Permit Il CITY OF TIGARD ELECTRICAL PERMIT
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S COMMUNITY DEVELOPMENT Permit #: ELC2012 -00309
T (GA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/23/2012
Parcel: 2S114BCO3800
Jurisdiction: Tigard
Site address: 10372 SW BONANZA WAY
Project: Thomas Subdivision: RIVERVIEW ESTATES NO.2 Lot: 75
Project Description: (4) branch circuits for bathroom remodel
Contractor: APOLLO ELECTRIC Owner: THOMAS, LAURIE
PO BOX 80783 10372 SW BONANZA WAY
PORTLAND, OR 97286 TIGARD, OR 97224
PHONE: 503 - 244 -4410 PHONE:
FAX:
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 05/23/2012 $78.44
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/23/2012 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 ' I 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 suspen• - •re the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Cent- Those • :-. t f;. in +AR
952 - 001 -0010 through OAR 52f001 -009 You may ob in a copy of the rules or direct questions
ermittee Signature: calling 50232. ����!���
Issued By:
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.
Cali 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.
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HI±UEIvED
Electrical Permit Application FOR OEEICE lust; ONLY 23201?
City of Tigard Received
2 Z SI Permit?' Ala - LID307
° 13125 SW Hall Blvd., Tigard, 7 F TIGARD Plan Review
:I 51
Phone: 503.718.2439 Fax: 5 , u1 /� DIVISION �g Date/B Other Permit:
Ins Line: 503 DP VISION Date Ready/By: ® See Page 2 for
TIGARD Notified/Method: Supplemental Internet: www.tigard- or.gov WE pp loformation
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items 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 ❑ 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
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2 ", "1 -3 ",
Job no.: Job site address: 10372 SW BONANZA WY. 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard ,Oregon, 97224 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: Thomas ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
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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, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family 75.00. 2
Bathroom remodel relocate 4 circuits residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation _
200 amps or less 100.70 2
® PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Laurie Thomas 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 10372 SW BONANZA WY Over 1,000 amps or volts 552.26 2
City/State /ZLP: TIGARD, OREGON, 97224 Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 I ❑ CONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: APOLLO ELECTRIC LLC B. Fee for branch circuits without 4 service or feeder fee, first 4 56.18 56.18 2
Contact name: RICK TAYLOR STREIFF branch circuit
Each add'I branch circuit 3 7.42 22.26 2
Address: P.O. BOX 80783 Miscellaneous (service or feeder not included)
City/State/ZIP: PORTLAND, OREGON,97280 Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: (503) 244 -4410 Fax: : (503 ) 635 -3740 Reconnect only 67.84 2
E -mail: rick.apolloelectric @gmail.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: APOLLO ELECTRIC LLC panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. BOX 80783 Additional inspection (1 hr min) 66.25/ hr
City/State /ZIP: PORTLAND, OREGON,97280 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18 / hr
Phone: (503 ) 244 - 4410 Fax: (503) 635 - 3740 Inspections for which no fee is 90.00 / hr
\� - 1 specifically listed (%: hr min)
CCB Lic.: 183120 .�` \ b E lectr ic al L 34 -394C \ Suprv. Lic.: 4123S �� `��3 ELECTR PERMIT FEES
Suprv. Electrician signature, required: �� -/ Subtotal: 78.44
p 9 �/ / Plan review (25% of permit fee):
Print name: RICK TAYLOR Date: 5/22/12 State surcharge (12% of permit fee): 9.41
Authorized signature: TOTAL PERMIT FEE: 87.85 /
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: RICK TAYLOR STREIFF Date: 5/22/12
• Number of inspections allowed per permit.
I:\ Building \Permits\ELC- PermitApp.doc 07/01/10 440-4615T(11/05 /COM/WEB