Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00371
T I G AR. O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/18/2012
Parcel: 1 S 125DD06200
Jurisdiction: Tigard
Site address: 6655 SW VENTURA DR
Project: Privitera Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 70
Project Description: Wire for NC, connect furnace
Contractor: ENGELMAN ELECTRIC INC Owner: PRIVITERA, PAUL
PO BOX 451 6655 SW VENTURA DR
HUBBARD, OR 97032 TIGARD, OR 97223
PHONE: 503 - 981 -8041 PHONE: 503 -297 -4169
FAX: 503 -981 -4026
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 06/18/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/18/2012 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 OAR 5 - 001 -0090. You may
y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. '1
Issued By: kd'c-!u Permittee Signature: DJ�, 4 Va A-�V14,
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.
06/18/2012 15:01 5039814026 ENGELMAN ELECTRIC PAGE 02/02
Electrical Permit Application FOR OFFICE USE ONLY
- City of Tigard Received • b Permit No.:L( (��(
n 13125 SW Hall Blvd., Tigard, OR 972 CE ; s 1 D Plan Review
DatelB ' — �
Phone: 503.718.2439 Fax: 503.598.1960
�� : OtherPermiv(45,0_ ,...) - Qb31
T l G A R D Inspection Line: 503.639.4175 Date Ready/By: r Sec cage 2 for
• Internet www.tigard -or.gov �N 1 8 2012 Notified/Method: Supplemental Information
. : =.Y :. .` , _ l • . ;IY F,W® . . . .. - PLAN REVIEW
❑ New construction �Addition/altera
. ∎\ •
t ' t Please check all that apply (submit 2 sets of plans w /items checked below):
� pplj
t( ' SION ❑ Service or feeder 400 amps or more ❑ Building over them stories.
❑ Demolition ❑Other: 1 + where the available fault current ❑ Marinas and boatyards.
4 µ' - ' " i exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
: : '. :'` CK3Gt? �'$ QON3rI RUG'ION; -: ..::. .` s
r 1- and 2-family dwelling ❑Commercial/industrial 0 Accesso building ass s o o r alloteri ns alla 1 n ❑Commercial - use agricultural
rY g amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
. + Y• • ❑ Emergency system. larger separately derived system.
•; < JOB SITE ; INFORMATION ' AND- L O!CA1 I ON`4 -; . ); ::'. • ❑ Addition of new motor load of ❑ "A" "5" "I -2" `•1 - 3"
Job no.: Job site CoGg. 6 lA J U� ' r(� 1) 1001.P or more. occupancy.
y. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: , U�0 G1P, 7 ❑ H azardous facilities.
❑ Hazardous ❑ Supply voltage for more than
•rat cJ locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Q.9S , (�)( 13 ry
Serv or feeder 600 amps or more.
` :: FEE•SCHEDULE
Cross street/directions to job site: Description I Qt ) Fee I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq. ft. or less 168.54 4
Ea add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential 75.00
. fit` B'ESORIPTioN OF` w li f--,--.:.-• _ - (with above sq. ft.) ' 2
1.'! Jc. Limited cncrgy, multi- family WI re, r Q / ce -r e rr►� � . e sq "+ / �1 Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
'"•13 PROPERTY OWNER > .. 1. ; ' : . fl T 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I 1
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
: " 0 APPLICANT? , • •'..I. :- `la CONTACT PE RSON.., above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18 C) � IG' 2
Contact name: branch circuit
Each add'I branch circuit ! 7.42 —1 `f- 2
Address: Miscellaneous (service or feeder nut included)
Each manufactured or modular
City / State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
. ' ' F4 : '•:.C ON T R A C PO R ' Sign or outline lighting 67.84 2
- Signal circuit(s) or limited-energy
Li()
Business ` name: ' � � ' �� e r d it i i.- Panel, alteration or extension. Page 2 2
p t n Each additional inspection over allowable in any of the above
Address: r� ( 9 f Additional inspection (1 hr min) 66.25/ hr
lT } / l Investigation (I hr min) 66.25/ hr
City/ State/ZIP: ,.., ei, 41 , , A 0 / � v,3 ;��Q Industrial plant (1 iv rein) 78.18/ hr
,� e • /
Phone: L]or<.i�! S!�11i Inspections for which no fee is 90 / hr
specifically listed CA hr min)
CCB Lic.: • gag" Jiir : � Electrical ii . s - i c.: Z •ELECTRICAL PERMIT :FEES
L . �� p.
Suprv. Electrigi. ignature, required: r t Su min
Plan review (25% of permit it fee ): fee):
Print name: f ■ t Date: • State surcharge (12% of permit fee): MUM
• lit I .14 ' .I / �'�r TOTAL PERMIT FEE: 1_ J
Authorized signature: This permit application expires if a permit is not obtain . within je,
days after it has been accepted as complete. I , ,,,7j$
Print name: I Date: • Number of inspections allowed per permit.
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