Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Permit
3//3k 4_pr,v)e-t4 7Lo /h/GC 2 se4 b leo rl CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2012 -00099 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012 Parcel: 2S103AA01905 Jurisdiction: Tigard Site address: 12350 SW TIEDEMAN AVE • Project: YORK Subdivision: COTTONWOOD PLACE Lot: 8 Project Description: (1) service installation. 3/13/12: REPRINTED permit to include (1) sub panel. Contractor: OAKLEY ELECTRIC INC Owner: YORK, DANIEL L & KATHLEEN S 4120 SE INTERNATIONAL WAY SUITE A102 1000 MADISON ST MILWAUKIE, OR 97222 NEWBERG, OR 97132 • PHONE: 503 - 855 -4712 PHONE: FAX: 503 - 908 -1729 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/14/2012 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/14/2012 $12.08 Type of Use: SF Electrical Class of Work: ALT 1 ea Services or Feeders - 200 03/13/2012 $100.70 amps or less Type of Const: 0 ea 12% State Surcharge - 03/13/2012 $12.09 Occupancy Grp: Electrical Total $225.57 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 dir t questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: / — ermittee 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. ii CITY OF TIGARD ELECTRICAL PERMIT il It. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00099 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2012 Parcel: 2S 103AA01905 Jurisdiction: Tigard Site address: 12350 SW TIEDEMAN AVE Project: YORK Subdivision: COTTONWOOD PLACE Lot: 8 Project Description: (1) service installation. Contractor: OAKLEY ELECTRIC INC Owner: YORK, DANIEL L & KATHLEEN S 12042 SE SUNNYSIDE RD STE 500 1000 MADISON ST CLACKAMAS, OR 97015 NEWBERG, OR 97132 PHONE: 503 - 855 -4712 PHONE: FAX: 503 - 855 -4723 FEES Quantity Description Date Amount 1 ea Services or Feeders - 200 02/14/2012 $100.70 Specifics: amps or less 1 ea 12% State Surcharge - 02/14/2012 $12.08 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $112.78 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 copy o e rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344. _ I Issued By • .e'�4----: Permittee Signature: 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. Electrical Permit A li t A d4 4-e. 1 , S ` ^° P r , F LC 20 1 a - Doo q di I C I FOR OFFICE USE ONLY City of Tigard 131® R eceived 25 SW Hall Blvd, Tigard, OR 't r Date/: : Permit No.: Phone: 503.639.4171 Fax: 503.5' t " t 1 2012 Plan Review Tt GA R p Inspection Line: 503.639.4175 Date Ready/Br : Other Permit Internet: www•tigard- or.gov CITY OF TIGARD Notified/Method: El See Paget for TYPE to 1; I to • , ` Supplemental Information ❑ New construct ion Ea:Addition/alteration/replacement p ❑ Demolition ❑ Other: ease Lek all that apply (submit z sets Ofptmts wrteras checked below): ❑ Service or feeder400 amps or more CATEGORY OF CONSTRUCTION where the available fault current M a de s g over Mace stones. rag exceeds 1 0,000 a Cr Q Mamas and boatyards. I - and 2 - family dwelling ❑ CommerciaUnd buildin exceeds 14.000 ❑ Conrmercia4 -use amica`O>rs I so volts or Flair buildings. ❑ Access less to ground or hural ❑ Multi family ❑Master builder Other amps for all other ias.'atlatioas. building. ❑ Fire pump. ❑ lnstalhtion of 75 KVA or ❑ Emergence, system. larger separately derived system. • JOB SITE INFORMATION AND LOCATION Job no.: Job site address: 1; ddition of new macr toad of (] ' p dE� I.2" l s •, co S sell/ 100HPor occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks ❑ Health -ewe facilities. ()Supply mhage for more than Suite/bldg./apt no.: Project name: OHazvdous locations. 600 volts nominal. Cross street/directions to job site: service of (Ceder 000 amps or more. FEE SCHEDULE Demo. floe tl+� New residential single -or multi - family dwed ® Subdivision: Jacinths attached garage. Tax map/parcel / Lot no.: 1,000 sq. ft. or less �� cep parcel n0.: Ea. add'I 500 sq. ft. or portion - DESCRIPTION OF WORK Limited energy, residential , ��0 (with above •.. 1)) 75.00 ill Limited energy, multi-family residential with above . R. 75.00 Services or feeders installation, alteration, and /o relocation El PROPERTY OWNER 200 mnps or less WM 1 °°. 7 ° EMU ❑ TEN/UST 201 amps to 400 amps 2 401 amps to 600 amps _ 22 ® © Address: 601 amps to 1.000 amps 11111 301.04 � Over 1,000 amps or volts - 55126 1111110E1 Temporary services or feeders installation, alteration, and /or Phone: ( ) relocation Fax: ( ) 200 amps or less - In Owner installation; This installation is being made on property that I own which is not 201 amps to 400 amps intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. I amps 599 amps 125 �© Owner signature: Branch circuits —new alteration, or extension, Date: A. Fee for branch circuits with °� above s or feeder fee, 0 APPLICANT ❑CONTACT PERSON Business name: each branch circuit - I S B. Fee for branch circuits wirhow Contact name: service or feeder fee, first . Address: I branch circuit City /State/ZIP: Miscellaneous service or feeder not included �© Each manufactured or modular ■ Phone: ( ) Fax ( ) dwellia_.serviceand/orfceder �13 Pump or irrigation Circle 2 67.84 CONTRACTOR Sign or outline lighting 2 67.84 2 Business name: r+ . . Si. circuits) or limited-energy ■��© alteration, or Ad dress: Each additional ins . coon over allowable in a , • i ° 4•a. S L. �• d ` . 5 � . ` of the above ( ; ^ -' 6625/ �� Phone. Industrial plant (1 hr met) �s` 71 Fax :( 5 )S » -. - �� CCB Lic.: /g. � s -, . � i �7 Inspections for which no fee is r Electrical Lic.:L �> Suprv. Lic.: Si � Mikan listed ('f 9o.oahr s. II Su GS Suprv. Elcctricitln signature, required: --� — ' ELECTRICAL PERMIT PEES Sol fee): 0 7, Plan review (25% of permit fee): Print name: — — Fj� Date: 3- 12_ Authorized signature: - •' ` �� TOTAL PERMIT FEE: Print name: ` Ibis permit application expires if if a permit not obtained within ISO 2;: is' vd Date: 3 - t L - r- O ; dare often it has been accepted as complete. • Number of irepectiotu allowed per permit • L'd 6ZL 1 °!JPei3 LePle0 d8£: LO Z l £ L Jen Electrical Permit Aps Ilea ticECENE 3 I I OR orrIc :F: csl•: O\LV' City of Tigard FEB 14 2012 Received r Q )� �" �� , 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review I N Phone: 503.718.2439 Fax: 503.598 6Q)/ OF TIGA V Date/By: tkherPerrtti TIGARD SI Inspection Line: 503.639.4175 „� i Date Ready/By: El See Psge for Internet www.tigard- or.gov BUILDING DIVION j Notifiedt vIethod: y Supplemental information • TYPE OF WORK PLAN REVIEW ❑ New construction p Addition /alteration /replacement Please cheek 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. l less to ground, or exceeds 14,000 ❑ Commercial - use agricultural 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 JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger 0' separately derived system. ❑ of of new motor load of ❑ "A ", `'t3' - , "7 -.. ] 3 100HP or more. occupancy. Job no.: Job site address: a 3 5 5L , l r e pt cr.,. yl AV:- ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: •7 ❑Health -care facilities, El Supply voltage for more than t r [ ei El Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: 1 Project name: El Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. 1 rec. 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') 500 sq. ft. or portion 33.92 ' 1 Tax map /parcel no.: Limited energy, residential DESCRIPTION OF WORK (with above sq. R.) 75.00 2 Limited ener multi- family 75.00 2 .. C r" t,r ! C -e - residential (with above sq. ft.) , Services or feeders installation, alteration, and /or relocation 200 amps or less i 100.70 /(,up Z 2 ❑ PROPERTY OWNER ❑ TENANT : 201 amps to 400 amps 133.56 2 ' 401 amps to 600 amps '. 200.34 2 Nye 601 amps to 1,000 amps j 301.04 Address: Over 1,000 amps or volts I 552.26 • 2 Temporary services or feeders installation, alteration, and /or CityiState/ZIP: i relocation _, Phone: ( ) 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 j 2 intended for sale, lease. rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits— new, alteration, or extension, perpanel Owner signature: Date: A. Fee for branch circuits with I © APPLICANT ❑ CON PERSON above service or feeder fee 7.42 2 each branch circuit Business name- B. Fee for branch circuits without C) .1 -t - (� j 1- - *t_ � t C service or feeder fee, first 56.18 Contact name: r branch circuit i ` L' 1 �i ' w Y Each add'l branch circuit . 7.42 2 I Address: Miscellaneous (service or feeder not included) Ci %Statci;7lP: Each manufactured or modular 67 84 2 ty dwelling, service and/or feeder Reconnect only 67.84 2 Phone: ( 5`6-3 ) ' 53—S--e/ 7/ y , Fax:: ( 5 . 0 g--/ 7.. Pump or irrigation circle 67.84 2 E-mail: . Sign or outline lighting 67.84 2 CONTRACTOR Signal circuits) or limited- energy ` panel, alteration, or extension. Page 2 2 Business name: O..�� try L I r 1 C, Each additional inspection over allowable in any of the above Address: 14 Z 6 Additional inspection (l hr min) 66.25/ hr City/Stale/ZIP: ( Investigation (l hr nun) 66.25/ hr Vv , ' r.,ln a.k_. f: i7 Industrial p l a nt (1 hr min) 78 / hr Phone: ( ) t Fax: ( 56 ) C/, g - / 7, Inspections for which no tee is 90,00/ hr C>� ! �� - Gil f ( 7 specifically listed ('/ hr min) CCB Lic.: I Electrical Li c.: Sup rv. Lic - ,`�?, " , . ELECTRICAL PERMIT FEES /f/- ,a5— ! Electrical ter—/ fi td e(, 7 / t � C� I t J 1 Subtotal: (G O � Suprv. Electrician sig a r regmre t Yi __ � s� e� Plan review (Z o % of permit fee): S Print name: j ` Date St ate surcharge (12 /o of permit fee): 1,2 `' � ,./ J, /�Zarc _ j / TOTAL PERMff FEE: f / 73— Authorized signature: -- �.�, Thla permit application expires if a permit is not obtained within 180 f / - days after it has been accepted as complete. Print name: f � �) Date: et/ 9/ 2 • t / G • Number of inspections allowed per permit. U I: 3uildingsPerm E iu \l,C- PermitApp.doc 01/01/10 ` 440- 4615TTO1705 /COMAvEB 6 6ZL 6 oialoel3 t(ei>{ep Feb. 20. 2012 10:16AIvtieE -TCC Q UAD A 50 908- 1729No. 0633 P. 1 1tl' - F , : Re to Energize an ElectricNl lns 1 ' " ' ll"a t3 •nth, t�0 :. .j 1 k Cr�r�ctriPG kCC1�riR. � T�VY'- �tkl� D l#v �D �/ REQUESTING SUPERVISING ELECTRICIAN INFURMATfON Name of supervising electrician: Ira•, Fi Si,e Supervising electrician's license ittber. S t - t t9 s Date of request: ,,J l �G / C � ; L nu Date installation was completed: I I Electrical permit no Ifa fer►por arypermif ?spoiled at the fah site, please include a ro py ofir with this farm, EMPLOYING ELECTRICAL CONTRACTOR INFORMATION Name of electrical contractor: r T L License no.: l Business address: ',p $ , ,, ..., / 5 �`i3 City: . .4., , , 1 - Z Phone: 6 _- gU - ar// Y Fax: State: 6.A.,_ ZIP: 9T�� ' ' E -mail: C USTOMER INFORMATION - Customer's name: � � fGLv.t..t_ Yi,J 1t Customer's address: z_o ��, City: vF - ..,/ Address of installation if different than customer's address: State: ZIP: City: —� State: ZIP: INSPECTING AUTHORITY INFORMATION _ Authority having jurisdiction to inspect: ° •' • Phone: Address: - City: State: ZIP: RECEIVING ELECTRIC UTILITY INFORM ATION Name of electric utility receiving request G. Address: Phone: City: State: ZIP: REASON FOR REQUEST — ~-- A. Restor'ng electrical service that was interrupted or disconnected because of either a: ervice change or ❑ Uncontrollable event, such as fire, flood, or severe weather - or , B. Electrical service at a remote location needs to be: Initialized .I xestored COMPLETION INSTRUCTIONS AND SIGNATURE ______ Supervising electrician Note: After sending this form to the electric utili Electrical contractor named above, you nuts' send a copy of this form to: energizing of a completed installation in response to the above (l) the electrical contractor, (2) the customer, and request, you must: (1) notify the authority having jurisdiction (3) the inspecting authority. • that the installation has been energized, and (2) request that the authority inspect the completed installation. Supervis electrician's signature Date Electric polity Note: Please consider notifying the inspecting authority f ' identified in this request when an installation is energized ev before inspection. II N Is. 44a -O 8 - COM pUiog/COM l