Permit x IN CITY OF TIGARD ELECTRICAL PERMIT
-- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00268
1 3125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/09/2012
TIGARD 9 Parcel: 1S125DB03300
Jurisdiction: Tigard
Site address: 9380 SW 74TH AVE
Project: Settle Subdivision: BOULEVARD HEIGHTS Lot: 15
Project Description: (1) branch circuit to reconnect gas furnace
Contractor: BULLSEYE ELECTRIC Owner: SETTLE, TERRY & SALLIE A
16510 NE 81ST ST 9380 SW 74TH AVE
VANCOUVER, WA 98682 TIGARD, OR 97223
PHONE: 360- 260 -4814 PHONE:
FAX: 360- 256 -4542
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 05/09/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/09/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 throughh • , R 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: IV 4 4 ay /L - Permittee Signature: e7� Z /` �C�4 - 77 `r
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 503.639.4176 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.
May 07 12 11:30a Bullseye Electric RECEIVED 360- 256 -4542 p.1 r
Electrical Permit Application MAY - 7 2012 FOR OFFIC USE ONL1
City of Tigard Received »ewe _ 0 , / • . Permit N o. i�� /� P O � . ,I
a 13125 SW Hall Blvd.. Tigard, OR 97223 CITY OF TIGARD
0 ' Phone: 503.718.2439 Fax: 503.598.1 a Othe- Perm ' � 0 2-MAW
Inspection Line: 503.639.4175 a le Ready /By: 1 Ei See Page 2 for
TIGAKD Int prom • "tivtvtilZnrd nn
.nr NotificdT4,ethod: / • Su. lentcntulinformation
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans rvritems checked below):
❑ service or feeder 400 amps or more ❑ Building 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 ❑ Cormnccial•use agricultural
® I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Fire pump. ❑ Instal: anion of 73 KVA or
' JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately de rived system.
. ['Addition of new motor load of ❑ "A ", `E ", 1 T, "3.3 ",
74th 100HP or mare. occupancy.
Job no.: Job site address: 9380 Sw 74 St
❑ Sin or more residential units. ❑ Recreational vehicle parks.
City /State ZIP: Portland Oregon 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suitt/bldg. /apt. no.: Project name: Terry Settle ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: DevaiptIon I pt... I pee. I Total I •
New residential single- or multi -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 163.54 4
Ea. add'I 500 sq. ft or portion 33.92 1
Tax map /parcel no.: -
Limited clergy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft)
Limited campy, multi- family 75.00 2
Reconnect of gas furnace. residential (with above N. It)
Services or feeders installation, alteration, and /or relocation '
200 amps or less 100.70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Terry Settle 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over [,000 amps Of volts 552.26 2
Temporary s or feeders installation, alteration, and/or
City/State/7,1P:
Phone: ( ) Fax: ( ) 200 amps or leas 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
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, per panel
Owner signature: Date: A. Fee for branch circuits with
Cl APPLICANT • � � ❑ CONTACT PERSON above service or feeder fcc 7.42 2
each branch cirrait
Business name: B. Fee for branch emends without
service or feeder foe. fast 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/7.1P: /Slate�7.IP: Each manufactured Of modular 67.84 2
Y dwelling, service anchor feeder
• Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit/x) or limits d- energy
Business name: Bullseye Electric panel. alteration, or extension. rage 2 _ 2
Each additional inspection over allowable In any of the above
Address: 16510 Ne 81 " St Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 6625! hr
City /State/Z.IP: Vancouver Was ington 98682 !
Industrial plant (1 hr min) 78.18/ hr
Phone: (360) 260 SR] 4
01 14 Fax: (360) 256 4512 - I Inspections for which no fee is 90.00 / hr
specifically listed (' /s hr min)
/CCB Lic.: / 8'?-.? 1 i Electrical Lie.: C 4 Suprv. Lic.: 5655S 1 ELECTRICAL. PERMIT .FEES 1011
Suprv. Electrician signature, required: 111 j Subtotal: 56.18
Plan review (25% of permit fee):
Print name: Mikhail David I I Date: 5/7/12 State surcharge (12% of permit tee):
Z / /6 �
Authorized signature: 77V � i TOTAL. PERMIT FEE: (p at ?,2_,
..../ Q r Zit t J
- L.O LLL�JJ Thu permit application expires if a permit is not obtained within 180
Print name: Sarah Rug( Date: 5/7/12 days alley it has been accepted as complete.
e J • Number of inspections allowed per permit.
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