Permit CITY OF TIGARD ELECTRICAL PERMIT
IN z COMMUNITY DEVELOPMENT Permit #: ELC2012 -00124
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/02/2012
Parcel: 1 S125DB07400
Jurisdiction: Tigard
Site address: 7165 SW SHADY CT
Project: Sweet Subdivision: SHADY DELL NO.2 Lot: 47
Project Description: Move (1) outlet & (1) switch.
Contractor: BECK ELECTRIC INC Owner: SWEET, MINOO S
15600 SE FOR MOR CT #B 7165 SW SHADY CT
CLACKAMAS, OR 97015 TIGARD, OR 97223
PHONE: 503 - 656 -7396 PHONE:
FAX: 503 - 656 -4397
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 03/02/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/02/2012 $6.74
Typq 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 . •r•a .- , ith 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. • TTENTION: Oregon a . -quires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -• -01 -0010 through OAR 951,11 -019' ou may obtain a copy of the rules or direct questions to OUNC by calling .232.1987 or 1.800.332.2344.
Is ed By: / I 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' �`Pir c-_______, 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.
Feb 2912 04:20p Beck Electric (503) 656 4397 p.1
Electrical Permit Applicatio �S) FOR OFFICE USE ONLY
�r���
City of Tigard �'l, Received
DatuE : . Y;L'!/ �GP.A1 PemritNo.: f ` 4 . 1/.1 -erva
I
a 13125 SW Hall Blvd., Tiger - . A � - Plan Review
• 0 Phone: 503.718.2439 Fax: . 98.1 Y Datc,Ev: Other Permit:
TIGAItU c
Inspection Line: 503.639.4175 T Gp�� �, Date Ready /By Judo: S5 See Page 2 for
Internet: tswa.tigard-or.gov 4,► 0 ,� t��0 NotifiedlMahod: Supplement Information
• TYPE OF '�i' a � \ • • PLAN REVIEW
placement Please check all that apply (submit 3 sets of plans wtnans checked below):
❑ New construction ® Addition!aI:C
❑ Sc :vice or feeder 400 amps or more C Building over three stories
❑ Demolition 0 Other: where the available fault current G Marinas and Boatyards.
. . CATEGORY OF CONSTRUCTION .. exceeds 10,000 amps at 150 vales or ❑ Floating buildings.
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 KCVA or
agency system. larger separately derived system.
.. JOR' SITE.•. L�NF(r1Rl TIQh1'_ ANTi4 IC'ATION. '..
:. •.. moto load of
. . . ❑ Addition dam ❑ ^A ", "E" "I i"
Job no.: 16648 Job site address: 7165 SW Shady Ct or more. ocutpancy.
Six x o or r more residential units. ❑ Recreational vehicle parks.
ar
Ci[ iState/LIP: Tigard, OR 97223 ❑ Health -care facilities ❑ Supply voltage for more liar
❑ Hazardous locations. y la 600 volts nominal.
Su1 tefbl dg./apt. no.: r Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross streetidirections to job site: Description I Qry. I Pea Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 1 168.54 4
Ea. add'/ 500 sq. ft. or portion 33.52 1
Tax map /parcel no.: Limited energy. residential '
DESCRIPTION OF WORK (with above sq. ft.) 75.G0 2
Limited energy, multi - family 75.00 2
. residential (with above sq. fl.)
Services or feeders installation, alteration, and/or relocation
Move one outlet and one switch 200 amps or less 100.70 2
Q. PROPERTY OWNER I • • • 0 TENANT 201 amps to - 0C amps 133.56 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 59 36 I
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 158.54 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
' ❑ APPLICANT ❑ CONTACT PERSON above service or feeder fee, 7.42
• each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add') branch circuit 7 421 2
•
Address: Miscellaneous (service or feeder not included) ,
Each manufactured or modular 67.34 2
City /State/ZIP: dwelling, service and/or feeder
Phone: ( ) Fax : : ( ) Reconnect only 67.34 2
Pump or irrigation circle 67.84 2
E-mail: Si or outline lighting 67.64 2 • • CONTRACTOR ... . . Signal circuit(s) or limited-energy
panel, a1 erasion, or extersion. Page 2 2
Business name: Beck Electric Inc Each additional inspection over allowable in any of the above
Address: 15600 SE For Mor Ct., Suite B Additional inspectton(1 •r min) 66.25/ hr
' Investigation (1 hr min) 6615/ hr
City/State /ZIP: Clackamas, OR 97015 Industrial plant (I hr min) 78.18! hr
Phone: (503) 656 - 7396 Fax: (503) 656 - 4397 - Inspections for which no fee :s 90.00! hr
_ specifically listed (V. hr min)
CCB Lic.: 2629 Electrical Lie.: 3 -5C Suprv. Lic.: 5024 - ELECTRICAL PERMIT FEES
Subtotal: 56.18
Suprv. Electrician signature required Plan review (25% of permit fee)
Print name: Charles Bannister Date: 2 -29 -12 State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE 62.92
Authorized signature This p ermit application expires if a permit is not obtained within 1
\ � J � G days after it hum been accepted as complete.
Print name: Charles Bannister Date: 2 -29 -12 • Number of inspectionsallonedperpermit. •
I :, Build 'ots':PortotilELC•PemitApp.doc 07.'0//10 '40- 46157( I VOL W'
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