Permit 1
CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00494
Date Issued: 08/21/2012
.TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S136CB04800
Jurisdiction: Tigard
Site address: 10830 SW 83RD AVE
Project: West Subdivision: STEVE & HUGHIE'S PLACE Lot: 20
Project Description: Replace 100 amp panel with new 200 amp panel
Contractor: RIGHT NOW HOME SERVICES INC Owner: WEST, TONI
BOX #701 12042 SE SUNNYSIDE RD 10830 SW 83RD AVE
CLACKAMAS OR 97015 TIGARD, OR 97223
CLACKAMAS, OR 97015
PHONE: 503 - 490 -9471 PHONE.
FAX: 503 - 775 -6006
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/21/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 08/21/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
•
Total $112.78
Required Items and Reports (Conditions)
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 R 9 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _ /
Issued By: Permittee Signature: 6/I1 �n e ��e)w
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.
08/20/2012 16:29 50377560 L 1 TOTAL ENERGY SOL PAGE 01/02
Electrical Permit Application AUG 2 0 2012 roll OFFICE; USE ONLY
City of Tigard ��//±� p Received �i
Til7A�D Dare/By: 2/ /Z ` Permit No,r(e .20 /off '00 7 '/7 9
9
• i7 q 13125 SW Hall Blvd., Tigard, OR 9722TM OF Plan Review
Phonc: 503.718.2439 Fax: 503.598.19 1 1 `�' r'r: Date/By: Other Permit;
TIGARD
Inspection Line: 503.639.4175 BUiLD �t ISiON Date ReadyBy: rurt ( ® SecPage2for
Internet: www, tigard -or.gov Notified/Method: [.i� SupplementalInformation
TYPE OF WORK PLAN REVIEW
❑ New construction ddition /alteration /replacement Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other:
-
where the available fault current ❑ Marines and boatyard
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating building.
Ices to ground, or exceeds 14,000 ❑ Commercial -use agricultural
and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
M ulti - family CI Master builder [] Other: ❑ F pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ['Emergency system. larger separately derived system,
['Addition of new motor load of 0'A ", "E ", "l- 2 ", "1 -3"
Job no.: Job site add ress: 7 aA.l 3 id I OOHP or more, occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City / State/ZIP: --` ep 9 Z _,3 ❑Health•earefacilities.
0 Supply voltage for more than
I CI Nuardous locations. 600 volts nominal,
Suite/bldg, /apt, no.: Project name: � ❑ Service or feeder 600 amps or more,
FEE 'SCHEDULE
Cross street/directions to job site: Description I Ote. I Fee. I Total L:7
New residential single- or multi- family dwelling unit.
Includes attached garage
Subdivision: I Lot no.: 1,000 sq. ft, or less J 168,54 J 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential —
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi - family
�'swv 'R-s1 ,J ,C residential (with above sq, ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
l 1 IIJ Z.LD - 04 EL 200 amps or less ' 100.70 2
i gppROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
•
Name: ' j i { , ` 6 s‘ 401 amps to 600 amps 200.34 2 —
ff�� `��G 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fa ( ) 200 amps or less 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
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 - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
, ❑ APPLICANT I er ONTACT PERSON above service or feeder fee, 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
.�� service or feeder fee, first 56,18 2
Contact name: branch circuit
Each add'l branch circuit 7,42 2
Address: Mlscellaneouagservice or feeder not included)
42
Each manufactured or modular 67.84 2
•
dwelling, service and/or feeder
Phonc: (5r (1C}0 9 44 l I Fax; : ( ) Reconnect only 67.84 2
E-mail:
Pump or irrigation circle 67,84 2
Sign or outline lighting 67.84 2
CONTRACTOR . Signal circuit(s) or limited -energy
Business name:' ',g4T n�d� - 1(L_.t y -- 1 i panel. alteration. or extension. Paget
CIO, Each additional inspection over allowable in any of the above
Address: £305c 7 01 , Ia 5r- S-u• /d fu ..I.1:. E /Z.IN Additional inspection (I hr min) 66.25/ hr_
City/State/ZIP: _ fie I,� c J� 0 . � 9 - 15 Investigation (1 hr min) - 66.25/ hr
- ' "� V Industrial plant (1 hr min) 78.18/ hr
Phone: ( ,3) clip 9q 7 I I F ax: ((03) - ,-, 600 4 Inspections for which no fee is 90 / hr
specifically listed yt hr m
( in ) • /�/i�CB Lic.: h ` Electrica - f . • . Lic.: ` ' /99,.S' ELECTRICAL PERMIT FEES
�� Suprv. Electricia si_nature, required: l �Ai `0 13 Subtotal: lQQ , 7f7
L• ` r= Plan review (25% of permit fee);
Print name: uaal�
• at) Lk , Dat - State surcharge (12% of permit fee): 42 • oe
Authorized signature: .. TOTAL PERMIT FEE: 1/,2 , 7� 4,..---
This permit application expires if a permit is not obtained within ISO
Print name: days after it has been accepted as complete.
Dace' * Number of inspections allowed per permit.
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