Permit •
CITY OF TIGARD ELECTRICAL PERMIT
'� COMMUNITY DEVELOPMENT Permit #: ELC2012 -00043
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2012
Parcel: 2S 10X800700
Jurisdiction: Tigard
Site address: 13044 SW GRANT AVE
Project: MY FINANCIAL WORKOUT LLC Subdivision: NORTH TIGARDVILLE ADDITION Lot:
Project Description: (1) service and (2) branch circuits for panel grounding.
Contractor: CONDUIT ELECTRIC Owner: MY FINANCIAL WORKOUT LLC
19461 SW 89TH AVE 4636 SW KELLY AVE
TUALATIN, OR 97062 PORTLAND, OR 97239
PHONE: 503 - 692 -1428 PHONE:
FAX: 503 - 692 -3652
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/26/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 01/26/2012 $14.84
Type of Use: SFA Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 01/26/2012 $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 obtain a copy of re rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: !_ _ Permittee Signature:
49%110
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.
Electrical Permit Application ���� FOR OFFICE USE ONLY City of Tigard rt Rec % ( -
t ' a . o\ DateB : I t r Permit No.: ?-b (�1
q 111 a
13125 SW Hall Blvd., Tigard, OR 97223 6 �- Plan te Rev iew
Phone: 503 639.4171 Fax: 503.598.1960 ` % Other Permit:
B
. I . I (.i A It D Inspection Line: 503.639.4175 ,}� . 1 , ate Ready /By: D ® See Page 2 for
Internet: www.tigard- or.gov � J ....,(4.11.1o:
� 1 � �� *5 Notified/Method: , Supplemental information
TYPE OF WORK , � ,\�9�� PLAN REVIEW .
111 New construction [Addition /alteration {r e placement 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
Kl- 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
❑ Emergency system larger separately derived system.
JOB SITE INFORMATIO LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "i -2 ", "1 -3 ",
Job no. /� 100HP or more. occupancy.
: 2 5(13. 2 `1 Job site address: 5', tAt V v'— A UK
/ t 1 Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: "Trot /� 0 � ' - t 2. 3 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
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
DESCRIPT ON OF WORK (with above sq. ft.) 67.84 2
/ Limited energy, multi- family 67.84 2
PANE( `1P. 6 /Njt P\-1 -C n-(_( /34e -13 (L..�S t/ 1/V) residential (with above sq. ft )
• 0 Services or feeders installation, alteration, and /or relocation
/ Np it.i -C 5. 7 C(e +3-N L'/1 r i€A j U ( 1 xi 200 amps or less / 100.70 /(3'• /(3'• 2
51 PROPERTY OWNER U ❑ TENANT . 201 amps to 400 amps 133.56 2
K l p� V 401 amps to 600 amps 200.34 2
Name: N' /� c F V-1 L 1 . fi C ' t P C l / I L l-2 2
pp 601 amps to 1,000 amps 301.04
Address: . `i (O 3 , 5 • W , t E l Ly A Luc_ Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /Z1P: ? -rL - C 4 c C^YL._ G 1 2 3 ? relocation
Phone: ( 5) `C3 ( ? — c t Z a? 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 2
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, 7.42 2
each branch circuit
Business name: B Fee for branch circuits without
service or feeder fee, first
56.18 e ,r 2
Contact name: branch circuit /
Each add'I branch circuit y 7 42 f 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
• panel, alteration, or extension. Page 2 _ 2
Business name: 0..‹)tv4)LiCT L - eC - T{ - 4 -C Each additional inspection over allowable in any of the above
Address: / YS I 5 , ici r / /' ,4' U -C Additional inspection (I hr min) 66.25/ hr
City/State /ZIP: Z 4
! C it �'/ N C F 7- rb CpZ Investigation (1 hr min) 66.25/ hr
C. Industrial plant (1 hr min) 78.18/ hr
Phone: ( 5 V 3 c. c( , - 14 Z S Fax: ( �3 Lei F 7 - 3 4e 5 Z Inspections for which no fee is 90.00/ hr
P f ��,,�� � specifically listed ('A hr min)
CCB Lic.: /c A f � Electrical Lic.: 2 Go o /i- t<uprv. Lic.: / I ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: C 5Pv_�
Subtotal: I (�
Plan review (25% of permit fee): , ----'
Print name: 'C., H- 0. S P (r--,z Date: / / Z /` Z-- State surcharge (12% of permit fee): / 3 g‘
TOTAL PERMIT FEE: 2 Q i
Authorized signature: This permit application expires if a permit is not obtained within 180
� ` days after it has been accepted as complete.
Print name: S -` D Q �C Date: //2 y / L r N um b er o inspections allowed per permit.
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1 \BuildingPerm \
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