Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00170
.I1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/27/2012
. Parcel: 2S114AB14200
Jurisdiction: Tigard
Site address: 9385 SW JULIA PL
Project: SKYBERG Subdivision: KNEELAND ESTATES NO.2 Lot: 105
Project Description: (1) 200 amp panel.
Contractor: WEST SIDE ELECTRIC CO INC Owner: SKYBERG, JON HOWARD & SUSAN LEE
1834 SE 8TH AVE 9385 SW JULIA PL
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503 -231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/27/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/27/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through 0 952- 001 -0090 You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature: gn/ /5 C �/7O/l/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept in a conspicuous place on the Job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
L &7RIC,9 1°-71-H / TiErFII ED r
• 1312$ SW Hall Blvd., T OR 97223 M � .- Qo1 o
Phone: 503.639.4171 Fax: 503.598.1 " A R 2012 . /iv : Other P c/yiro, /.2 QOosep
•r ; r, n Inspection Line: 503.639.4175 Date Reedy/ay. , e , See Page 2 for
Internet www,tigmd or.gov CITY OF TIGARD Notieed/Matlad Supplemental Information
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❑ New construction .Addition/alterationheplacetnent Please cheek all tent apply (submit j seta efpim, w /items chocked below):
❑ Demolition ❑ Other
0 Service or feeder 400 amps mime 0 Building over deco stories.
where dm available fault current D Haines and boaeyardx
g:.a�. h , y � \'> ..r�.. ..fi .,. p.,.� A• ... •+•�J1J7 � l ' (�'�; (�� k }y� ill 1O,Qlt° et'
leas eo at I" "Its �w'f4ka� : r�' ��., ��. ��4�T; y� :+it?sr';k:5,.a::�:t :;G"�:;��: "m � � A00 0 Commercial-use agricuituml
.. and 2 -family dwelling ❑ Commercial/industrial a, or succeeds is
0 building amps tar all other iastauotiom. buildings.
Cl Mull -family ❑ Master builder ❑ Other, 0 Fire pump. 0 Installation of 73 KVA or
ag,�� ��. :ems Q ; " t . �,, r +:
0 gmullem7 BriterA larger separately derived system.
` � �"� t a T , x - + D Addition of new motor load of 0 °A , °6", "1.2 "1 -3 °.
Job no.:.7 Laipl Job site address: S5 5L.) JU(lCt,, fL 10011P ormore. °CC ''
0 Sot or more residential units ❑ Remotional vehicle parks.
City/State/ZIP: 't 101 D Ti.. ° I. - 72. Oxeoltn- eare&'lides. kac for more then
5ut. no.: I 1/1 / 0 Service or feeder 600 locations. 600 volts nominal. ite/bldg ap
Project name: !j " "' 1 J (:)1Q �Sorvicoor
A fe.:,,nCs'� 7 t ; a- i , • ' T, w : i :.� � , t w '(y ]L•-uaytis'..,.; • • ,t � , � 1/. •.,
Cross street/directions to job site: r s: �: �,7t : aj?. r �1SC1 'rcE .:l Jel
mowiww New residential single• or meld-Emily dwelling unit
Includes attached garage.
Subdivision L ot no.: 1.0°m. ft or Ions 168.54 4
Tax map/parcel no.: Pa paa'I 500 s4. It or 33.92 1
,.
•��I.w .• � \ �...} � ... S ... na,,, .•,,. . energy. 75,
"Yam pa ri Rte' Y h .iAi S `� a Limited calf 2
'U�• .ASV, � ^::,�q� �. '• py ��a:a ,.;� ) l hy
' '�+�1.�7T�1� :..o�.►a1$7�.�JfIM �.::�w,..dlti:f� J.� � �'�;: (with Above SQ. RI
Limited energy, multi - family 75,00 2
residential-(with above sq. ft.)
Services or feeders installed° alteration and/or relocation
Male _ 200 amps or less 100.70 „it) 2
i ZagaI :Fkt4» "n 201 empSt0 133.56 2
Name: $ K y 6 G 401 amps to 600 temps 20034 2
/ 601 amps to 1,000 amps 301.04 2
Address: 93 (9.5- Sol ... 7 - it L / A / Over 1,000 amps or volts 55226' 2
City /State/ZIP: T G/f- e 9 72 c1 Temporary services or feeders Installation, alteration, and/or
7 relocation
Phone: ( ) I Fax: ( ) 200 maps or less 59.36 1 1
Owner installation This installation is being made on property that I own which is not 201 amt s to 400 m ops 125.03 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168 54 z
Owner si elute: Branch circuits — aew,.alteration, or extension. per panel
Sn , Date: A. Fop ibr bnmch circuits with
% 'fi n „ 1. ee Leh �: c . .., �� �, r
� :i a 1 : . ,, M .! yes . v\, Five", , ',', ;, . , y ;� r (.r' g above service or feeder fee,
,: ' �� each branch oirettit 7.42 2
Business name: B. Pee for branch circuits without
service or fades fee, first
Contact name: branch circuit 56.18 2
Address: Each WI branch circuit 7.42 2
Miscellaneous service or feeder not included
City/SNIP; Each manuihctuted or modular
dwelling, service and/or tacder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
' cr .� L . Sign or outline lighting 67.84
x : ;ri ly1 , c■0 • M' v.' tih'C IS .�� 6atY4 [I�Ir':'L*n e,,,va1!a'M,�".�r:•� p . 2
, , 'J:J /b-'K^i a12:]Y.' \�' stool (ttrrtat�.S) or lltlll
Business mole: West Side Electric Co., Inc. ,, alteration. or extension. Page 2 2
Each additional inspection over _ allow aWe in any of the abov
Address: 1834 SE 8th Ave. — Additional inspection (1 hr min) 6625/ hr -
City/Statn/ziP: Portland /OR/97214 lnvestigtttion(lhr 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
(503) 231 -1548 I Fax: (503) 736-0677 Inspectionsfor whirls no fee is
deal listed We br rain) 90.00 / hr
CCB Lic.: 13306 i Electrical Lie. I S tv. Lic.: 4 6 5 4- S "'1�'
0 /244°
26 - 135C up '.;x. °.:�ri:�..»rt +'4+r.:v:rsr. ,,:: a,��„r ,�..
SUM. Electrician signature, Hired: r r �' $ � L)
Q Ubtotai V
- Plan tee' (25% of pem it fee):
Print name:
Randall F Roberts Date: 3 27/12 - State surcharge (12% of malt fee): k'L .0
Authorized signature: t TOTAL PERMIT FEE: I' 7 ✓
This permit applordon expires ire permit is not obtained within 180
Print name: I Date: days after it has been accepted as complete.
• Number or *sections allowed per permit
i.'taaemsrmnstut a tapp.40e mum 440.44m r(tuos/COAUwt?8
Z /1 # L8661£Z£09! 0961.869E09: 0 / 1 1 09 13 ap!S ;saM:woa3; 60 :WZ1 -LZ -£0