Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00205
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 2S103DA02201
Jurisdiction: Tigard
Site address: 10975 SW PARK ST
Project: Residential Reconnect Subdivision: DERRY -DELL NO.2 Lot: 23
Project Description: Reconnect only.
Contractor: OWNER Owner: BANK OF NEW YORK MELLON, THE TR
BY RECONTRUST COMPANY
400 NATIONAL WAY
SIMI VALLEY, CA 93065
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 04/06/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 04/06/2012 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
•
Occupancy Grp:
Total $75.98
• 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 throu AR 9 -001- 090. You may obtain a copy of the rules or direct questions to ()UN •,y c: 'n. 503.232.1987 or 1.800.332.2344.
Issued B • 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' 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 RECEIVE:t
FOR OFFICE liSE ONLY
1.1,1111 CI of Tigard E i e perit No.: 131 SW Hal RlvdTigard, OR 97223 APR 6 2012 D �° �Z " : &-4/1,20 IOC ,.
• m Phone: 503.718.2439 Fax: 503.598.1960 Date/B : Other Permit: ••
1• I G n R I) Inspection Line: 503.6394175 CITY OF TIGARD Date Ready/By: lulls: ® See Page 2 for .
Internet: www.tigard- or.gov BUILDING DIVISI 11i. otified/Method: f-- & Supplemental Information
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❑ New construction ❑ Addition /alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
El Demolition El Other: ELEC. RECONNECT ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards. .
WE � 1,�, f; rr4, (+ I '�� 9'r 1 ft 7TFT` "M i'1 I �lW ���A } �l I' c 7 , � 1 ;��� 1 � u `e 1 W " i v exceeds 10,000 amps at 150 volts or 12 Floating buildings. •
h 4. maiti L L''I5a1a u.3. l3.) �l .4 air :t'.'! llI ,413. :1;a� .�a ; I . ;
l ess 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
`� ., ^I;:d " ; v[rr,j ; 0 }0 y r0 pi , • t � i 1• t�ZF^�p IC d i � � ❑ Emerg system. large separately derived system.
,, . • , ,, , i• , 1 F � ; .. ,. , " m l i ` b :1�i,T _IT L .?L / u:: 1 k : d ( l.- ' .th.t' i ❑Addition ency of new motor load of ❑ "A•• r "E" "1 -2• "1 -1••
Job no.: Job site address: 10975 SW PARK 1001 or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ELECTRIC RECONNECT ❑ Service or feeder 60 ^ amps or more
:t f I'M".'. �"., rN '1-' . r,. 4 4 c N , t'1 G ,' s i f
:1-.'. 1 . ���(i�11!3,CC.*"i:r +l I, u, ..g 9 1�M1i�11
Cross street/directions to job site: Deseriptton Qty. Fee. Total •
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'I 500 sq. ft. or portion 33.92 1 mited energy, residential
Tax map /parcel no.: R0476675
aK a map/parcel
" " Limited 75.00 2
. I.r Il , l,+, I t a t lx:a t • c � 4 r. r (withebovesq.ft.)
iti r• �. m4a_w 6,s4, .� tom+ 3 �'.mat ' , l 1..;ia`G. „tF:, . ,,I'�:.A .• Limited energy, y •
•
ELECTRIC RECONNECT residential above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
1 ! Vii,, U I ,M„7,M c' f� " l ' $ ii liti'. r:H 3t rr l F � ,t�- T 201 amps to 40 am
12 ill. .113.,: , _'., ,_ 't"�e l:r&:T� isi 1Ii..!. 410, ,11� llg411.4",,,i.a Ps amps 133.56 2
Name: BANK OF AMERICA 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps . 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and /or
h 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 168.54 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
tv t i 1 ar l m, k n, , ., , t rl P" zr � a >r l I : '. above service or feeder fee,
. t e11 1 : :3e n i '1fr.�t ii=i- e i liltG i ` r*t b , tiVe a �b,ilgi i t iie. each branch circuit 7.42 2
Business name: RE/MAX EQUITY GROUP B. Fee for branch circuits without
service or feeder fee, first 56.18 2 •
Contact name: MAUREEN "MO" IERULLI branch circuit
Each add'I branch circuit 7.42 2
Address: 9200 SE SUNNYBROOK BLVD. SUITE 100 Miscellaneous (service or feeder not included)
City /State/ZIP: CLACKAMAS, OR 97015 dw II ng sery ce�and/or feeder 67 2 or modular •
Phone: (503) 495 - 3646 Fax: : (503) 653 - 1170 Reconnect only I 67.84 67.84 2
Pump
ig n or a lined lighting 67.84 2
E - mail: MOI @EQUITYGROUP.COM
+;tl"r;G 1. 'N6��;�1- �, G "�''t'F" ,� Tt :i�' ult "1U'I`t'� �'' t e'••�z Sign or outline lighting 67.84 2
�It{ItY ETIE x l!_,Gf'I�{IiY �,Y "���}: r'";l,ll:,4: 'r. rr.�i,;�II;iJ l ,'i6'�I� I,VP' Si circuit(s) or l tmited-energ'
Business name: panel, alteration. or extension. _ Page 2 2 •
Each additional inspection over allowable in any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City /State/ "LIP: Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: ( ) Fax: ( ) Inspections for which no fee is 90 / hr
s3.- ificall listed %:hrmin
CCB Lic.: Electrical Lic.: Suprv. Lic.: u i ElE I !.s=` � .r� YNYAM :igal :.y
Subtotal: 67.84 •
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Printnam : ate: State surcharge(12 %ofpermitfee): 8.14
Authorized sig u .2�%�j /�jJs� • TOTAL PERMIT FEE: �S.9g
G� K.Y /�f This permit application expires if a permit Is not obtained within 180
Print name: MAUREEN "MO" IERULLI Date: /e/407/2,.....- days after it has been accepted as complete �
• s
Number of inspections allowed per permit. t
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