Permit q CITY OF TIGARD ELECTRICAL PERMIT
C - COMMUNITY DEVELOPMENT Permit #: ELC2012 -00164
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/23/2012
TIGARD Parcel: 2S111DC11901
Jurisdiction: Tigard
Site address: 15880 SW OAK MEADOW LN
Project: Subdivision: SUMMERFIELD NO.11 Lot: 615
Project Description: Change (1) 200 amp panel, add grounding and replace (1) branch circuit for NC.
Contractor: GENIE ELECTRIC CONSTRUCTION INC Owner: DENKER FAMILY TRUST
8701 SE 156TH AVE 15880 SW OAK MEADOW LN
HAPPY VALLEY, OR 97086 TIGARD, OR 97224
PHONE: 503 - 762 -9296 PHONE:
FAX: 503- 762 -9188
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/23/2012 $100.70
Specifics:, amps or less
1 crt Branch Circuits w /Purchase 03/23/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 03/23/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 OA • 52 -0 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /
Issued By: %/' � Permittee Signature: 0/1/ (9 j ". L /e� o .
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 603.639.4176 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.
•
Mar . 22 .2012 04 : 14 PM Genie Electric Constructi 503 762 9296 PAGE. 1/ 2
., f oc)
Electrical Permit Applicationc\ No •oR 01•1•1( 1. ( !,1.• ().1.■
City of Tigard .31 vs' (ip'■1; Received I iigr A g51r1,71 / 11 . .
11111 ' Phone: 503.71/1.2439 Fax: '',1 .598.lek - 1J
1 eA) Da..14.4.1
Plan Review
Data : Other Permit
C \
RI , inspection Line: 503.639.4175 *es' - ..c \c1,, ,A Unto koady/By: hots: 9e
. eel Page 2 for
Internet: www.tigurd , 06. N . Notified/Method: 1 1( - 11.' '
tiupploasental Information
7i14:WWPO:;',K4OMAIFelif0A4i4tYfW.:%`;.,X t a*,,00004P0)10..4t044gKga':
[]New construction AddtionaIttqthplacement Please chock all that apply (submit a solo anions Witems checked Wow):
0 Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition 0 Other: where tho avaihible fault current 0 Marinas and boatyards,
''"5-..."1...1.‘'Plitikift01**,:it%01 pAktga-0-1:41;',1::,,I;N:::.■;:;t:I:;!7?'.,;y.?.,;:eli exceeds l0,000 amps at 150 vohs or 0 FlOraing buildings.
,;.2.K.'. A*. • ,,, 7 —. ' , z. .....-' - • - ^ • • - . - - - ,' • r -. ' ,- • "i km to ground, or oxecois 14,000 0 Commaroinktso agricultural
E1
1 1. and 2-family dwelling 0 Commercial/industrial 0 Accessory building runps for all other illation. buildings.
0 Multi-family 0 Master builder C] Other: 0 Fire pump. 0 lnstallolinn ur7s KVA ur
.. Dlim onaysyt t ani. larger soparealy derived system.
14
, .,„.,......,...' 0 Addition of new motor load of 0 " A ", "It", "1-2", "1-3",
• , •
Job no.: 51 I Job site address: 1 5 ts O ... ai p eac t v , / ,. 10011P or more.
1 is 0 Six or more residential units. cowpony.
0 Recreational vehiclo parka.
City/State/ZIP: 'Tk • 0 Health-care facilities. 0 Supply voltage for more than
-1 LI ri.. i 0 Hazardous Mentions. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 1 0 gervite or feeder 600 amps or more,
,*d•i:'6
Cross stied/directions to job site: uuerision Cft. Fee. Total
—...—.....— .....
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It or less 168,54 4
Ha. adcel 500 sq. It UT portion 33.92 1
Tax map/parcel no.: Limited energy, residential It) P 75.00 2
! Z• 4 1 . *, '-'4. ' , Y ,l 'i t ":WVV44# 4 0 1 0104*** 1 4-W 3 l 1: fig t' r i1 ,?.a . e . J , I .' : : . : ' i (th abac 841
i Limited erangy, multi-family
e Ct 11
A
6 ; ylt, as . CiPtApt 0 w'i / 6f0 :11 residential (with above sa. It) 75.00
Serlo
ves or feeders Installation, alto Moodie ! 2
A
a 'it. -)1,NPre- . Vt., 4le..+" 200 amps or has I 100.70 1
1f e 7
. ,-.. ‘,._,,.,,,,,,,,....,,,,, ".gp 201 amps to 400 amps 13336
II
7,:::7, ,, t , ,•,‘, ..,AIR.t,*. , :!.„,:,:, ' .•;
Name:
401 amps to 600 amps 200.34
—....„--
601 amps to 1,000 amps 301.04 2
Address: over 1,000 amps or volts 552.26 2
Temporary services or Headers Ingtallation, alteration, andfor
City/State/ZIP: relocation
Phone: ( ) Fi(-----) .-- 200 amps or Icsa 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
401
intonei for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps to 599 amps 168.54 2
...et. Branch elreults - new, alteration, or c tension, it cr panel
0m4i4lignature: Date: A. Fee for branch circuits with Cf __,...
si k... ek ... , ,,,..., z , • ,. • .• .... • • ,.,;,..,. ; ...-,1....:,7 above service ur feeder Pse,
- "= . - :',.-„It-.' ? ' 'i,', -;•:-.... : .4iitsgio- ..i ,:; ,.:., ( 742 ? - 2
. • .. ,„ . ..• ,. • 1 ,:, - • • - - .,.::'-':''. " - •-!.. each branch citrault
Business name: B. Fec for branch circuits without
advice or feeder fee, first
56.18 2
Contact name: branch circuit
Hitch add bruuch circuit 7.42 I 2
Address: Miscellaneous (service or feeder not Included)
- Hach manufactured Of modular
City/State/ZIP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or inigatien circle 67.84 2
, Sign or outline lighting 67.84 2
• '"l;.
Signal . . „_.... .
'' .. ,:..-- • N- , „:94 ,...-, • Sigma CJIVUlga) OT lunged-energy
Business name: 87 SE h Ave panel, alteratimor extension. Page 2 2
Ends additional Inspection over allowable in any_of the above
01. 156t
Address: Happy Valley, OR 97086 Additional inspection (1 hr min) 66.25/ Iv
. —.
Investigatiim (1 hr min) 66.25/ In
City/State/ZIP:
Industrial plant (1 hr Ilan) . 78.18/ hr
Phone: -3) ?a, 2,.. < 6 "Fax: (02 ? 6 z_. 1 / 8 Inspirations for which no fee is 90.00/ kr
. 'flea Hued 'A hr min
6/ CCB Lie.: c6 3 rip illk Si ,5" Kal Lie.: 7 At Suprv. Leo.: 4.1 , ny,
11
Suprv. Electrician signature, required: - 1 . to if I g
Plan review (25% of perm t . ''''.....-..
i
Print name: e ....e o4 ((e) Dale: 3/ L -v, 2.-. State machine (12% of permit fee): ,
TOTAL PERMIT FEE: '
Authorized signature: G-
Thi vermtt appc
----cp ; --
s lIatirm expires If a permit Is not obtah. wont IVO —
L 4.......v*
Print name: . _re) &Ale Date: '3 2:21/ a-, "urnh.. a i tys p. a i l i ler . k o has iowed been pbr accopt t ed as complcto.
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o 440-4613T(I INYCOM/IVIiil le4(
•• ••• • •„_• • • • . ... ...... .. ...... ..._