Permit CITY OF TIGARD ELECTRICAL PERMIT
la COMMUNITY DEVELOPMENT Permit #: ELC2012 -00142
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1 S134BD01600
Jurisdiction: Tigard
Site address: 11715 SW HAZELWOOD LP
Project: Beatty Subdivision: ENGLEWOOD NO.2 Lot: 104
Project Description: (4) branch circuits for HVAC.
Contractor: ERIC OLSON ELECTRIC COMPANY Owner: BEATTY, STEVE E
10013 NE HAZEL DELL AVE PMB 432 11715 SW HAZELWOOD LOOP
VANCOUVER, WA 98685 TIGARD, OR 97223
PHONE: 360 - 609 -4901 PHONE: 503 - 547 -4747
FAX: 360 - 693 -2980
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 03/14/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/14/2012 • $9.41
Type of Use: SF 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 co.)/ of the rules a • irect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
5///2‘.■-at
Issued By: 4r ,_ _ • erm ttee 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.
Electrical Permit Application ❑ ® toi:o1�11c1l : IiSI ONLY
City of Tigard a o °, °� j �� L a-
14 131 25 SW Hall Blvd., Ti �yS
, ' gard, OR 9 „. Flora Re)vluw
Phone: 503.639.4171 Fax: 50 , ''. r', Dom ; . 1 IN
11 c ,� i�t7 coon Line: 503.639.4175 ��.�� Due Ready/13y; El Sae P a 2 fur
Internet: www.tigltrd- or • 1
xn Notinud/MethoM Sapplemeaml lurormotiou
1( ant . 'Kgr , �•Z' . ., ,, r q :rrripv. . , M" a
• ` 1 . � .4, :r. ^' A ,1 1:iitl I'' 1::a ..'Z ''.. ` i . 1, : auI.A .r.1-1.4-7',... `, .i
o New consbuction ,�►ddition/alteran• .., .4 • , Flo dleck that apply (submit 2 Gets of plea Wham chatted bolow)
0 �r - plow ❑ Set or fccder 400 amps or more 0 Building over three Morita, ❑ DDemolition Other: �� &m et
where Ms available hull currant 0 t4arivas anti buotyerdie
s a u � 2r ■` `- '/ ' r3. errcooda 10.000 amps at 1!0 voile ur 0 Floating buildings.
�n �f .� ma: o;
` ' �a 1.0 Ie. a�a ,1' . ' l lees to wound. or exceeds 14.000 ❑ Commercial•uee agriculture!
f gt. and 2- family dwelling 0 Commercial/industrial ❑ Accessory building snips for all other iwiallotioue. buildings.
❑ Multi -family ❑ Master builder ❑ Other: Cl Vire pump. 0 ttedSUaaua of 75 1:VA or
, $� aa ar ;• epp t 7� , rr' , CI =mcrgelwy ayslem kraut &opt:otaly darlvad system
- ,w di •
9 '' ����� + � t'. ` r���i�r '� �3 ^ � `` � ; 1" � �� 0 Addipun of now motor loud of ❑ "A ". "E". "1.2 ", "1 ".
Job no.: Job site address: boom' or more. occupancy. • re", ,r L.4 ., .- 1 Kl !,r.lx or more residential units. O Rarroatioual vehicle) putt:. Ci
City/State/ZIP: + e aar ffmar •om dow cii
ro facilities.
ID Supply aoltago for more than
ty C f� 600 volts nominal.
�` ❑ H lorw
Suite/bldg./apt. no.: Project name: 0 Service or fonder 600 amps or mono.
i t4 ' N. _r eU ,,.
Cross street/directions to job site: it? SS Dart • • •. �e Total •
New residential single• or multi- family dwelling rulli.
_ 1.0 /I :/ ,- i Includes attached garage.
Subdivision: Lot nu.: 1,000 sq, ft or less 168.54 4
Ea. add'! 500 sq. ft. or portion 33.91 1
1u
1 no.: tom tee nl 2
Tma Ghee ; : : •c 't�e •e' Limiter! 67.84
...,-
_ � l 67 g4
�C . (with aba
I. itrd energy, m •Thrruly
ry 2
t ire a �l y� 4 � re D el wir seeders Inilath above 9c,. !t) —
1 ��`-- Se [ues oUullOn alteration relocation
200 amps or less I= 100.70 • 2
4 r' ' • " 201 amps l0 400 arrhpa 133.56 2
s' °8 401 snips to 600 amps — 200.34 EMI 2
Name: s' e- drip 601 amps to 1,000 amps NE 301.04 2
Address: 7/5 _'. (� • _ Over 1.000 mime or volts =MEI C 2
Temporary services or feeders Installation, alteration, and/or
City/State/ZIP: d l + et c relocation —
Phone: ) Fax: ) oo amps o less �, 39.36 i
(� � 2 01 amps to 400 amps 123.08
Owner installation: is installs ion is being made on property that I own which is not 401 imps to 599 arrut9 146,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, laid 701, Brunch circuits — new, alteration, or extension and
Owner signature: Date: . A. Fee for branch circuits with
:, t„, a • above sareiee o Corder fee. 7.42 2
' --a a' , «i "� '� , "h , : r ;,t `' ' : '^ ' ' °'' eachbmochcircuit
Business name: Eric Olson Electric, Inc. B. Fee for branch circuits without l
xervice or feeder fee, first 56,18 5Z, i . 2
Contact name: Eric branch circuit
Each add'1 branch circuit 7A2 ",t1 2
Address: 10013 NE Hazel Dell Ave PMB 432 Misceuaneous (service or feeder not Included)
Bach manulbctured or modular 69 2
City /State/ZIP: Vancouver, WA 98685 dwelling. s a - vice and/or fade'
Reconnect. only 67.134
Phone: (360) 609 -4901 Fax: : (360-) 693 -2980 Pu,rq, ur irrigation circle 67.84 2 11111 2
E- mail: ericolsonelectricggtnalLcutn Sign or outline lighting 67.84 2
•,,~','9 l gicrsi 1 �.o. ��'",� : ' ''r :721 . : k 1 st circuit a or c 2
Business name: Eric Olson Electric panel, addition. or P 2
Each additional ins at over allowable In . of the above
—
Address: 10013 NE Hazel Dell Ave PMB 432 Additional inspection (1 In' min) 6625/ hr
Investigation (1 hr min) 66.25/ hr
City/State/ZIP: Vancouver, WA 98685 78.18/ hr
Industrial plant (L hr min)
Phone: (360) 609 -4901 Pax: (360) 693 -2980 inspections for which no fee is ■ 90A0/ iu.
soecificall listed ('h kr min)
CCB Lic.: 179408 Electrical Lic.: 37.1053C Suprv. Lio.: 49105 ." ■ • ` .' ' ' '" .m '2 ' x
Subtotal: Ma. ,
Suprv, Electrician signature, required: Plan review (25% of permit foe ,!,
Print name: Eric Olson Date: (12% of y
State surcharge permit fee); • "Cl
TOTAL PERMIT FEE: + t
Authorized signature: Ties peewit application expires If a permit In not obtain %Adds 180
days alter It sax bear accepted us complete.
Print name: Eric Olson ^ � I Date: • Nuwbui' of iuspecilorn mull oliowed per mull
MIcild ci Pern tAtiC- PerceWpP doe 10/01/9 440Aelrltt I/OS/COM/WU
20/10 30Vd 0I810313 NOS10 086ZE6909E1 L0 :0Z Z10Z /E1 /E0