Permit o CITY OF TIGARD ELECTRICAL PERMIT
° ' COMMUNITY DEVELOPMENT Permit #: ELC2012 00203
T f G A R. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/06/2012
Parcel: 2S102BD00701
Jurisdiction: Tigard
Site address: 12785 SW PACIFIC HWY
Project: Burgerville Subdivision:RTH TIGARDVILLE ADDITION, AMENC Lot: 8
Project Description: (3) 200 amp service and (69) branch circuits.
Contractor: ACCURATE ELECTRIC UNLIMITED INC Owner: BENNETH, CATHERINE MCNICOL
PO BOX 871866 3830 ROBIN CREEK LN
VANCOUVER, WA 98687 WEST LINN, OR 97068
PHONE: 360 - 567 -3330 PHONE:
FAX: 360 - 567 -3320
FEES
Quantity Description Date Amount
3 ea Services or Feeders - 200 04/06/2012 $302.10
Specifics: amps or less
69 crt Branch Circuits w /Purchase 04 /06/2012 $511.98
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 04/06/2012 $97.69
Electrical
Type of Const:
Occupancy Grp:
Total $911.77
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 -001 -0 u may obtain a copy of the rules or direct questions to OUNC by calling 503 or 1.800.332.2344.
T 4 4 .
Issued By: � Permittee Signature: UA /�i p C -/ / 70"i
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 603.639.4175 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.
APR /06 /2012 /FRI 11:18 AM FAX No, P.002
Electrical Permit Applicatior1 FOR OFFICE IJSE ONLY
City 6 2012 R eceived 'J_ • ermitNo.: 3
° o Tigard 2012 E CC
Tigard, OR 97323 A P R Date'B : 5' - _ W A% o �0 / e 2 DDS•
S
' - m 13125 SW ball Blvd., Ti Plan Review
C Phone: 503.713.2439 Fax: 503.598 Date/13 : Other Pend ate oz2 -dav y/,.
'I' 1 GARD Inspection Line 503.639,4175 OF TIGAR Date Ready. By: El See Page 2 for
Internet: www.tigard- or•gov BUILDING DIVISION Notified/Method: IliMst Supplemental Information
TYPE OF WORK PLAN REVIEW . .
❑ New construction r Addition /alteration/replacement Please check at that apply (submit Z sets of plans vellums checked below): -
0 Service or feeder 400 amps or more ❑ B over three stories.
❑ Demolition
❑ Other where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1 - and 2- family dwelling NI Commerciallindustrial Li Accessory building amps for all other installations. buildings.
_ ❑ Multi- family ❑ Master builder ❑ Other: El Fire pump. ❑ Installation of 75 OA or
JOB. SITE INFORMATION AND LOCATION 0Amergeno new large system
/ ( ❑ Addition of new motor load of ❑ "A ". "E . "1 2 "1 -'. 3
Job no.: (v ( � Job site address: 12 ' , a R %� 1 7 r 1 Six or or more oec a
re �tcy.
l.\ s LS ' � K ❑ Six or mom residenial units.
❑ Recreational vehicle parks.
•
City /StateZIP: s l ( CR. Q`12 =.., 13 Health-care facilities. ❑ Supply voltage for mom than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.. 3 Project name :b • r j ., 1 -v ' _ 0 Service or feeder 600 amps or more.
` \ ' J FEE SCHEDULE •
Cross street/directions to job site: Desviptian I Otv• I gee. I Total I •
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
Tax map /parcel no,: _ Limited energy, residentia .,
DESCRIPTION OF WORK (with above sq. R) 75.00
f Limited energy, multi - family 75.00 2
«"1 t'! try 1—Inn i y� _ residential (with above sa. ft.)
b� ^ Services or feeders installation alteration, and/or relocation
200 amps or less - 100.70 Nil 2
j] PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: • 40 t 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
Ciry /State/ZIP: Temporary services or feeders In stallation, alteration, and/o
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not
201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54
Branch circuits - new, alteration, erteusionyer panel
Owner signature: Date: A. Fee for branch circuits with `T /
APPLICANT I CI CONTACT PERSON above service or feeder fee
El 7 47 t 2
each branch circuit �UICA�
Business name: B. Fee for branch circuits without
service or feeder fee. first 56.13
Contact name: branch circuit
Each add') branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manuthctured or odlar
City/State/ZIP: dwelling, sex 1 a and/or
feeder 67.84
Phone: ( ) I Fax: : ( )
Reconnect only 67.84 2
E Pump or irrigation circle 67.84 2
Sign or outline lighting 67.34 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: Accurate Electric Unlimited, Inc. panel altetation, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: P.O. Box 871866 Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: Vancouver, WA 98687 Investigation (I hr min) - 66.251 hr
.,. Industrial plant (I hr min) 78.18/ hr
Phone: (360) 567 -3330 Fax: (360) 567 -3320 Inspections for which no fee is 90.00/ hr
specifically listed (' /r hr min)
CCB Lic.: 191346 Electrical Lic.: C638 1 Su . Lic.: ELECTRICAL PERMIT FEES
Suprv. Electrician signature. required: a Subtotal: ( ��,
�di4Z Plan review (23% of permit fee): 0
�-l" `
Print name: Bill Dixon Date: Q ..`Z Stare surcharge (12% of permit fee): �_ __ '. '/ •
Authorized signature; 3JO`^ -� l TOTAL PERMIT FEE: within •
This permit application expires If a permit Is not obto ned +vithin 180
Print name: ` b 1 1 1 1/11 -� Date: ��� q days after it has been accepted as complete.
S^ J` Nmnber of inspections allowed per permit. /� // '/
1 : Building Permits ELC- Permil App.doc 0T 01 10 440.1615T(11 03 COMM WED i