Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMEN Permit #: ELC2012 -00081
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/03/2012
Parcel: 1 S134AD01100
Jurisdiction: Tigard
Site address: 11385 SW LAKEWOOD CT
Project: Varga Subdivision: ENGLEWOOD Lot: 51
Project Description: Panel replacement and (2) branch circuits.
Contractor: SAM HARDING INC Owner: VARGA, RANDY
23833 NE GLISAN 11385 SW LAKEWOOD CT
WOOD VILLAGE, OR 97060 TIGARD, OR 97223
PHONE: 503 - 492 -3697 PHONE:
FAX: 503 - 492 -3978
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/03/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 02/03/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/03/2012 $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 co• of the ru =t questions to OUNC by calling 503.232.1987 or 1.800 332.2344.
Issued By: - r r a 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.
02/02/2012 14:47 5034923978 SAM HARDING INC PAGE 02
A
Electrical Perl1PPIllt A, lication
City of Tigard V R D:tt v 3 e ? 2/Afft#111EIMIZZEISTPAIIEN
IN . D1 25 SW Hal 1 Tigard, OR0 cArt. Plan Review Other Permit: ac .., :A _
Phone: 503,718.2439 Fax: 503.598 Date/ft :
_
sill 'pection Line: 503,639.4175 ‘ ° r, ' 21
.1.1!■ ..:: iiiii See Page 2 or
Ah I) r Supplemental Information
Internet; www.tigatcl-or.gov 'N° s ‘ 0\
7 •• .: • -. .. 1 .: ' '';.- : ',. ....... '.:.'•,''''''''.'''. it•Cif:#ktit.- : ::i:. .;C: 0...: '.•••• '.? ': :''.,.:.. ,1 : •.;;;,• . '. . • . . . ',,„' .. k•'r: '.,••'::
picsae check all that apply (submit a sets of Ouns w/items checked below):
CI New construction gAddition/altemtionNt :lapetrictit
0 ion 0 Other: 6 \\;'' DSOTtrice Of feeder 400 amps or more El lauilding over three stories,
Demolit
where the available fault current 0 Marinns and boatyards.
• ' .. • •]. , '.:::•':,.. . ' :'• • :' • ;'.• .:..:'t A.' . thiaetttsrAltiltitiON, ' :•:':'' ..,...!•: :'. -; . : ::'.. ': :':1,' exceed!' 10000 snipe t 150 volts or 0 Floating buildings
less to Fround, or exceeds 14,000 17:1Commercial agricultural
P.5 1 and 2 dwelling 0 Commercialtindustrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. LI Insanitation of IS KVA or
El Emergency system. larger separately derived system.
• . : ..' ''. ' .... . ' .."ArhilltillOok ' , ''':'':::.'' '..' ' - : '•'' 0 Addition of new motor loacl of 1:I"A","E",
100HP or mote,
Job no.: no.: Job site address: it.3 g si4 jj emi ,,_
0 Six or more residential units. 0 Recrentiotull vehicle parks.
C /State/ZIP: 0 Health-care facilities, 0 5opply voltrige for more than
ity
ci El Ranrdoux locations. GOO volts nominal,
Suite/bldg./apt. no.: Pmject name: lig i4e.„, A „ d
0 Service of feeder 600 amps or mom, -
'. 1:': :,:',.:" .:.....::::. • •. ' • ',,.''•,' ,'
Cross street/directions to job site: ..cri„... r
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: 1 Lot no.: i .000 sq. ft. or less 168.54 4
— . ..... - Ea. add'I 500 sq. R. or portion 33.92 1
Tare map/parcel no.: - Limited energy, residential
mEIrnON OF WORk (with above sq 75.00 2
-s .--. 75.00
residential (with above sq. ft.)
_&ir L C -6 hitivi e $ c_fgee_i_si -
scrvic, ar feeders instsillationotiteration, andfor relocation 2
200 amps or less t 100.70 /60, 2
tyfilCiittrent..:b*ittg: .....:, -.• '...:•• :' 1 . •:i .., ,•' .: :.::."': tr TENANT • ::, . ;: . ...'..•''' ' ,.‘:' 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: Vg R A-, Rit At dy 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: rlcation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
Owner installation: This installation is being made on property that 1 own which is not 01 amps to 400 amps 125,08 2 4 0 1 amps to 599 snips
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 circuit with
. . . . . . . . .. . ,, . hove service or feeder fcc,
- :'' •••••: •• APP. :::::': ,...,..: ::.:[ each branch circuit 7,42 ty,sy 2
Business name: B. Pee for branch circuits without
. service or feeder fee, first
56, I 8 2
Contact name: branch circuit
Each add'I branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included)
— . .
Each manuflietured or modular
City/Statc/ZIP:
dwelling, service and/or feeder 67.84 2
Phone: ( ) 1 Pax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign ot outline lighting 67.84 2
. ,. •,,, ... ...., • .,.,.; ,' • .: , .. • ,.. ' ;,': ...M.r.rFkKrr ' ••.••; ... 1: '.. , : ,:: .. ''':.: :::, • • ' . '. ,:"•: . .,* ,., - Signal circuit(s) or limited-energy
Business name: Stu hi A et) we. ityc panel, alteration, or extension. Page 2 2
— Each additional inspection over allowable in any of the above
Address: ‘ 1 ?" N E 6I-Z s /5w sr Additional inspection (1 hr min) ,— 66.25/ ht
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City/Suite/ZIP:
Investigation (1 hr min) 66.25/ hr
9
/.. • - 4. OP ...Lod.
r Industrial plant (1 lir ft1/ 78.18/ hr
Phone: Ur 3) 76 3. 0 _375-9 Fax: (.518) IfEE - 3 7 ?,4›. Inspections for which no fee is
90,00/ hr
specifically listedly, hr rati
CCB Lie.: 5— v 8 Electrical Lie .6 Lie,: a .. L.! : :...: . , :;,. .;.,.;• ..ingcratcalpigontr
Suprv. Electrician signature, required! 4 4eRfo Plart,review (25% of permit &C I I 4 nri
Print •
name ,-51 - I 0 to r (1 F. htegdr Date; , A _ State surcharge (12% of permit fee): J 3 6 .4 _
Authorized signature: TOTAL PERMIT FEE; / 2 ? Ya
This permit appticatiou expires it a permit is not obtained within 180
days after it has been accepted as complete.
Print name; Date: ' Number of inspections allowed per permit.
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