Permit CITY OF TIGARD ELECTRICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00256
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/02/2012
Parcel: 1 S134CA05700
Jurisdiction: Tigard
Site address: 12025 SW BURLHEIGHTS ST
Project: Ricci Subdivision: BURLWOOD NO.2 Lot: 30
Project Description: Branch circuits without service for bathroom remodel
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: RICCI, MARK ANGELA
PO BOX 3948 12025 SW BURL HEIGHTS
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 05/02/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/02/2012 $7.63
Type of Use: SF Electrical
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $71.23
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: • - •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 thro e OAR -001 . You may obtain a copy of the rules or direct questions to OUNC by callin 87 or 1.800.332.2 4.
Issued By: ( Gcifl� 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' -. �� �L� 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.
ST
Electrical Permit A lication FOR OFFICE USE ONLY •
City of Tigard RE CEIVED Received Permit Na.: u- '�p l •d4) aP
IN 13125 SW Hall Blvd, T igard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.59/) 0 _ 1 2012 Date/13 : Other Permit T I C A n D Inspection i.ine: 533.639.41 H^ �� Dat Read ® See Page 2 for
Internet: www.tigard -or.gov Notified/Method: Supplemental Information
TIGARD
� jii DIVISION• PLAN REVIEW
❑ New construction Additiotffslternnon/replacemenl Please chat: all that apply (submit 2 sets of plans whims checked below):
❑ Service or feeder 400 amps or most El Buildm g over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 1SO volts or ❑ Floating buildings.
less 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 of75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION Q Addition of new motor load of ❑ "A" "E" "1 -2" "l -3"
r 100HP or more. occupancy.
Job no.: Job site address: 11025 50 A(,,, Neitq u l� G • -1 ❑ S eE more residential arils. ❑ Recreational vehicle parks.
City /State /ZIP: 13 Health-cart facilities. ❑ Supply voltage for more than
❑ Hazardous locations, 600 volts nominaL
Suite/bldg. /apt. no.: J Project name: ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Ott. I roe. 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'l 500 sq. ft. or portion 33.92 I ,
Tax map/parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. ]L)
Limited energy,
�, `, w h , r it above sq. I ) 67.84 2
C_.1/� -1S �p1pOM �!�'�G�LLr residential (with ab�ve sq. It)
or feeders installation, alteration, and/or relocatio n
200 amps or less / 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 20034 2
601 arnps to 1,000 amps 301.04 2 ..
Address: Over 1,000 amps or volts 552.26 2
C /State/ZIP: Temporary services or feeders installation, alteration, and/or
R3' relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 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 2
Branch circuits— new, alteration, or extension, . er panel
Owner signature: Date: • A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or fecderr. __ - --___ — 7? 2 j
each branch circuit ( fir
Business name: B. Fee for branch circuits �]� i
'— without service or feeder fee, ,, Jn r C� 2
=ranch Contact name: nch circuit
Address: ,chh ad�d'l branch circuit ` 7.42 MOM'
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Purup or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: c.-1-4,,c Signal circuit(s) or limited-
_ P �� VI (�. 1 Z energy panel, alteration, or
Address: T. 0 39 gfi extension. Describe: Page 2 2
City /Stale /ZIP: WZ(,o „Miner 0 TI o7 0 Each additional inspection over allowable in any,of the above
Per inspection 66.25
Phone: (1`?() 51,3 g I I Fax: ( 5b ) ( (34 /investigation per hour (i hrmin) 66.25
CCB Lie.: ( t1�� /Electrical Lic.: 'L4 L Suprv. Lie.: 5 S t Industrial plant per hour 78.18
f ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1 ..---..—_` • Subtotal: (03 , coo
Print name: 1 /x / ,T $\ (0 I Date: I 0 _ c Plan review (25% of permit fee):
/ r C'I State surcharge (l2% % of permit fee):
Authorized signature: TOTAL PERMIT FEE:
This permit application expires if a permit is not abtnin sn
Print name: Date: d ays after it has been accepted as cow
•
• Number of inspections allowed per permit. "7 1 f 15
r: IBuildins1Perot s\ELC- PermilApp.dee 1Mnr09 440.4615T(I I/OS/CONLA'ka L
Z 617£199Z£09 o!J3o°I3 )!noi!O aid uSZ :90 Z 1.0 AeW
•