Permit CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00335
T t G A R.D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/04/2012
Parcel: 2S115AA04600
Jurisdiction: Tigard
Site address: 10827 SW CHATEAU LN
Project: Templin Subdivision: REBECCA PARK Lot: 3
Project Description: (3) branch circuits for kitchen remodel
Contractor: PRECISION NW ELECTRICAL Owner: TEMPLIN, RAYMOND JEROME
12020 SE ANNA CT 10827 SW CHATEAU LN
DAMASCUS, OR 97009 TIGARD, OR 97224
PHONE: 503 - 413 -9870 PHONE:
FAX: 503 - 594 -2873
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/04/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/04/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 9 2 -001 -0 90. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '� I
Issued By: Permittee Signature: Oij1 A PPLI �7���' � 15 k1,
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 503.639.4175 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.
05/31/2012 02:32 FAX 5035942873 PRECISION NW Z003/005 5 maw
CA
Electrical Permit Applicatip�p � " r : : ,.1 R l)FFl(.:� 1,s1. ()N1.\
City of Tigard F ttm Da An • — ' 13125
Phone: 03 7 8.2439 Fax: 503.59 10 pAy 31 20 1 2
. -- .. Other Pam; ;:
. , , Ins Line: 503 Date Ready/By; ® see Page a for
l
�: Supplemental Information
vv
Internet: ww.tigard -Or.gov t 11 Notihod/Methodl
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y , t n, i f 5 :, 1C I , - .� j1i , ,, :I( iii t t t in Sr ,, , K' a I. .• , VJh
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7^{�1!E}.. 1 �15}!S,„, ar:. hr,i6(11 e _. .,. � l.'"' i l ! ,.1Jltl ��'' t J . • hyA! t� p lh1 i t or piton ' • ,� :
❑ New construction :i Addition/: c ion/replacement
please check all that apply (submit ? tets of plan w /items checked below):
❑ Service or Grader 400 snipe or more ❑ Building over three stories.
❑ Demolition • Other. where the available Milt current O Marinas and boatyards.
H t+ , • P ❑Commercial use a
� �{ � 11 . 1 , t _ , , I .,.„,:. . , 'I l,yl; :.' , 10 ', + :) - , ', accaedi 10,000 amps at 150 volts or ❑ Floating buildings.
1 , !.2'10.Y'•; Ii.‘, Use I NN ..11 ,h,n. !.. , , 1 ;, i ' 1 ! , 4it';G .� t ? �.. 1d. ilnl loo
( � 1 11 �t i LI 1 el..:..! o.n . . , m ground, or cxcadw 14,110;1 4,04
0.: 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps fbr an other inatmltmions. buildings
❑ Multi - family ❑ Master budder ❑ (hher I7 i'im eumtx ❑ Installation of 75 KvA or
of ❑ "A" motor lo
r y ; a rl owl ,,t t rr Ir)1p� ., n at t + x
; a ••• ^Ill 1 , i I.mr,ir ��, CI l•:mernancy sysreta larger separately derived rtystem.
. � � b 'iftlE 1 mickl ' n, ' ' ,i:a.mmMi it ,,:' .uL, t a:w .r . f .r' , t, li ,t o , .r ..e, ' _�� N( iL ��' ❑ Addition of new load "E . "1 _2 "1.3•",
F un r i _t r ' t .. lr r
C
^ Job no.: Job site address: 162.. k 4 + �A L � 10X or mars Recreational occupancy.
' ❑ Six rrt more residential omits. ❑ Rcc vehicle parks.
City /State ZIP: •�r i ` �, o ) Q l g ) ❑ Hazardous l ure oc a t i c ies. ❑ Supply voltage for mare than
J ❑ liamtoacatioes 600 volts nominal.
— 1-• 1 ❑ Service or feeder 600 amps or morn
Suite/bldg./apt no.: Project name: � j
\ "� _ 411 1;(,1 , .. t rlll},..(:, '., r '', I 1' ill r l 'Y i !' YItT � r� , ,
:,....1.:::e, l.'61 f .(1r1 }r !'t. a l r.`[rn - ,f r,r:•, ,r,. ., r.:,!• t vt.
Cross street/directions to job site: oerert ,__1013 Oar. Pee. ;'oral "
' New residential single- or maid- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.5_4 4
i n. add'1500 sq, ft. or portion 33.92 I
Tax map /parcel no.: Limited ener , residential
,.,, .:,,w ,70: , . - +WM r I m r,q,< o p . ; (t c A y,' 1 7..00 2
,.t, . .a, if t (t 1, 1 (with above 54' It)
1 ,9 AbM I:,a. 11F1`�, <<,(tt+,(,,,.��. . inlh 1,.. - :nn,,..,ns)! t ;.. 1 ., , I�1., ,:',lts !U�,,,i.,:..
� � .. � Limited energy, multi- family 75.00 2
3 (.t r c ..,,1 k +rte a �° •v l r - cANA 1.� residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relucation
200 amps or less 100.70 2
f 377,AY, {{q( l , n j} ,, m { r, In SI 1 ( ill r tilt ffi 1 4 R r !r 1 ' ., qr - 1 , 1 — _
'' re. ' i lI' r 41 ttl (, , r l 1 r +� 1 , , + K ;411 1 ' I , , } i 1 7 t d '04. :. r , e1iuf J t i il201 amps to 400 amps 133.56 2
"itaru.t m,.ildm Pl !!INIU.1ai ( LL U..d +l r� t'c.tLfim,... ,. s hi•��.. ,. iQ},'� h i ±h,,... s. „u. n.r „u...i. d,,n : H 1,0i! ( Ir 1,::.
401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 atnpa _ 301,04 2
Address: Over 1,000 amps or volts 552.26 2
City/State /ZIP: _
Tempo
e nip oo services or feeders Installation, alteration, and/o
Phone: ( ) l Fax: ( ) 200 amps or less 59,36 1
Owner installation; This installation is being made on property that I own which is not ZOl amps to 400 amps 125.08 2
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, perpanel
Owner signature: Date: A. Pee for branch Circuits with
+,altprpru�947'(,l l Itfino l! fUm 1 a 1
r ; r,„ rr {,� ,. I I ryI E j , 4 I i ) �ly� + p } above service or feeder fee, 7. 2
, j 1 tl�'i.f ,C ; ', r� i ,. P R I : H uu�wtx nn, `.4g, 4 I ° '= e. , ✓ , P.37,1,ViNT,i .l.P :: . . L l .fi :,Si,t , i ?u . : .!¢Se l.:. i.W,1l r .r. ,} /
each breech circuit _
Business name: B. Fee for branch circuits without
service or feeder fee. first 1. 56.18 1 6,) % 2
Contact name: branch circuit
Each add'I branch circuit Z I 7.42 1 4-, g 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Sta[eJLIP: ling, service and/or feeder 67.84 2
dwelling,
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or 'irrigation circle 67.84 2
E-mail: Sign or outline lighting 67,84 2
,. ' i+`i !) °i, ,� i, "; 1 ! t, tw� ° , t : , f sl , '�;ra�111�
`i +, ,, 1 ,.. t,y1 ?u/
154.Fh. 12 ! �VENI � !r!7,.m,f�l, 1:)., :i " {"X:,_ +C... -1�..��l�d •2! +, Signal circuit(s) or limited-energy
Business name: 4,ccast 063 i W .te C r I C 1,.... Each alteration, or spec extension. on Pagan 2
Each additional inspection over allowable in an of the abov
Address: ( Zgla Q SE I N A, CI'. Additional inspection (1 hr min) 66.25/ hr
City/Statc/ZLP: p 1 n, At e u 5 i C C t.Og c7 Investigation (1 hr min) 66.25/ hr
industrial plant (1 hr min) 78,1 S/ hr
Phone: Q$G4s) ,(-\ 3-4,810 I Fax: (3%) S44.--7..-13 inspections for which no fee is
p� s tficall listed Y. br mot 9000 / hr
ti CCA I.1c.: 112 331 Electrical Liu, Su rv. L .S05 LD-S i l f i ll l `y ,, 1'1 . 1 ;' , ; J at ±, P .:,: ' ' i I, a, 7, 7 I ! l ' I -.
Suprv. Electrician signature, required: ,� , -,� Subtotal: / . b
�•�AJ`� ` 1... �-rYJ C� � Plan review (25% of permit fee):
Print name: � kw Q NA r 1, Avle ‘, Date: '5..3 ,--z.01-1_ ,--z.01-1_ State surcharge (12%of permit fee);
Authorized signature: "t' -� - J ^ � FEE: TOTAL PE RMIT SEMI
�� �Jµ `, A _ k. A w X l � � ( — � / This permit application e>tplres If a perm111s not abta�ned within n l - I .
Print name: M� Q �to N$i 1/) I Datc:G -3) -70LZ • days after permit. edsacomplete `7Q �
Number of inspections allowed per permit.
( l
I: WvildisSVwmlrsEt,C- PermhApp.doe 07/01/10 440 46151(11/0S/COM!W®
05/31/2012 02:32 FAX 5035942873 PRECISION NW 2J001 /005
PRECISION NW ELECTRICAL
CONTRACTORS
12020 SE Anna court
Damascus, Oregon 97089
Cell (503)413 -9870
Fax (503)594 -2873
Precisionnwelectrical (aivahoo.co m
To:
s►ft T :604
Name: From: KAA LLf
CC: Date: s _at- l x
Phone:
Fax: sizz _ $t m Number of pages: 3
M cssage:
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