Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00451
T t G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/31/2012
Parcel: 2S102BCO2400
Jurisdiction: Tigard
Site address: 12805 SW WATKINS AVE
Project: Rizzutto Subdivision: NORTH TIGARDVILLE ADDITION Lot: 24
Project Description: (4) branch circuits and (1) 200 amps or less
Contractor: BOONES FERRY ELECTRIC INC Owner: RIZZUTTO LIVING TRUST
PO BOX 628 12805 SW WATKINS AVE
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503 - 682 -4936 PHONE:
FAX: 503 - 682 -7946
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/31/2012 $100.70
Specifics: amps or less
4 crt Branch Circuits w /Purchase 07/31/2012 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/31/2012 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
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 OAR j35 -001 -0 90. You ma obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. A `
Issued By: /� Permittee Signature: 0i3 4 Pet/
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.
Jul. 30. 2012 10:29AM No. 9439 P. 1
Electrical Permit Application FOR 01 1.1(. I, I_:S[ ONI.1
City of Tigard Received 1, (3 ( / (L 9r Permit 14a, 6 O(x /
1 SW Hall Blvd, Tigard, OR 97223
Pam Review
PboDc. 503.639.4171 Pic 503.598.1960 See.Page 2 for
Omer Permit;
T ,
Inspection 503.639.4175 Rua Ready/By: r ' Li U �_ 0 2 12 � �g x
I i Ll PJ
Internet www.tigard -or.gov Notifsed/M Y / - u a Y - tai information
—
/ , ) S
❑ New construction .. .1RAddrtlon/ • . .1 replacement Please cheek all that apply (subatit z sets of plans w /items checked below):
0 service or feeder 400 amps or more ❑ Building over three „.
❑ Demoiiti0n ❑ Other
Vw zf j i , t , exceals 10.available amps at 150 volts or 1] F boatyards.
jai- and 2- family dwelling 0 Commercialfmdustrial Li Accessory building for other inslaUrdi El om use agrieulmal amps ❑ Multi -family ❑ Master builder ❑ Other. O p. O Installation of 75 KVA or
r /� v F ❑ E as e 6 'av'7 SYStem- lard separately j: S / ' � derived System.
M . :., _ -... ❑ Addition of mew motor load of ❑ - A . s". 1.2 ". "1 -3 ".
Job no.:2.00 ? 1 2 lob site address: / 2 8 0 5 S1. W ai' by n-v 10o11P or tnae, ooc ttpatxy.
❑Six e mote tes itkntisl anus. ❑ Rareational vehicle pets.
City/State/ZIP: ? Q„ d v ' ❑ Health -care facilities. 0 Supply voltage for mom than
.� p ❑ Hatardoes locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Or i z Z tAf' 0 O Service or feeder 600 amps or more.
,;
Cross street/directions to ': "
job site D ae.fetioa Orr. � . •® .
"' - New residential single- or multi-family dwelling unit.
' Includes attached garage -
Subdivision: Lot no.: _1,000 sq. fl: or less 168.54 4_
Tax map/parcel no
Ea. add', 500 sq. it or portion 33.92 1
Limited energy, residtartial 67,64
,. . _..... _.. ... r.. _ - I 5 s t ov sq. R ) r 2
.
A , Limited energy. multi- family
67.84 2
i p 0.11.0-I C h., c ... crick residential (with ab idential (with above sq. ft)
Services or feeders iustalla • alteration, and/or relocation _
200 amps of less i 100.70 2
' . l: r ' 201 amps to 400 amps 13356 2
.. .. .,,. a..,, ... -- -_ _ .. .� „•:, ... .... . .... .. ,.,,_..,. --- -- ,........--- --._ _ ,...
Name:
401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Lim: Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation _
Phone: ( ) Fax; ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which, is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch 'circuits - Owner sigramre: Date: A. Fee for branch circuits alteration, circuits extension, per panel
} { above service or f eeder fee
_.... _._ ...... =.> -;',.;;-__=:‘ .... i f 1.42 2x,66 z
• ....... - -- eachbtmtdtt
Business name: B. Fee for brand circuits withora
service or feeder few first 56.18 2
Contact name: branch circuit
t ach add', branch circuit 7.42 1 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( )
I Fax:: (• ) Reconnect only 67.84 y 2
E- 1: Fitton or irrigation circle 67.84 2
Sig, or outline lighting r 67.84 2
r. :"..
-� Signal tirwit(s) or limited-eoergy
Business name: Homes Ferry Electric Panel alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: P.O. Boa 628 Additional inspection (1 br min) 6625/ hr •
hr rnin)
City/State/ZIP: Wilsonville OR 9 7 0 7 0 I n v e s t i g a t i o n (1 66/5/ ht
Industrial piing (1 br min) 78.18/ hr
Phone: (503) 682•4936 Fax: (503) 682 -7946 Inspections for which no fee is 90.00/)u
I � s . cal listed ''4 hr mm)
,.B Lic.: 88482 trical Lic.: 3 -2Z3C trprv. Lic.: 3) 70 3 7:, r . . t .
Su ) 30 , 9
Suprv. Electrician signature, required Plan revive/ (25% of permit tee): .---
Print name: j 14 e ,,.,, Date; State surcharge (12% of permit fee): /s, (, 1 F
Authorized signatrtrt:: TOTAL PERMIT FEE: 1 t}6 , 0 Z
Tba permit application expires if a permit o not obtained within 180
Print name: Date: • Numlxs of
don after it has been accepted as complete. 3 y(
inspections mowed per permit
L• 18w14i°atPamita\ELC- Pamrtnpp.doc 10/01/09 440 1 /05/COW WES
07/30/2012 10:54 FAX 0001
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