Permit CITY OF TIGARD ELECTRICAL PERMIT
111 a _ COMMUNITY DEVELOPMENT Permit #: ELC2012 -00428
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/19/2012
Parcel: 25101 DB00710
Jurisdiction: Tigard
Site address: 13235 SW 72ND AVE
Project: Chase Home Finance Subdivision: ROLLING HILLS Lot: 30
Project Description: Electrical reconnect
Contractor: Owner: CHASE HOME FINANCE
6415 VISION DR
COLUMBUS, OH
PHONE:
PHONE: 503 - 989 -6359
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 07/19/2012 $67.84
Specifics: 1 ea 12% State Surcharge - 07/19/2012 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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 i ccordance wi - pproved plans. This permit will expire if work is not started within 180 days of issuance, or rf work is suspended for more the 180
days. ENTION: Oregon I• r= u' =s you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 1 -0010 t rough OAR 9 r 11-00 • r ou may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Is ued By: � � �� Permittee Signature: \ _
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.
Orr t/ 6 $,1-2 ece.A0/ ,--60ya
1 4 0 ' c° Electrical Permit Application
Current Planning
Washington County, 155 N. 1 AV, Suite 350, MS 12, Hillsboro, OR 97124, Approval
, N Phone: 503 - 846 -3470, Fax: 503 - 846 -3993, Project-14
Inspection. Requests: 503 -846 -3699, www.co.wasllington.or.us
TYPE OF WORK PLAN REVIEW
❑ New construction ❑ Addition/alteration/replacement Other. Rr`,..fk Please check all that apply:
❑ Service or feeder 400 amps ❑ Hazardous locations
CATEGORY OF CONSTRUCTION or more where the available❑ Stavice
fault current exceeds ❑ Building over three stories
* *NI- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building 10,000 amps at 150 volts or marinas and boatyards
❑ Multi-family less to ground, m exceeds
Y ❑ Master builder ❑ Other. 14,000 amps for all other ❑ Floating buildings
❑Commercial -use agricultural
JOB SITE INFORMATION AND LOCATION installations.
❑ Fire pump buildings
Job no.: 1 Job address: r3 S W 72. �`/ Art ❑ Emergency system ❑ Installation of 150 KVA or larger
separatel
City/ State/ZIP: Addition of new motor y
T �(a le Q/L 1114.; ❑ load of 100HP or more
Suite/bldg. /apt. no.: I Pro act name: ❑ Recreational vehicle parks
J ❑ Six or mere residential units ❑ Supply voltage for more than
Cross street/directions to job site: ❑ Health-care facilities 600 volts n ordinal
• FEE SCHEDULE
Description I Qty. I Pee I Total 1 •
Subdivision: 1 Lot no.: Residential single- or multi- fancily dwelling unit.
Includes attached garage.
Tax map/parcel no.:
1,000 sq. it or less 163.78
•
4
DESCRIPTION OF / WORK Ea. add'i 500 sq. ft. or portion 46,00
4 • drib l y .- 10440 q6026.- Limited energy, residential
rw d,�.• (with above sq. R) 105.00 2
�f1, . ,Q,, Limited energy, multi - family
U r e ' lk 4 residential (with above sq R) 105.00 2
PROPERTY OWNER I ❑ TENANt v Services or feeders installation, alteration, and/or relocation
Name: CS t ll f t " r 200 amps or less 105.00. 2
�i ' � 201 amps to 400, amps 158.00 2
Address: 4yI r g- De. 401 amps to 600 amps 210.00 2
` City/State/ZW: Cd4.� J M 601 amps to 1,000 amps 315.00 2
9 s • Over 1,000 amps or volts 630.00 2
Phone: (ris3) q 8. 9 60/ r i I Fax: ( ) Temporary services or feeders installation, alteration, and/or
200 a m p
Owner Installation: This installation is being made on 1 or turn s
my immcdlate-fart . This ... - is n •. r a "' o wned by l) or a member of 200 amps less 105.00 2
Y cif• , Ic , e.� .�• or rent ( RS479.540(I) and 479.560(1).
Owner signature: _ / I 201 amps to 400 amps 158.00 2
Date: //� Jr v 401 amps to 599 amps 210.00 2
( AP' CANT I r CONTACT PERSON Branch circuits — new, alteration, or extension, per panel
Business name: y� // o r,1„ syn
A. Fee for branch circuits with
W 5 S� TwC above service or feeder fee, 9.25
Contact name: �/ each branch circuit 2
Kr ` — s d � 4 B. Fee for branch circuits
Address: ,4111 pti�►3 C wifhowithout service or feeder 105.00
v S fee, fast breach circuit 2
City /State/ZIP: 54 J 6n 9130 Each add'l branch circuit 9.25
7 Miscellaneous (service or feeder not included)
Phone: (15b3) Ci C 1 l _ 6? 'c I Fax: ( ) . Each manufactured of modular
e ce, and/or feeder 111.25
dwelling, , servi
Reconnect only 105.00 aK l
. CO fl .TOR
Pump or irrigation circle 105.00 2
Business name: Sign or outline lighting 105.00. 2
Signal circuit(s) or limited -
Address:
energy panel, alteration, or
City / State/ZIP: extension. Describe: 105.00
2
Phone: ( ) Fax: ( ) Each additional inspection over allowable in any of the above
E -mail: Per inspection 105.00
CCB lie, no.: Investigation fee tsee comptirrc)
Electrical lie. no.: City or metro lie.: Other
Supervising electrician ELECTRICAL PERMIT FEES
signature, required: Subtotal CD 7 6 e / [
Print name: I Date: Plan review (25% of permit fee) .16C y
Authorized State surcharge (12% of permit fee) (3r 8 `
r/
signature: TOTAL PERMIT FEE /1.7r Gel
Print name: I This permit application expires if a permit is not obtained .
Date: within 180 days after it has been accepted as complete
• Number of inspections allowed per permit Revision 6/12