Permit CITY OF TIGARD ELECTRICAL PERMIT
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I :H.- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00358
13125 S W Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/11/2012
TIGARD. Parcel: 2S110DA01500
Jurisdiction: Tigard
Site address: 10684 SW NAEVE ST
Project: Gulholm Subdivision: RENAISSANCE SUMMIT Lot: 6
Project Description: (4) branch circuits
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Contractor: SUNLIGHT ELECTRIC INC Owner: GULLHOLM, BJORN & ELLEN
2800 NE 65TH AVE SUITE B 10684 SW NAEVE ST
VANCOUVER, WA 98661 TIGARD, OR 97224
PHONE: 360- 772 -3877 PHONE:
FAX: 360 -694 -9728
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo /Purchase 06/11/2012 $78.44
Specifics: Service or Feeder
• 1 ea 12% State Surcharge - 06/11/2012 $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 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 -0090. 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: 61.1 AP i P./�1- Troll,
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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 603.639.4176 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.
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Permit Application c°
City of Tigard L . 1 1 I . e /� it (d— PermitNo.: E 1 0035
• JUN 13125 SW Hall Blvd.,Tigard,OR 97223 . PlanRoviow .
Phone: 503.7182439 Fax: 503.598.1960. N 0 7 2012 Dat Aly: Other Permit:
r i , `) Inspection L ne: 508:639.4175 Daze Ready/By: 1'u+yi /� _ I la See Page 2 for
Internet: www.tigard Sapplemeu1a11ato
NotI5al0fcthod: �' l Y/
ITV OFTIGAR�
y�TPE OF ..WO ICf IN DI \IISlOW � .. : :: . :: • . - . ::.. REVIEW : °..''::.::`: •_..;,:
El New construction ,tSDr+
: difion/altcra i rep s Oemn e n t Please check as that apply (submit g sea of plans whims checked below): '
17 Service or feeder 400 amps or more O Building over three stories.
❑ Demolition ❑ Other:
wham the moldable fault current Marinas and boatyards.
C AT E G O RY `OF CONSIIUJCTIONI exceeds 10,000 amps at ISO v0113 or 0 Floating buildings.
teas to ground, or exceeds 14,000 D Corn aicial -use agricultural
'®, and 2 family dwelling ❑ Commercial/industrial 0 Accessory building .
amps for all other installations. buildings.
❑ Multi - family ❑ Master builder , ❑ Other: • CiFire lump. p Installation of 75ICVA or
.I011 S INFORMATION AND LOCATION ° E�ncy system. brsee separately derived system.
O Addition of new motor load of 0 A ", "E", "1 - Z", "1 ",
100RP or room. occupancy.
Job no.: - Job site address: /06 $ ti 5 Vt/ N ct P (/. Sy O She or more residential writs. CI Recreational vehicle pane.
City /State/ZIP: T r d ®( 9 72_2 L/ O Health-care facilities. ❑ Supply voltage for more than
• D Hazardous locations, 600 'volts nominal.
Suite/bldg. /apt no.: Project name: • O Service or feeder 600 amps or more.
FEE • SCHEDULE . • .
Cross street/directions to job site: Dererindoa I ver. I Pao I Tow I •
• New residendai siagte- or multi-Emily dwelling unit.
Includes attached garage.
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Subdivision: Lot no.: 1,000 sq. R or less 168.54 _ 4
Es add'l 500 sq. R. or portion 3392 l
Tax map/parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WPRT(.. (with above sq. R)
• I t.5 Limited energy, multi - family 75.00 2
0161(1141 0 v1 fib 1,t/t (i r , II (, f G u ( residential (with above sq. R)
/ Services or feeders installation alteration, and/or relocation
• 200 amps or less 100.70 2
❑ PROPERTY OWNER Ll ! y .0 TENANT 201 amps to 400 amps .133.56 2 •
Name: & — L L 6 L /i) 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: over 1,000 amps or volts 55216 2
City/State/ZIP: Ttmpotary services or feeders installation, alteration, and/or
• relocation
Phone: ( ) I Fax: ( : ) • 200 amps or tars 59.36 1
201 craps to 400 amps 125.08 2
Owner installation: This installation is being made on propeaty that I own which is not 401 to 599
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. am • 16854 2
Branch circuits– new, alteration, or extension, Per panel
Owner signature Date: . A. Pee for branch circuits with
❑ APPLICANT , . I I ❑ CCIV TACT • PERSON above
eaeh branch a feeder far, 7.42 2
Business name: B. Fee for branch circuits without
strike or feeder fee. lust . 56.18 ,SL. , 8 2
Contact name: branch circuit
Each add'! branch circuit 3 7.42 22.2h 2
- Address: Miscellaneous (service or feeder not included)
City /State/ZIP: Each roamtfachaed or modular 67.84 2
• . dwelling, service and/or feeder _
Phone: ( ) I Fax : ( ) ct only 67.84 2
E Pump or irrigation circle 67.84 2
CONTRACTOR • . Sign or outline lighting 67.84 2
] L Signal circuit(s) or limited- energy
Business name: ti /r 1 l � t!/ t� v Panel, alteration, or extension. Page 2 2
O � i 14 -c- 0 _ Each additional Inspection over allowable in any of the above
Address: 2g 0 /1/E. 6--s-42 — g Additional.p.mon ( 1 ht.... . 6625/ hr
City/State/ZIP ' A/ Q/ / _ Investigation (1 brmin) 6625/1w
1 //f�r h C o k i 1/' . V "4 . 9 /1 6 C l Industrial plant (1 hr min) 78.18! hr
Phone: (36 .57g2_ 7-31...9 Fax: fgai) s 966 O Inspections for which no fee is 90.001 hr
specifically listed (54 hr min)
CB Lie.: 112 5 2 ,I.> a ctncal ic.: C2 30 rv. Lic.: / 7 9g S . • • lEI2QCPRiCAL PE Rmir FEFS' . • . ,
Suprv. Electrician signature, required: • /L Date: Plan review (2596ofperm Subtotal: C y y
Print name.Ch 6 STiz i t /> 2 X 71 Date: 0 _O 6-1°17. State surcharge (12% of permit 614 .
Authorized signature: � s// - TOTAL PERMIT FEE 8 T . kg
• Ms permit application expires if a permit spot obtained within ISO
complete.
Print name: days after u has been accepted as e
', j i a/ ' fie: • Number of inspection allowed p
ulding \ Pemtetac
u-Pomitapp..
1: hn 07ro1n0 44046I5T(11/05/COM/lvm
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