Permit CITY OF TIGARD ELECTRICAL PERMIT
• 7 2 " COMMUNITY DEVELOPMENT Permit #: ELC2012 -00079
TiGAR:D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 2S112ACO2200
Jurisdiction: Tigard
Site address: 14835 SW 72ND AVE
Project: GeoPacific Engineering Inc Subdivision: FANNO CREEK ACRE TRACTS Lot: 48
Project Description: TI
Contractor: PRAIRIE ELECTRIC INC Owner: GAROUTTE, GENE & NORENE FAMILY T
6000 NE 88TH ST 632 CHARMAN ST
VANCOUVER, WA 98665 OREGON CITY, OR 97045
PHONE: 800 - 573 -2750 PHONE:
FAX: 360- 573 -9866
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 02/03/2012 r $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/03/2012 $9.41
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 • es -.r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: _ e,:�� _ G - 10. Permittee Signature: !k c
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.
02/02/2012 10:00 FAX 360 573 9866 Prairie Electric Inc. Ej 001/002
Electrical Permit Application FOR OFFICE USE ONLY
1111/1 Cy Tigard Da - Pe rmit No.: •
(0 e, , • .
" 13125 it SW of Ha1 Blvd., T i g ard, O Plan Review
>s Phone: 503.718.2439 Fax: 503.5949150 �t��� Date/B : Other Permit: el Si See Pa e 2 for
Inspection Line: 503 639.4175 1J Date Ready/By e
TIGARD 1 Su lemental Information
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❑ Demolition ❑ Other: �� Please check all that apply (submit ?sets of plans w/items checked below):
❑ New construction ® Addition /alteratk
1 ,i I2 Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current Q Marinas and boatyards.
LL , t - 1W I.T, t t y `; + .' exceeds 10,000 amps at 150 volts or Q Floating buildings.
_� t , : '= * � � '- �°� j �.t`.�'n � t '''''''' '� i '` : °'?;' ` less to ground, Or exceeds 14,000 I] Commercial -use agricultural
❑ i- 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
a7 c ,a gym , e r ,4,1i rno :1:7:q ❑ Emergency system" larger separately derived system.
h; o , 9 " t , , � . s El Addition of new motor load of El "A ", "E ", "1.2", "1 -3 ",
Job no.: SCO Job site address: 14835 SW 72 AVENUE 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: TIGARD, OR 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: GEOPACIFIC ❑ Service or feeder 600 amps or more.
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Cross street/directions to job site: ' ' Description Qty. Fee. Total •
. 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.: Limi ted energy, residential
"i..ac. , -,-� .'r ..j(' x t! • t 9 '' % ZW :1 • ? ., (with above sq. ft") 75.00 2
,
,�k x ' 2 a ~. � '..�'' c ` - � �. 4txa !':11(� -
w ^ ° j = "� * Limited energy, multi - family
CIRCUIT FOR PHONE/DATA residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
iTi 4 W.++ * l & a 4g J 1-.,r� "" x G...M fir w; 201 amps to 400 amps 13356 2
_ -
401 amps to 600 amps 200.34 2
Name: -
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State /ZIP: relocation _
Phone: ( ) Fax: ( ) 200 amps or less
L 59. 1
201 amps to 400 amps 1 25.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 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
' i7. do � i `i w fix a l S N s t ` + e; service
each branch circuit
or feeder fee, 7.42 2
Business name: PRAIRIE ELECTRIC, INC, B Fee for branch circuits without
service or feeder fee, first I 56.18 0 2
Contact name: ANITA PASO branch circuit
Each add'I branch circuit 3 I 7.42 ,Z. l 2
Address: 6000 NE 88 STREET Miscellaneous (service or feeder not included)
City/State/ZIP: VANCOUVER, WA 98665 Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder _
Phone: (360) 573 - 2750 Fax: : (360) 573 - 9866 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E amtap@prairrelectric eom Sign or outline lighting 67.84 2
d ! f " h • ^ u . -: 'g• g �•: , q.. ,tG ' � • • ,k () -energy
aM E� �• °14 4 Pi : r. < - ` Wit ' .F. Signal • circuits or limited -ev •
Business name: PRAIRIE ELECTRIC, INC. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 6000 NE 88 STREET Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/State /ZIP: VANCOUVER, WA 98665
Industrial plant (1 hr min) 78.18 / hr
Phone: (360) 573 - 2750 Fax: (360) 573 - 9866 Inspections for which no fee is 90.00 / hr
s+ cifically listed ('V hr min)
CCB Lic.: 60178 Electrical Lic.: 7 91C Su p IIIC . ' a ter` .t✓+� c °a't. s.�:?° is
A c 3 S 1
Subtotal: ,� t
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: BILL HALBERG ' Date: 2 -2 -2012 • State surcharge (12% of permit fee): t II I
- TOTAL - PERMIT FEE: 11.61K -41'3
Authorized signature: This permit application expires if a permit is not ob. ' ed within 180
days after it has been accepted as complete.
Print Dam : Date: Number of inspecno Il r ermit�a 4,4
i s - tAppd 7 1
PtrG
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