Permit •
CITY OF TIGARD ELECTRICAL PERMIT
• • COMMUNITY DEVELOPMENT Permit p: ELC2012 -00366
T t G A R O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/13/2012
Parcel: 25101 BB01400
Jurisdiction: Tigard
Site address: 12006 SW GARDEN PL
Project: COI Custom Decorators Subdivision: CROW PARK 217 Lot: 2
Project Description: (1) branch circuit for TI
Contractor: ALL AMERICAN ELECTRICAL CONTRACTORS Owner: WALTON CWOR PARK BC 8 LLC
PO BOX 1426 BY CTMT - WALTON RE TAX
GRESHAM, OR 97030 4678 WORLD PARKWAY CIR
ST LOUIS, MO 63134
PHONE: 503 - 657 -4351 PHONE:
FAX: 503 -496 -3995
FEES
Q uantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/13/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/13/2012 $6.74
Type of Use: COM 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 9 2- 001 -0090. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.19877 or , 1
Issued By: O�VLCJC� Permittee Signature: D� 4 rT ti t, 4 / 1040
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.
Electrical Permit App licatio _ ECEIVE 1 II II: tr i it I t 'l. I l\I., , o' P
City of Tigard JUN 1 2 2012 (s iI 31/ y s PemtitNo6 -00344,
Il 13125 SW Hall Blvd.. Tigard, OR 97223 Plan Review QQ����
Phone: 503,715.2439 Fax: 503.598.190, , t tsta/By: Other Permit (3 p.20a.— 00080
Inspection l.ine: 503.639.4175 LS I ! OF ! IG. t'•�j Date xead l la see Page 2fbr
Internet: vw.tigard-0t.gov Ill i
` r ' 1i roc Notified/Method: I, Supplemental Information
v n ,
TYPE OF WORK PLAN REVIEW
❑ New construction Addition/altcration/replacement Please check all that apply (submit i sets of plans w/items checked below):
CI Service or feeder 400 amps or more ❑ Building over throe stories.
❑ Demolition Other: whole the available fault omond ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or Q Floating buildings,
less to ground, or exceeds 14,000 0 Commercial -use agriouhuml
❑ I- and 2- family dwelling Commercial /industrial ❑ Accessory building amps for all otter installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
❑ EmarsencY
JOB SITE INFORMATION AND LOCATION Addition o f new m m. larger F, "1-2","1.3", -2l'. de. system.
El o new motor load of Q "A °, "E",
10E111P or mom. occupancy.
Job no.: Job site address: ress: / 200 G ..A. 6 oo rel ev. ❑ Six or more residential units. 10 Recreational vehicle parks.
City /State /Z1P: ` v «� 3 Cl Hazardous locations. Cl Supply voltage for more than
{ �� 4 ❑ Hazardous locatio s. 600 volts nominal.
Suite/bldg. /apt no.: 1 P r ro oject name: cj service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: neurtatioe I Qty. I F . 1 - row T
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: (l,ot no.: 1 ,aoo>x1. R• to tens 168.54 4
Ea.add'/ 500 sq. R. or portion 33.92 1
Tax map /parcel no.: - ` Limited energy, residential
DESCRIP'T'ION OF WORK (wilt above sq. R.) 75.00 2
Limited energy, multi - family 75,00 2
INS ' I d. v c. k r v i ces ia (with abo sa. ft.
Services or feeders installation, alteration, and/or relocation
200 amps or teas 100.70 2
❑ PROPERTY OWNER ' ❑ TENANT 201 amps to 400 amps - 133.56 2
401 amps to 610 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552,26 2
Temporary services or feeders l mutilation, Mk-radon, and/or
City/StateJZIP: relotwtlon
Phone: ( ) ` Fax: ( ) 200 amps or hue 59.36 1
• 201 amps to 400 amps 125.08 2
Owner Installation: This installation is being made on property that I own which is not 401 mope to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branch circuits -- new, alteration, or eneaslou panel
Owner signature: - _ Date: A. Fee fbr branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON strove service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for brunch circuits without p
- service or Seeder foe, first ' 56.18 SG. $ 2
Contact name:
— Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular 67.34 2
City/State/ZIP: dwelling, service and/or feeder
Ph one: ( ) I Fax:: ( )
Reconnect only 67.84 2 -
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited-cnergy
,.�[ panel, alteration, or extension. Page 2 2
Business name: - _ � � r j f L j 14 d t►nf l Each additional lnapection over allowable in any of the abov
Address:
1 .. + C c / 2i. Additional inspection (1 hr min) 6625/ hr
Investigation (1 hr thin) 6625/ hr
City /State/ZIP: C� ( f_ r i r It.- q7030 o Industrial plant (1 hr mm) 78.18/ hr .
Phone: (50 T Fax: ($ , ) t ' - .. , • Inspections for which no fee is 90.001 hr
- �,, �: a. -. call listed li hr min
• at: L .: IS' 24q0 Fag Lie.: 2G -ii YY( i Stifirv. Lie.: (./ 7714 ELECTRICAL PERMIT FEES i
j' —i - Subtotal: fro .4
Suprv. • 'clan Signature, required: /iZ%55 �.Jti/ � Plan review (25%of permit fee): -- _
Print name: D , AY k L I , (IV-1 f Date: // 2// 2 state surcharge (12% of puma fee): 4.1 t(
W,/ TOTAL. PERMIT' FEE: Cot . k.C� 1
Authorized signature: Tbb permit application expires d e permit is not obtained within 180
J / days after It has been accepted as complete.
Print name: —ivy 0, ; �/ L LL' [� Date: -II. • Number of iaspeolitne snowed per permit
I:1BuI1dlaglPe uiWELC- PamitApp.• • 07M1/10 440-4015W I/OS/COM/WElI
20021 'IVDI/1.LD3'I3 NIVOI li3PV - 'TIV C0.t' TO' COS lira LS:ST ZTOZ /ZT /90