Permit q CITY OF TIGARD ELECTRICAL PERMIT
111 " COMMUNITY DEVELOPMENT Permit #: ELC2012 -00080
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 2S103BA00107
Jurisdiction: Tigard
Site address: 11710 SW ANN ST
Project: POTTHOFF Subdivision: LERON HEIGHTS Lot: 7
Project Description: (1) branch circuit for additional lighting.
Contractor: PARKIN ELECTRIC INC Owner: POTTHOFF, ROGER & MARY
14001 FIR STREET PO BOX 23968
OREGON CITY, OR 97045 PORTLAND, OR 97281
PHONE: 503 -657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/03/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/03/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 co. of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: Permittee Signature: '� /mile -
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: 02/02/2012 11:34 #214 P.002/002
• Electrical Permit Application , ti FOR OFFICE USE ONLY
City of Tigard e Received
DateB Q 1 " • • „ • 1
711 4r 13l25 SW Hall Blvd., Tigard, Plan Review -
P hone: 503.718.2439 Fax: 53 1 i ti5 \ Date/B : Other Permit:
_ _
T I G A RD Inspection Line: 503.639.4175 �� ® ® ® ®W i Date Ready /By: 0 See Page 2 for
Internet. www.tigard or.gov ! C � r ,Q ts` Notified/Method: Supplemental Information
- ,ti ~ ` ":.� "5'; :Ye;::.> itf� s"<f> :.sib;. �, y ..
;`jf
R x; O g g ;: W. � -
❑' Y New construction Addition/alterat� lad n t Please check all that apply (submit 2 sets of plans w /items checked below):
" ` vie' ❑ Service or feeder 400 amps or more ❑ Building over three stories.
El Demolition ❑ Other: `) ‘ L where the available fault current ❑ Marinas and boatyards.
::,;,1S-.. °'yl�' �" �Q�T
;:{ "" " "i`s`.�•. - :.r. ar.. f.�ii''- ',.5•�; exceeds 10,000 amps at 150 volts or Floating buildings.
�'l %'; : � "? + -.:� „- _ ,"=; �:,.:. �-..<...:•.,^ �,:...,. f,: r., ._- ..,- s.�.- ,.. ;:x-'�.. ..'- .�'r; "___t s�f.=..,�,...v,, -.,t, less to ground, or exceeds 14,000 ❑Commemial•use
(s 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
v" >r: - _ ❑ Fmer enc s stem. lar er se amtel deriveds stem.
_ _ _ : -riser nx,;:s ^,° - �t�- 8 Y Y g P Y system. ..:. � �.,, . - - - . - < - - � -pis Addition fnew motor load of "A” "E" "I -2" "1 -3"
Job no.: / ,RGti Job site address: ` 10 100H
or oo e occupancy.
�/ ✓✓ ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: 0 facilities. El voltage for more than
/ �� 2(/t�f/ l / 600 volts nominal.
/t ❑ Hazardous locations.
Suite/bldg. /apt. no.: Project name
`./h Jil. ❑Service or feeder 600 ramps or more.
Cross street/directions to job site: ""'" ..,..Y r. ,
I Qty. t Fee. I Total
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'] 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
,:
.
- ..: ,. ::: -: r -a,:� : (with abovesq.fL)
' :'�he; rtie'
'T _ �:. >,J,i,:.4�:.za:,':.,,
I (1R ) fUlU 1I 1 Limited energy, multi -famil 75.00 2
1 17 )b residential (with above sq. ft-) _
}` Y t^ r (r Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
" "'3°l +w: - a +° lit ^= = -`'.< = 201 amps to 400 amps 13336 2
_ <p ROPERT:Y..bt'4NETt- -:� - - - - f� ;�,�tE . A'Nfit�;��- -- = '>",._ p
. i ce : :: :" ... :,. :.....,.. ,...... �:.....,..:::- tF.:" - �. - ! z:' - . . -,. .m _s.,. - � - -" ,� y.� -
Name: " " 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: _ Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I 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 168.54 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
- - - '= - > `_v,r- _ ;,a _ - P -- __ . .. a bove se rvice o r feeder fee
. • :E '' : . : 7.42 2
i1P'YMiCi1N1`'�; -. - ._�'. O ]HTAC;T,�:PF.[tSON- �: < "r�:.� ,. .
...... n ,.. ,..., ..,,, -... ..�- -.., .,. . ^�,�' ^�..,... ,. ��:...,...,,..:, ., ...... - _.......,, . ,...,, ° each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first / 56.18 63 /1 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.84 2
City /State /ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail:
Sign or outline lighting 67.84 2
=`-:
- . _ -., ,,. -. •N'�'ItA , ... ., ...., , , ,:, Signal circuits) or limited
. Business name: Parkin Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (I hr min) 66.25/ hr
City /State/ZIP: Oregon City, OR 97045 • Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 657-4958 I Fax: (503) 557-1059 Inspections for which no fee is 90.00/ hr
specifically listed Oh hr min)
CCB Lic.: 3515 Electrical Lie.: 34-4C Suprv. Lic.: 4241 -S r' "Y.- ::..,..".;� - AJ
L�� .;�. ?x. }w•w�:.- : ?���EIT�";<'tuC _O12i4IiIMFS' A Xwt'::
Suprv. Electrician signature, required:
Plan review (25% of permit �� /'
rmit fee):
Print name: David B Parkin Date: Z. 2,•/ a State surcharge (12% of permit fee): (,, -7 (1
TOTAL PERMIT FEE: - ' p2 , 6-1
Authorized signature: This permit application expires If a permit Is not 0 fined within 80
Print name: Date: s days after it has been accepted as complete.
Number of inspections allowed per permit.
IABuilding VermitsAELC- PermitApp.dac 07/01 /10 440 - 4615T( t l/OS/CO)NWES