Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00346
T tGAKO 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/06/2012
Parcel: 25101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: Russell Construction Subdivision: PACIFIC RIDGE Lot: 2
Project Description: (3) branch circuits for bedroom remodel
Contractor: CLACKAMAS ELECTRIC INC. Owner: ALBERTINA KERR CENTERS
PO BOX 51 ATTN: JERALD A HOFFERT
BEAVERCREEK, OR 97004 424 NE 22ND
PORTLAND, OR 97232
PHONE: 503 - 969 -5684 PHONE:
FAX: 503 - 632 -2421
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 06/06/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/06/2012 $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 0 R 52 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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Issued By: Jt i'Xi / 00
al ►" PP L4 vl t!4 4 Ti al
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.
Jun 04 2012 10:44RM Clackamas 503 - 632 -2421 p.2
a
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Electrical Permit Application JUN 0 4 2012 l 0'.''11. I I ;1 ( "I 1
OF TIGARD
U I2S S Tigard Tigard, OR 97223
CITY 1 Received li E-'� ' , •'.. ltrl
ii
• Phone 503.7182439 Fax: 503 598.1� i S Olhe rPermit:
Line: 503.639.4175 �v• - DING DIUI�IO � y: Page
L
Inspection
www.tigard-or.gov Notified/Method: far
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• s rjr � ' i r m 1 i , r,A1.5'. 7a • 29 ,. s ' z i .f. � x Vi t .; 5 , � .. - ,.
i t � lfia_�''"i..0 CS r 7 :�tt: �����i 1.4�.! i u. . C
❑ New construction t :/ Addition/alteration/replacement m
Please check an that apply (submit 1 seta of plans w /ites checked below):
o pia or feeder 400 amps or mar D Building over three stories.
❑ Demolition ❑ Other: whets the available fink current 0 Marinas end boatyard&
yw.v •.P "we=e r s ay �:', ;:. V . VW ; ,, exceeds 10.000 amps at 150 volts or D Floating buildings.
�'X.; g,.1 �:'yie yz . r f „ 1,: a 5 ry , z . { y '4 ,. f,; .. :'K' � M ' ` +^ 4,
s, : rrdt +a'�'i� �tr�• ��' � �'' _ ., a. ^ ?� 4 *.':n.r''.• ' .�° - " (� m ground. or exceeds 14.1100 D Commercial-use agri�vWrral
1 -and 2- family dwelling ❑ Commerci builder stria) ❑ Accessory building amps Por all other exceeds one. buildings.
Master builder ❑ Fero pump. 0 ueulladon of 75 KVA or
Multi ❑ 0 ?n . ° D ELY "eel larger separately derived system.
II - ' s' ,ts*' s( =nxy,'x v. - f .I . - �'.4 1� +. �. ■ 1
.:.C.?u? s`�•...4 ,'. -•::',, a
A°° ' , 1 ? .
, '?(, 1;".:it /'' +., 1, A..:9,31t. i ' 4 z os !+ ;i.' a Addition of new mctorload of 13"A". "E". 1- 2", - 1 - ".
I / � /� (} v six or or awes. nc5•.
Job no.: Job site address: v.� /• t p Six or more residential users 0 Recreational vehicle parks.
City /State . aA - ) b� 0 Health-care facilities D more voltage for re than
no.: [� � � ❑ (] Hazardous locations. 600 voile nominal. ` name 0 Service or feeder 600 amps or more.
Stlite/bldgJapt. no.. Project �It►5 �1 ru- I
Cross street/directions to job site: ororrlpdoa otv. Fm That •
New residential single or mold-family dwelling unit
Include' attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. adel l 500 sq. ft. or portion 33.92 1
Tax trap /parcel no.: Limited energy, residential 75.00
try s r • �, �i ` , (with above sq. f3 J
I - -•ww, a r' ' } Limited energy, multi- tinnily 75.00 2
Zea Q1:147-. re.
I residential (with above aq. ft.)
.
Services or feeders inatalladon and/or relocation
200 amps or leas 100.70 2
. � �;G a S (.::;: �rx:K�:r ••cw ez:, .•r w ; : eZ' ° � ° �y`� '., 201 amps re 400 stops 133.56 2
uu { �W 'ur.:,L vY�'r. 9:_` , `t. - ';' C�- d 6s:: M A M Mt8: 2
401 amps to 600 amps 200.34
Name 601 amps to 1.000 amps 301.04 2
Address Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteradon, and/or
City /State/ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 an 125.08 I 2
Owner Instaiht on: This installation is being made on property that I own which is not 401 a to 599 I 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 petrel
Owner signature: Date: A. Fee for branch circuits with -
q 1 .a,� � yt , ;j , ,te � '''. ' above service or feeder fee, 7.42 2
¢, epYii. 'i , .t"I.31 1Iu�,7i' ?..ye�zcv each branch citizen
Business name: B. Fee for branch circuits without v
service or feeder the fast 4 56.18 .lain 2
Contact name: branch circuit q �
Each add') branch circuit c _1... 7.42 i . v 2
Address: . Miscellaneous (service or feeder not Included)
Each manufactured or modular 67.84 2
City/State/MP: dwelling, service and/or feeder
Ammer only 67.84 2
Phone: ( ) I Fax: : ( ) Pump or irrigation circle 67.84 2
E -mail: Sign or outline lighting 67.84 2
!' .?1,.,.211:^;: t2 M fi 'EMI! Signal eircuids) or limited - anew
Business name: drat panel, alteration. or extension. Page 2 2
�/ -iii . :lam Each additional inspection over allowable in any of the above
Address: 1)6 61 Additional inspection (1 br min) 66.25/ hr
Investigation (1 hr min) 6625/ hr
City/Statc/ZIP: 76 r e 0 ie 9704- ` Indust plant (1 hr min) 78.18/ hr
` w
Phone: te,3 1/42, Fax: . / J 1 li tAr r w hicc h n n o is
min in `x►90.00/ ! br
CB Lic.: f + Elecuical1�l , * . , C. l Suprv. Lic 11 Li% � 7 InspecdInspections Q S :, 'u : 1 i ;i ' *- ?' a' .w .?( ri-s ':. u4
A\ Subtotal:
Suprv. Electrician signature, required: 4 .� ! _ Planrevitw(25 %ofperrnitfee):
Print names t(A` ..Li ■ • . I Date 47 4.// - State surchrrge (12% of permit fee): 5
I TOTAL PERMIT FEE: 9 9 ,
Authorized signature: This permit applkatloa expires If a permit Is not obtained winds 1
days after It has been accepted as complete.
Prim name' I Date: • Number of inspections allowed per permit
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