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Permit
CITY OF TIGARD ELECTRICAL PERMIT s , COMMUNITY DEVELOPMENT Permit it ELC2012 00399 T E G AR O 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012 Parcel: 25101 DCO5000 Jurisdiction: TIG Site address: 13410 SW 76TH AVE Project: Albertina Kerr Subdivision: Lot: Project Description: (2) branch circuits for low voltage alarm and monitor Contractor: TYLER ELECTRIC LLC Owner: ALBERTINA KERR CENTERS INC PO BOX 801 424 NE 22ND AVE MULINO, OR 97042 PORTLAND, OR 97232 PHONE: 503 - 829 -4146 PHONE: FAX: 503 - 829 -5747 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 07/02/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 07/02/2012 $7.63 Type of Use: COM 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 OA 952- 001 -0090. You r _a� may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: o✓ Permittee Signature: 0k. Opt( 4 r b 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. 2012 -07 -02 06:49 GRF ELECTRIC 5038295747» 5035981960 P 1/2 )E lect rical Permit A lie CE1 'E rt►R 0FFICU I.SF.0 1,1 Received Per mit N0.: City of Tigard JUI 972 2 2012 Date/By: 7 ?`I I $- 0 ®O Q • 13125 SW Hall Blvd., Tigard, OR Plan Review — Other Permit:149�l.- 00/q/ Phone: 503.639.4171 Fax: 5 0- • Date/By: Line; 503.639.417 ' ^ t TIGAR Date ReadyBy lone. ® SecPa e f" z 2 for 'TIGARD „ B 1�DlJ,.I tr.n t No tified/Mmhod: .. -ric l Supplemental Information Internet. www.tigard -orgor 1 7 Z n � e - . • TYPE OF WORK PLAN REVIEW Please check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction dditiOn/alteration/replacement ❑ semce or feeder 400 amps or more El Building over three stories 0 Demolition _ El Other: where the available fault current ❑ Marinas and boatyards CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. less to ground, or exceeds I a,000 Q Commercial - use agiicultural ❑ I- and 2-family dwelling `,- Commercial /industrial 9 Accessory building amps for all other installations. buildings. ❑ fife rc pump ❑ Installation of 75 Kv A or 9 Multi ❑Master builder ❑Other: larger separately derived system. . ❑ rc pw np)'sysrom. W )' JOB SITE iNFORMATION AND LOCATIO ❑ Addition anew motor load of 0 "A ". 'E•'. ••I.2 ", .1 -3 ". 1001lP or more, occupancy. Job no.: Job site address: - 1 �, I , �7 - 5 • - / 0 Six or more residential units. El Recreational vehicle parks. --1 F 6� ❑ Health facilities. ❑ Supply voltage for more than .^ • City/State/ZIP: a __ ❑Hazardous iocanons 600 salts nominal. ❑ Service or feeder 600 amps or more. $uitctbldg. /apt no.: • Project name: ` - FEE SCHEDULE Cross street/directions to job site: _ _ Deoc o?_ rot., L _ Yee I Total I • New residential single- or multi - family dwelling unit. Includes attached garage. Lot no.: 1,000 sq. ft. or less 168.54 4 - Subdivision: En. add'I 500 54. ft, or portion 33.42 I Tax map /parcel no.: Limited energy, residential 6784 2 DESCRIPTION OF WORK (with above sq 8.) - , Limited energy, multi - family 67.84 2 residential (with above sq, ft.) 1 /a Services or feeders installation, alteration, and/or relocation - r. 200 amps or less _ 100.70 l 2 PROPERTY OWNER © TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 ;\lam (� 1 _ I �� r � 601 amps to 1.000 amps 301.04 2 �Addre5S: r f '' Over 1,000 amps or volts 552.26 2 Temporary services or feeders installation, alteration, and/or City /State /ZIP: i,� _ relocation -. r 200 amps or less 59,36 1 201 amps to 400 amps Phone: ( ) l Fax ( ) 125.08 2 Owner installation; This installation is being made on property that I own which is not 201 to 599 amps 168•x4 2 intended for sale, lease, rent or exchange according to ORS 447, 449, 670, and 701. Branch circuits - new alteration, or extension, per panel Owner signature: . Date: — _ — A. Fee for branch circuits with APPLICANT APPl1CT I 9 CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit -- B . Fee for branch circuits Business name: without service or feeder fee, ' l— - I Contact name: _ first branch circuit 96.18 `?t.I .1 Each add'I branch circuit ` 7.42 7• .f 2 Address: _ Miscellaneous (service or feeder not included) City /State/Zll': Each manufactured or modular 67.84 1 2 dwelling, service and/or feeder Phone: ( ) Fax:: ( ) Reconnect only 67,84 2 Pump or irrigation circle 67.84 _- 2 - E - Sign or outline lighting 67.84 2 CONTRACTOR _—_— Signal cireuit(s) or limited - I Business De iness name: ' o E (r c . ` L , I energy panel, alteration, or ��jj extension. Describe: Page 2 2 Address: 1.7 _ X , t r _ i CiryiState /ZIP: /J/} u / li Each additional ins action over allowable In an oft the above L , / C � Per inspection 66 Phone: 3) O M CI - • • . Fax: ( 3) , - 5 — 'r• investigation per hour tl hr min �� CCS L ic.: ` �:� c Electri t industrial plant per hour 78.18 ' c '3 4 f Suprv, Lic.: p C • % ELECTRICAL PERMIT FEES & ` ' Suprv. Electrician signature, required: t 0 t Subtotal: `" 1...=•___ Plan review (25% of permit fee): , — Print name: i, , ��`�� ; >t , e: L' State surcharge (12% of permit fee): '1 _ Authorized signature: • TOTAL PERMIT FEE: 'r • - mitt permit application expires if a permit is not o w it hin t80 Fril]t n:]mc: Date: days after it bas been accepted as complete.