Permit CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit #: ELC2012 -00240
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/25/2012
Parcel: 25111 BCO2700
Jurisdiction: Tigard
Site address: 10380 SW CANTERBURY LN
Project: Miller Subdivision: TIGARDVILLE HEIGHTS Lot: 5
Project Description: (1) branch circuit for oven
Contractor: RED'S ELECTRIC CO INC Owner: MILLER, PAUL E & JUDITH A
6336 SE 107TH AVE 10380 SW CANTERBURY
PORTLAND, OR 97266 TIGARD, OR 97224
PHONE: 503 - 233 -6467 PHONE:
FAX: 503 - 233 -1281
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04/25/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/25/2012 $6.74
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Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
Required Items and Reports (Conditions)
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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: Ore on 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 95 - 1 -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: i1N 2. /7/4/;:e./C41-770^/
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:
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LICENSE NO.
Call 503.639.4176 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.
Apr. 23. 2012 3:11 PM RECEIVED No. 1085 P. 1
Electrical Permit Application Merit OI'F 1CL USE ONLI'
C i of Ti a APR 2 3 2012 Received
DatNBx y 2 5 /2_ - , ermitNn.: %2 — a y0
i '! 13'1 SW Hall Blvd., T tgard,OR 97223 Plan Review • Phone; 503.718.2439 Fax: 503.59 8X OF TIGARD na Other Permit:
t lt;ARD w InspectiOnLine: 503.639.4175 BUILDING DIVISION Dale Readyroy: luris: RI See Page 2for
Internet: vw.tigard or.gov Notified/Method: �IS Supplemental Information
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TYPE OF WORK • PLAN REVIEW
❑ New consltuetion ® Addition/alteration/replacement Please check all rea a pply (submit 2 sets of plans *Menu cheekcd below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault ourrem ❑ Marinas and boatyards.
CATEGORY OP CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.000 0 Commercial•use agricultural
® I - and 2- family dwelling El Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
El Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ Installation of 75 KVA or
JOB SITE INr'OR,�fATION AND LOCATION ❑ Emergency system. larger separately derived system.
.. 0 Addition of new motor load of ❑ "A° "E ", "I.2 ", "I-] ",
Job no.: 68179 Job site address: 10380 SW CANTERBURY LANE Io011Pormore, occupancy.
0 Six or more residential units. ❑ Recreational vehicle parks.
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City/State /ZIP: TIGARD, OR 97224 ❑ Health-care facilities. ❑ Supply voltage for more than
0 Haaardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name; MILLER ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: . oescriotton I otr. I Pee. I roan I
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'l S00 sq. R. orponion 13.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIPTION. OF WORK (with above sq. R.) 75.00 2
Limited energy. multifamily 75,00 2
WIRE FOR OVEN residential (with above sq. IL)
Services or feeder installation and/or relocation
200 amps or leas 100.70 2
❑ PROPERTY OWNER I ❑ °TENANT . 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/Slate/ZIP: Temporary services or feeders installation, alteration, and/or
y relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
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
❑ APPLICANT 1 ❑ CONTACT: PERSON above service or feeder fee. 7 a2 2
each branch circuit
Business name: B. Pee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
- Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or (ceder not included)
City / State /ZIP:
Each and/or feeder 67.84 2
Phone: ( ) Fax::( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-energy '
Business name: REDS ELECTRIC CO panel, alteration, or extension. Page 2 2
Each additional Inspection over allowable in any of the above
Address: 6336 SE 107 AVE Additional inspection (1 hr min) 66.25/ hr I
Investigation (1 hr min) 66.25/ hr •
City /Stare/ZIP: PORTLAND, OR 97266 Industrial plant (1 hr min) 78.18/ hr
lone: 503 Fax: 503 233 - 1281 Ins for which no fee is
hone: ( 503) 233 6467 ) (
specifically listed (h hr min) 40.001 hr
CCB Lie.: 4443 Electrical Li '26 - 152C �j Suprv. Lic.: 5010 - S / • . ' . ELECTRICAL PERMIT 'FEES
Subtotal: 56.18
Suprv. Electrician signature, required:
( ) ,. .: fre ., 6-----"E'IA.° Plan review (25 %ofpcnnit fee):
Print name: JIM FERRIS Date: State surcharge (12% of permit fee): 6.74
TOTAL PERMIT FEE: 62.92
Authorized signature: Thit permit application expires Ira permit is not obtained within 180
Print name: Date: dare after It has been accepted as complete.
N um b er of inspections allowed per permit.
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