Permit ; CITY OF TIGARD ELECTRICAL PERMIT
"7 ! COMMUNITY DEVELOPMENT Permit #: ELC2012 -00024
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/18/2012
Parcel: 2S103DA01200
Jurisdiction: Tigard
Site address: 10635 SW DERRY DELL CT
Project: Kile Subdivision: DERRY -DELL NO.2 Lot: 12
Project Description: subpanel and circuit for basement wiring.
Contractor: WEST SIDE ELECTRIC CO INC Owner: KILE, BERT V & JUDY M
1834 SE 8TH AVE 10635 SW DERRY DELL CT
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/18/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 01/18/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/18/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
This permit is iss = • - to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in acc, dance with a. .roved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTEN ' ON: Oregon la re• ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 hrou•h OAR 952 -00 009•. • may obtain a copy of the rules or direct questions to OUNC by calling 582232.1987 or 1.800.332.2344
Issued By: k. . 1' 4LLlI _ Permittee Signature: 41111M !Ai / ! —
r
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
• NTRACTOR INSTALLATION ONLY
•
SIGNATURE OF SUPR. ELEC' ■ / /( / Date:
y
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
2012 -01 -13 13:02 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit Application 1•01< (n..1.1( I I .I l' 1\ I )
City Tigard R aves
III t3' 8 r Pcmt ,. A
13125 SW Hall Blvd., Tigard 0,1t 9223 O ' ' . man /
• Phone: 503.639.4171 Fa$'503k598r1,960 `� pate/11 : Other Permit
• i c I , , , inspection Line: 503.639.4125 eep N -0 r Q w \ Date Ready/By: huffs: '• P age 2 for
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Internet: ww.tigard- or,gov N. \>,\\ \>,\\ Q i �', " ' NotifudJMethod: Sapplemeatal Information
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„ ° ` " Please c hock all that apply ❑ New wnslruction Addition /alteratidn!['ep�aeemen � pp y (submit Latta of plans wriremy checked below):
\4, ❑ Sonia: cc feeder 400 amps or more ❑ Building over throe ratmiea.
El Demolition ❑ Other: ,,N�
where the available fault cwrenr [] Marinas and boatyards.
: :'f
!t �� +' i•'^ i'�'! : r d � • lrfe. ., .'ik -b ^ix' y ,." i"w <. �;,y.y; !� i.,�.p � �.,:� ,¢
r c, N> 416:1 .� .4 iy " ,;3106 . l s : ?y nl� 1 ';t : a r " ; y �r k,kgri; i R elcceeds 10.000 amps at 15o volts or ❑ Floating buiidiags. .
INS to bound, or exceeds 14,000 ❑ Commercial -use agricultural
(El 1- and 2- family dwelling ❑ Commercial /industrial 0 Accessory building amps for all other installations. buildings,
❑ Multi family ❑ Master builder ❑ Other: ❑ Fire pump. D Installation of 75 KVA or
'vt 4r ,>Ii r I�'W' , ' 7 04,3!•4•,.,1•A Kw "a �. r' T ,, ❑ Entergency system larger separately derived system.
' t r 't +i °, r1 : 41 i a s , . �, - • ' , • . , . o e k s, rs, 4r,'a b l ' ai. � , r :s' z,"
" � - , _ y;, (, „cy:Rq, �r ❑Addition of new motor load of ❑ "A” - `E" •1 - "1 -
!
Ci / State/ZIP' // �! / � l �� � f Job no.: j g c( 3 Job site ddress: / L .S , a f f o ry s/� C/ ❑Health -Dare facilities. ❑ 3 100HP or more, occupancy.
ty [] Six or more residential units. ❑ Recreational vehicle parka.
f / 1 voltage for more than
�p Y ts8
❑ Hazardous locations. 600 volts nominal,
5uite/b[dg. /Opt. n0_: Project name: < / f /e_ r ❑ � Service o
411.! feeder 600 amps or more. y . —
;. 1 .A.6A i�i'..`'�`kw'A'.f. .. .. (SY.S'..' :lCjii : ;T .'Ai . .. /.
Cross street/directions to job site: ow,4adei
errr- l Fe I raw 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'l S00 sq, ft. or portion 33.92 1
ulii , a �M7�M t ;','.' x Limited energy,
bov residential 75,00 2
Tax ma arcs no.: /
S 2 �l 'l 9 �l/ D n , f/ � Z t /, (w above bov t Iil
. g '�'", kt / n0 � : :t�!iV.� -$i t L� °.�
L energy. y. multi- fiunily 75.00 2
L /� n 1 n j ! residential (with above sq. ft.) .
f" Services or feeders installation, alteration, and/or relocation
tAi //7/1( 200 amps or less / 100.70 / 00 z2 2
n , �k.'-1 ., Jr '(t 1 f.i a g ..,yC Iap 't•J:ri■,,`5 ' "V' 201 amps to 400 amps 13336 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Addre88: Over 1.000 amps or volts 552.26 2
City/State/ZIP: • Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 1
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 125.08 p 2
intended for sale, lease, rent, or exchange, according to OR 447, 449, 670, and 701. 40l am ro 599 ams 168 2 .
Branch circuits — new, alteration, err extension, garland
Owner signature: Date: A, Fee for branch circuits with
• , - rr if w • . , Ir a(R ra above service or feeder fee, LO---
�ys ' :! ii': tu ' , i ;'; S! , '" r'''-'' c C -: T. f. (i . : E M r .... � . i vl' / 7.42 7 2
,�" .i " •. ., a each branch circuit
B. Fee for branch circuits without
Business name. .._ service or fender fee, that
Contact name: breach circuit 56.18 2
- each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) 1 Pal;: ; ( ) Reconnect only 67.84 2
— Pump or irrigation circle 67.84 2
E - mail Sign or outline lighting 67.84 2
ry >"!1 ' t1 �wg�y� t .r T.W. ` M'°' I ' ,'., ey a pi t ' , ° # ?J1' 1a,4 �' + arty
. ,.?k , .0 '� .ti`� ,M1..,7 �; 4�i�Ya� ^ a ,�.�ira�..,: , n,� x' ,..1 . -'f `v 1:� 1 �°.4; �,. Si circuits) or limited-energy
Each Janet, additional on, insp extension, Page 2 2
Business name: west Side Electric Co., Inc.
Each al inspect over all owable in an of t above_
Address: 1834 SE 8th Ave. Additional inspection (I hr min) 66,25/ hr
City /State/ZIP: Portland /OR/97214
Investigation l hr 66.25/ hr
Industrial plant (1 hr m in) 78.18/ hr
Phone: (5 0 3) 231 I Inspections for which no fee is
F ��(503 736 -0677
specifical listed (i41v mm 90.00/ hr •
ctrical Lic.: 2 6 -13 5 C 5 uprv. Lic.; c} 6 5 4 - S '"'' ;'. •{ r-. lE [., , a.;,
CCB Lie.: 13 3 0 6 i Ele
Suprv- Electrician signature, required: , � ,. / Su it fcc) /
.. 1 / Plan review (25% of permit fee):
Print name: Randall F Roberts Dote: / /1 State surcharge (12% of permit fee): / ...1 '
TOTAL PERMIT FEE: / L /
Authorized Signature: This permit eppaeation aspires if a permit Is not obtained within 180
days after it has been accepted as complete.
Print name: _ -
L• Date: • Number of inspections allowed per pemtit. V
, amid,neWarmis1ELC- PemutApp,doc 07/01110 d40.4615T(I I/05/COM/WPB V
4.