Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit n: ELC2012 -00425
T (. G AR. D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/18/2012
Parcel: 1 S134ACO2627
Jurisdiction: Tigard
Site address: 11145 SW COTTONWOOD LN
Project: Streight Subdivision: ENGLEWOOD NO.3 Lot: 184
Project Description: (1) 200 amp or less panel change
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Contractor: WEST SIDE ELECTRIC CO INC Owner: STREIGHT, KEN AND BARBIE
1834 SE 8TH AVE 11145 SW COTTONWOOD LN
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/18/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/18/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT •
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
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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 OAR 95�. You may obtain a copy of the rules or direct questions to OUNC by calling 50 3 . Kirk 3.22322.19877 or 1.800.332.2344. ,,. 1
Issued By: _ .(f . l ))i .4 + Permittee Signature: Okl, /PA RL
r 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.
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2012 -07 -17 11:49 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit Application I. ;1: RECI .1 i t is O r r I t r. 0 . 1 .,
City of Tigard . ' I �-2•-• PenndtN °.:(;'[.��0 /fit- 004`3.. tell ,
13125 SW Hull Blvd., Tigard, OR 97223 J U L 17 2 012 Plan RNi omen ;,:
Phone: 503.639.4171 fax: 503.598.1960 Date/B : •
Inspection Line: 503.639.4175 CITY OF TIGAR Date R4 Metho Stu fermatioa
Internee www.ligard-or.gov Notified/Mahwd:
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V_�011'�t� '
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�.�., ��J�,'1'x�:�'�7"0!?�� .'.`°- ' x'�:���- / ..y.•� , ' • .'~ . . •.: ':: F. ` =�' y !.:'.'Sn'.�e .. ..... YA�FYTArE�1 i :, . .. ..
o New construction 'Addition/alterationheplacement MOO cheek ell thM apply (submit 2 ems of plans whams checked bel ow):
El Service or faxder 400 amps or mom 0 Building over three swim
❑ Demolition ❑ Other. w the available fault currant 0 Marines and boatyards,
w , ' y; e l
5. t - •. : , '• s exceeds 10.000 mops at ISO volts or ❑ Floating bmldings. .
... leas rr x1d, or e racers 14.000 ❑ Cemmmeiel -ova
dwelling Commer:ciaVindustrial ❑ Accessory building sagricultural agricultural 1- and 2-family � ❑ rY g amps for ell other installations. buildings.
Multi - flintily ❑ Master builder ❑ Other: ❑ Fire pump. a i statletiso of 75 KVA er
r'S t err . ' ;,, ... ,.,.. - . t...: � `, CI Emergency system lager separately derived tyuam.
r ,1 1:' b' � y' :, . . _ !• • J , !* _ . e , ., %;: r . . ... ❑ Additee of new motor load of 10 "A ". - E". "1.2 ". - i -3
100HP or mere. Job no Jt) S Job site address 4 C 74/07),./00/Z4 - 0 Of mare rcaidentw unite. D �ional vehicle parks.
City/State/ZIP: 7Aa 0� q 1
17 ❑ llealth-caro halides. 0 Supply voltage for morn than
/i ❑ Hazardous �. 600 volts nominal.
Suite/bldgJapt no.: P roject name: 5 » ieon >4sr ij Oservix o< feeder 600 amps or mom
Cross street/directions to job site: s,n '`''' " 5"" . _,
New residential single or multi -fa ally dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1.000 sq. II. or less 168.54 4
Ea add'l 500 sq. R or portion 33,92 1
Tax map/parcel no.: Limited energy. residential
*- t. i . * T . m - v r . y: , u,.,• �44''.,,t,��g,' teH (with above sq. tt) 75.00 2
Limited energy. multi - family 75.00 2
AAA./ �/Y..E / C X anj e. residential (with above SO, 1 -
Services or feeders In halation, aihration, and/or relocation
200 amps or leas / 100.70 //70 t... 2
.:, i; _.r ' �c 1 � .y, ' °`'' .n.ls>'1. ?;. , 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
Name: 601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 55226' - _ 2
Cityl$tate2lP Temporary services or feeders installation, alteration, and/or
relocation
Phase: ( )
Fax: ( ) 200 amps or lass 59.36 1
Owner Installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 1 1 1 25.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 1 amps m 599 amps 168.54 2
Branch circuits — new, alteration, or extension. Eer panel.
Owner signature: _ Date: ; A Fee for branch circuits with
. ; ii a,,•rp .' w tree' n •t ^ ,r cvine te
ark ar k', .;y , va, ,4' '5r ' s :• K�' '•rt4 l..�t. .: `:a ^�' , T , ,: . ;': above a
, rr
,�. wt each bleats t ior feeder e,
7.42 2 n nit
Business name: B. Fee for branch circuits without
service to fonder fee. Rest 56,18 2
Contact name:
branch circuit
Each addl branch circuit - - 7.42 2
Address: Miscellaneous (service or feeder not included) _
Each manufactured or modular 67.84 2
City / State / ZIP: dwellinx, service and/or feeds
Phone: ( ) 1 Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: signor outline lighting 67.84 2
:fa �^L ° - , •�.. .. '.l�` .. ° ,Y Mgr 3 �... - ,yr,T' .gt,-
.-;';'*!r''t . t ' " i.''' *s; >§ :e 7,a t , . ,•''. ; ' :.5;+.rgilfr$ 'r. o0. ,L.x'� „nN - Signal cirmtit(s) or limited-mew
Busmessnatne: West Side Electric Co., Inc. — �De�ci�"0 "' «°pection ve Page n 2 _ 2
Each additional inspection over allowable in aav of the above _
Address: 1834 SE 8th Ave. Additional inspection (I hr min) l 66.25/ hr
Investigation (1 hr min) 66.25/ hr
City/Stare/ZIP: Portland /OR/97214 industrial plant (I hi. min) 7$.12/ hr
Inspections for which no fee is
:' 13306
Pane: (503) 231 -1548 Fax (503) 7 s�ecifieallylisted(hrmin) 9°
Lic.: • Gillett! laic.: 2 6 -13 5C '-3/6 -0677 . Lic.: 4 6 5 4 - S � ax" ;,? 1/r • „ ':'al.'. .` ', '
Suprv. Electrician signature, required: - F re Plan review (25% of ptat
nit feetal): : /( J() '
Prmt name: Randall F Roberts Date; , /7//2_ State surcharge (12% of permit fee): /z
TOTAL PERMIT FEE: 7.
Authorized signature: This permit epp8eadeu empires Ira permit is not obtained within 180
deo after it has been accepted as complete.
Print name:
"pate; • Number of inspections allowed per
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