Permit CITY OF TIGARD ELECTRICAL PERMIT
I • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00389
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 • Date Issued: 06/27/2012
Parcel: 25111 CC21200
Jurisdiction: Tigard
Site address: 10240 SW GREENLEAF TER
Project: Wright Subdivision: SUMMERFIELD NO.5 Lot: 270
Project Description: Panel change -out and (6) branch circuits for kitchen remodel.
Contractor: PHOTO ELECTRIC LLC Owner: WRIGHT
PO BOX 13657 10240 SW GREENLEAF TERRACE
SALEM, OR 97309 TIGARD, OR 97224
PHONE: 503 - 551 -9611 PHONE:
FAX: 503 - 375 -9829
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/27/2012 $100.70
Specifics: amps or less
6 crt Branch Circuits w /Purchase 06/27/2012 $44.52
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 06/27/2012 $17.43
Electrical
Type of Const:
Occupancy Grp:
•
Total $162.65
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 accorda . I 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. ATTEN s 1 : Oregon - requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001-00 % through OAR 952 -00 • • 0 •u may obtain a copy of the rules or direct questions to OUNC by cal '..,.r. r .232.1987 or 1.800.33 .2344.
Issued By: / / L � Permittee Sig = ure: ' ii u
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' ,4 e • Date: 6/27 /, r
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.
Electrical Permit • nccation CiB Ii I UI(01 FI('h 1 si: O \'L1
City of T ., ; ;:,' �Q � ,,.
13125 SW Hall B igerd, DR 97223 JUN 7 2012 P lan Review
Phone: 503.7181' Fax: 903.598.1960 D B Other Parrott:
Inspection Line: r 9.4175 CITY OF TGARD Dige ReM /BB, hub: 10 See Paget for
h
Internet: www gov r, r N atfft:d/ltealro� Supplemental laforma oe ■ .t1 Pa r(,, ,► / , ttM
: ._,.:. � . ..__ � a ,,,.: • _ ' ',. c_a_ mF..:c e , ._ ':,'ks
❑ New construction 1. • , ition/alterati on/ replacement �ecir all that apph submit i sots of Man, wlaems checked below)
❑ Demolition ❑ 9 r er:. D Service or reader 400 ,... or may D Building over throe aerie&
where the available fault current D Marino and boatyards.
M, . , .: t , ty exceeds 10,000 amps atI150 volts or D Floatute bullttings.
,., ` h e a l to greed, or eaccds 14,000 D Commrrad.use agrlcuharal
■ _ 1 1 and 2 family dwelling U I . mmercial/industrial ❑ Accessory building amps for ail otlur instal buildings.
• Muth family ■ aster builder ❑ Other: D roe pump• 1 ❑ Installation of 75 KVA or
-� t � rs
j ( h
D Enwrgency syaam I larger separately derived system.
a Ir ::: : . .IC Ir€ 3,cb. t '_k .. r A > : ?:-.- ... .F
.. . �.: � r ..._t.. _ 0 Addition of new motor 1:13d of ❑ °A ". °E', "1 -2 ". 1-3 '.
Job no.: 4q14 4 ( Job ;;; r ss: 1029 0 S 6•211..0 L F i 4r Silt or o e rest
I occupancy.
- ' D Six or moo residential ❑ Recreational vehicle parka.
City/State(ZIP: Ti - ` 4 ',OIL 9 7 Z Zy D Health-care facilities. I D Supply voltage for more than
D Hozadoas locations. I 600 volts nominal.
Suite/bldgiapt. no.: • roject name: g D Service or hinder 600 angel or mina
Cross street/directions to job s te: Duet( 0941 PM Sc' . ® •
IDi � 0
go
New residential idential sins or malts- family dwelling noiL
• ok _ Fr _ 1 • Includes attached ga : ge.
Subdivision: L no.: 1,000 sq. ft. arless 168.54 4
Tax amp/parcel no.: Fa add'1300 sq. ft. or .. 33.92 I
�itt „ rytt Limited energy, residents
. .. .. _ , _ ;,: with atwve . ft 75.00 2
�r
Q +�� Limited energy. multi : ily
75.00 2
K t O Services or feeders I , I. do alteration and/or relocation
amps or leas r, 100.70 pip. " 2
31 `,,.. S , .:,., :d, - i " ^,ems. ,i 0/t: E. ..1_r 201 amps to 400 amps NEI 133.56 2
Name: 401 amps to 600 maps I 200.34 2
601 amps to 1,000 amps 1 301.04 Address: Over 1.000 amps or volts 552.26 2
City/StatrJZIP: Temporary services orj feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 k
Owner installation: This IAds liars mg property that I own which is not is be' made on 201 amps to 400 amps 125.08
intended for sale, lease, rent, o • t : r lei accenting to ORS 447, 449, 670, and 701. 401 w 599 amps 168.54
e
Branch circuits — new, alteration, or a tension, per panel
Owner signature: Date: A. Fee for branch circuits with
jst >.Y£r . Fs =;3 :,:' •• ) ..., 9 _..> z:. ;r,. each branch circuit fadsrtea. 7.42 2
Business name: B. Pee for branch circuits
service or feeder fee, 56.18 2
Contact name: branch circuit
Each add'I branch circuit b 7.42 Liy 2
Address: Miscellaneous (serviee]o feeder not Included)
City/State/ZIP: Each atam�acdrned or rrrodular 67.84 2
dwelling, service and/or metier
Phone: ( ) I Fax: : ( ) Recommas only 1 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
e Si 67.84 2
+ s i iu §, w r'I w r4 •rz i 8 ..... O •u, EMI
' - j r..: __., 2 • 11 .- rsz 7• li.i;xli,lt me : SI Cire4alS or
Business name: p - . : r dtereti or ... 2
E ac h additional l � � . . v over allowable io any or the above
Address: po t 3 _ s') Additional irnpecticn (1 . min) 6625/ hr
City /State/ZIP: 5/11,. (912. 97309 Investigation (1 by min) 6623/ hr
7 Industrial plat (1 hr mt0 =I 78.18/ hr
( SaS ) SS/ 961 I Fax: Gb3 375 2-• Inspections for which >ua fee u 90.00/ lir _
CCB Lic.: 142.114 El: 'cal Lac.. C I upr•v. ic.:3 27? "s 1. .. -` 1, + �° ' I j i t
,. eil'11;<
Suprv. Electric s ig n ature, tnglmi • ' � � ` i . 4b 1..1 Subto �r� e u
.,•,,
� Plan revs • • (25% of • emit fee).
Print name: /ZOO LO I, Gi` Date: 6 -27.• (Z State s rchar (12% of pornit fee): f 7
TOTAL PERMIT FEE: (eZ •
Authorized signature: 716 permit application aspires If a permit Is not obtained within 180
Print name: I Date: days doer it has been accepted as complete.
Number of inspections &lowed per permit.
I.' lBuildog■ermfrsII.C•PeruutApp.dae 07/01/10 4404613T(11105/COM/WFB I
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FAX COVER SHEET
DATE: 10 -11- I Z.
TO: E L t C L. piawter p CS tL
FAX: 1- Sd 3 - S9g I`� c O
FROM: ROD LODER - PHOTO ELECTRIC INC
PHOTO FAX 503 - 3754829
RE' it C r
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