurisdiction: Tigard
Site address: 12980 SW 132ND AVE
Project: NORTON Subdivision: MORNING HILL NO.7 Lot: 165
Project Description: Electrical for accessory structure.
Contractor: CONDUIT ELECTRIC Owner: NORTON, BRIAN D &
19461 SW 89TH AVE MARGARET E
TUALATIN, OR 97062 12980 SW 132ND AVE
TIGARD, OR 97223
PHONE: 503 - 692 - 1428 PHONE:
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/18/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 01/18/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/18/2012 $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 may obtain rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
From:CONDUIT ELECTRIC 5036923652 01/17/2012 13:46 #144 P.002/002
RPCEIVED
Electrical Permit Application HoR fJFFIC l • • t>u '`
N Ci of Tigpard JAN 17 2012 Received i
b Date/B 5'. PermitNo.: ' O
't 13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie
• n Other Permit:
Phone: 503.639.4171 Fax: 503 -5 1'95- TIGA i® DateB
1 A R I) Inspection Line: g 03.639 I � r � Date Ready/By: ®See Page 2 for
Internet: www.ti ard -or. ov V L!NGt ON Notified/Method: 11=111 Supplemental information
T OE:WORK - • , _ .. - • ,- ..REVIEW,, : =_ i • .i ; ' :
❑ New construction L'Addition /alteration/replacement Please check all that apply (submit 2 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
74.1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. JOB SITE INFORMATION, AND. LOCATION , . ❑ Emerioncy system. larger separately derived system.
,. . , ❑ Additioa of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
Job no.: Job site address: / 2. r e i 5, W t / 3 ZN--•1 /i <J (, IOOHP or more. occupancy.
❑
Six or more residential units. ❑ Recreational vehicle parks.
7'
City/State /ZIP: ` 'l+td -O `" + e... ry 2 Z '2 / f - 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt.no.: Project name: �U (L'TONS ❑ Serviceorfeeder600ampsormore.
'` FEE SCHEDULE,
Cross street/directions to job site: Description I Qty I Fee- I Total I .
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
. -DESCRIPTION,OF•WORK'. . (with above sq.ft.) 67.84 2
;7 Limited energy, multi - family 67 84 2
/ . . c' .0 ,T c) `: % 23 u t L/O / /' y' residential (with above sq. ft.)
O Services or feeders installation, alteration, and/or relocation
200 am pso r tens ! 100 70 / �C` ' 2
PROPERTY OWNER, ❑ ;TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 73gtA ls-1 N c=t12 W`J
601 amps to 1,000 amps 301.04 2
Address: / . `l C5 5', b-J. / 32 -� A l Over 1,000 amps or volts 552.26 2
City/$fate /SIP ' f y1912 f'-- Z Temporary services or feeders installation, alteration, and /or
(J ' relocation
Phone: ( 5 - Q3) -- j �-- t' y Et' 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 to 599 amps 168 sa
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, each branch circuit 7.42 �y- �'� 2
Business name:
B. Fee for branch circuits without
service or feeder fee, first 56 t 8 2
Contact name: branch circuit
Each add'l branch circuit M`. 'W.A.--
Address: Miscellaneous (service or eeder not included)
Each manufactured or modular 67 84
City/State /ZIP: dwelling, service and/or feeder
Reconnect onl 67.84 2
Phone: ( ) Fax:: ( )
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67,84 2
' . ' CONTRACTOR . " , . , .. Signal circuit(s) or limited- energy
Business name: ent st..a t T E l,- L`' (�- t panel, alteration, or extension. Page 2 2
C7
�+ Each additional inspection over allowable in any of the above
Address: / 9 t / / ', �tr, % ti't._ Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: t +C./ T / f j /Z r 4 et ,_ Investigation (I hr min) 66.25/ hr `
C Industrial plant (1 hr min) 78.18/ hr
Phone: ($ 3) b' Z - / y 2. z.; Fax: ( $I Q. F 1 '- 3 S Inspections for which no fee is 90.00 / hr
specifically listed ('h hr min)
CCB Lic.: J G f.' ,;� Electrical Lic.: 2 ki - i'c > C_,Supry . Lic.: yS0 /s ,, , . :-ELECTRICAL` PERMIT,FEES :
Suprv. Electrician signature, required
' ]t" Subtotal: /" /s'
: � �- `c
P lan review (25% o permit fee): - .z--- -
Print name: 4 yL (Li Date: / .7 / ? State surcharge (12% of pemtit fee): / 3
TOTAL PERMIT FEE: / Z
Authorized signature:
This permit application expires if a permit is not obtained within ISO
Print name: ._. -(' Date: / / /� Z_ Num days after it has bees accepted as complete.
ber of inspections allowed per permit.
I V 3uilding \Fennits\ELC- PermitApp.doc t0 /01/09 440- 4615T(l l /05 /COM/WEa