Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00353
T [ . A 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/07/2012
RO
Parcel: 25111 DD08500
Jurisdiction: Tigard
Site address: 8721 SW AVON ST
Project: James Subdivision: CHESSMAN DOWNS Lot: 11
Project Description: (1) branch circuit for furnace;'(1) ckt wire furnace
Contractor: BECK ELECTRIC INC Owner: JAMES, SUSAN MARY
15600 SE FOR MOR CT #B 8721 SW AVON ST
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 656 -7396 PHONE:
FAX: 503 - 656 -4397
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/07/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/07/2012 $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 through OA -001 -0 0. 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: Permittee Signature: 1J/L A-PR- / -+ - L �7
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.
Jun 0512 01:46p Beck Electric (503) 656 4397 p.2 S _
Electrical Permit Application fl EC IVP, mo eceived 07
FOR OFFICE USE O iYL1'
I
r City of Tigard Date/By: , I a- sr Permit Nof tap /a - DU 3 53
13125 SW Hall Blvd., Tigard, OR 97223
JUN U N U 5 2012
Date/By:
IN . Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 Other Permit:
TIGARD
inspection Line: 503.634.4175 Date Ready/By: BI See Page 2 for
Internet www.tigard- or.gov CITY OF TIGARD NotifiedrMethod: • Supplemental Information
v'. -- : �.; � -fP 7= t , - . ,♦ . >f�il _..
' � Ywl'r� �- s_ . �.. . s� 51y`_, )' M'._: 'q.7 - .: i_P f - itiii''.J ?
. =kl - ' : :'.I :rte ... id ... .. .-: .... ,.. ..- .
❑ New construction 'i Addition /alteration/replacement Please check all that apply (submit 7 sets at plans wbtems checked below):
0 Demolition I tion ❑ Service cr feeder 400 amps or more D Building over three stories.
❑ Other: where the available fault current C Marinas and boatyards.
= - .... , .. , . - —gfe:' i i 1 „` ..',_ i .- _ :; .!'. f -� ` exceeds 10,000 amps at 150 volts or ❑ floating buildings.
r __ .. less to exceeds Commercial-use agricultural
. g
I - and 2-family dwelling G Commercial/industrial ❑ Accessory building less xcee lations. buildings.
Multi - family ❑Master builder P ❑ In cf 7 5 KVA or
❑ Other. ground, or ds 14,000 ❑ ❑Fire ump. 75
'�`" .: ;' '' ` �•� .;�i�' ;six ;-:::75 „ . : ❑ E�tergcncy system. larger separately derived System.
. t"`�'� ;!.” :a 's e� g ,..; Addition of new • _ _ ❑ n a motor load of ❑ „ A" ••E", • 1 �2 .•i _3^ •
Job no.: s ( Job site address: g72../ ....14.) 'k'p i • 1001•IPermore. aec
D Sox or more residential units. El Recreational vehicle parks.
City/State /ZIP: —77 e d O L ❑ Healthcare facilities. ❑ Supply voltage for more than
1 1 J ❑ Hazardous locations. 600 volts nominal.
Suitelbldg. /apt. no.: Project name: r 1 D Service or fader 690 amps or more.
Cross street/directions to job site: r° .'.1?l�]Y1S#itDYJ1f4 ;
Do xrtptlo a I Qty. 1 fee. 1 To al 1 •
New residential single -or multi- family dwelling unit.
_ Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Tax mapiparcel no.: Ea. add'I 500 sq. ft. or portion 33.92 1
" -rqr - _ - r•z_ _.- . _ . . kr _. Limited energy, residential 75.00
,‘., - . .= i! A1k ' ;:'_ :. : :. .fy:F r' ; , :' ; , _3: (with above sq. ft) 2
"' Limixd energy, multi-family 75.00 2
I C / T t Acr/l a cg___ residential (with above sq. ft.)
' /
Services or feeders installation, alteration, and/or relocation
/
/
t;G
C � or p �0
.. . . - • less 200 amps 1 100.70 2
.
r. . - . _; -'�- ���r.�RaP ''; +� �. :... - , :� _� r,, _ . � - .�y i 201 am 40C a
;- a� tom': �: °.- amps amps 133.56 1 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 12
Address: Over 1,000 amps or volts 552.26 2
CityiSta[e!ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less i 59.36 I
Owner installation: This installation is being made on property that I 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, per panel
Owner signature: Date: A. Fee for branch circuits with
t -` }; " r 742
ssw- r: �; �, �. � � -v� : a ._. ��- - _,. - . e service circuit or feeder fee
a v
. iy , [' I " � . - - _ - �� ' ��. each bmn
Business name: B. Fee for branch circuits wtthorxt
service or feeder fee, first r 56.18 1
Contact name: branch circuit l
Each add'l branch circuit 7.42 r 12
Address: _ Miscellaneous (service or feeder not included)
City!State/ZIP Each manufactured or modular 67.84 2
dwelling, service and%or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
Si oroutline lighting 67.84
, . . .::g.... �'; P. . o r it _ : r.:- :r ' . .111.x, .., Signal circuit(s) or limited•erergy
Business name: G4 [.e rr irriiaa G e � ` G panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: ,,5 )) ,.. /x_, / - nt/K, GJ f) Additional inspection (1 hr min) 66.25/ hr
/ G✓m 4 • S 0 �r /� 7 ' 7 , Investigation t mm) 66.25/ hr
City/State/ZIP: � - +
"0/5– Industrial plant (1 hr min) 78.18/ hr
Phone: (5 ) 4,SG. - i N Fax: (5) LSG, - `1 3 17 Inspections for which no fee is
specifically listed CA lU min) 90.00/ hr
CB Lic.: 5 j, Tectrical Lic.: rv. L. :';:t.:;:74-!! :'. : r FEES- .
Suprv. Electrician signature, required: i , y i . Subtotal:
Plan review (25% of permit fee)
Print name: y 4 .6 ,5 ‘gr,i.i S - . • Date: (p /sllZ— State surcharge (12% of permit fee):
e_dt TOTAL PERMIT FEE , 4a.- q l sr
Authorized signature: " la • permit application expires This ermit a lication e: if n
permit is not obtained within 180
Print name: a - ea i t (j „ Date: 1 C 1Z • days after a has been peesni, accepted as complete.
Date: /G l; trmbero f inspections allowedper pesmit
Clauil diog■Peno ito.ELC- PermitApp.doe o7/C1 :10 440-66157( I IN5/COM/WEa
Jun 0512 01:46p Beck Electric (503) 656 4397 p.3
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
• n Burglar Alarm
❑ Garage Door Opener*
n Heating, Ventilation and Air Conditioning System*
❑ Vacuum Systems*
❑ Other:
- :�•^L•�.�,TlR1� �'�;,,Wf[�:�]� a.~ _ Y €�p�- �nyq y l.� _
Fee for each commercial S75.00
system
(SEE OAR 918 -309 -0000)
Check Type of Work Involved:
i ] Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
n Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
1.` 9uildiny \PamiblELC- PermitApp.dac 0)/71/10