Permit - NI CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00513
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S103DC00500
Jurisdiction: Tigard
Site address: 13705 SW 110TH AVE
Project: Rogers Subdivision: FAIRHAVEN COURT Lot: 4
Project Description: (1) sub panel and (2) branch circuits for water heater and dryer.
Contractor: WEST SIDE ELECTRIC CO INC Owner: DAVIS, JANET E
1834 SE 8TH AVE ROGERS, MARK W
PORTLAND, OR 97214 13705 SW 110TH AVE
TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/04/2012 $100.70
Specifics:, amps or less
2 crt Branch Circuits w /Purchase 09/04/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/04/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
•
This p is issu-• bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be •one in accordance wi • 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
• - ys. ATTENTION: Oregon aw •uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 95 • •1 - 1. 0 You may obtain a copy of the rules or direct questions to OUNC by callin . 32.1987 or 1.800.332.2344.
Issued By: . / / Permittee Signatu :
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 603.639.4175 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 -08 -31 09:56 WEST SIDE � lic 15037360677 » 5035981960 P 2/2
Electrical Perm A ' rO R ( t I R.. I : ( i.I.
City of Tigard 2 P 0 4 2012 E: , 9i1LrsP!i Permit N..: �, N /' 13125 SW Hall BlvdTigard, OR 97 ew
Phone: 503.7182439 Fax: 503.5 yy 1/� Tire DclB . Other Permit:
Inspection Lint: 503.639.4175 1 i T O F 1 II A 1 ® Date R '/By: runs: ® gee Page 2 for
! : (,,. F' m. Internet: www.tigard- ir.gov [11111 L D!NG Di 1S O N'''''''' Supplemental Information
..:.::,•
.Y -'•'( y-; :l .. D :.T?.:` 1.' ! . !{ .` i k - '- : -. - . i { tF �rr l , 1 r 7, - , . .7-,-,,7., �. 7 �.. M1 .,
.., - •.. , tiv..i'. •‘ +ctt.. F�L'.L,' ',TPA'�i ,,, s4. ` .ra_irA.a:; , "1..k.....vTr'c.o- ,)Mi... .T..cc,ik+aiE. ..,. ., „,) ,
❑ New construction 1't Addition/alteration /replacement Please dark all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder no amps or more ❑ Building over three ato
❑ Demolition 0 Other where the available fault current ❑ Marinas and boatyards
q• v;” . �' , ^ r 'v r+ - 'f ^A� " l . �.'�: exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
,F : •'e ' . i , ' : :. , Z tr , - ".w ` :., -., A. c ..L : ' �� . : 41'...';':f :' s? . - Ltlf , ti:L• ;. leas to rood, or exceed, 14.000 ❑ Commaeial•aso agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
■ Multi- family ❑ Master builder ❑Other: ❑Fire pump. (] Icatultation of f 75 of KVAA r st
p �� r Y 4 . k ❑ E t larger separately system.
�v, ` "'R r , rl..-.l "'1�' ,! _ Y Y. A ". E ".`1- Z ". " ",
� e ;r � -:,� :- . s.:.: ,� r ^ �i_.. �.�`.:.., d,v !r 5 • x; Ni?`•.... 3 t=r. :: his ,; r`.•. ❑ Addition of new motor load of ❑
Job site add 7 70 S� `(� r 1�HP or more. Recreation•
Job no.:
tea l 1 ' ! J l 0 six or more residential units. ❑ Recreational vehicle parks.
❑ Health-taro &ditties. Q Supply voltage for more dm City /StateJZl P: / ice,-al ae / f / �-• 2 Y Q Hazardous locations, 600 volts nominal. f
Suite/bldgJapt. no.: Project name: Ake /3. a`•L ID Service or per 600 atitps or more.
4 _ nr • is
Cross street/directions to job site: t I Celli e'en 1 Total 1
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'I 500 sq. ft, or portion 33.92 I
Tax map/parcel no.: • Limited energy, residential 75,00 2
.Vy��, i 1 ;rig' .. i! 1 ° �•�'7 "' ' 1'<r' r ('•�r tg.f Y .i; c 4f` �e (with above sq, ft)
_
'. `+u!. SIB,. . A.17 '%�'.r �.. i,:f .fj.kr. tr,t_.aa-.r.�i ..`Y:'.tii.. �Jixl: ]1. J .,-....=-,,.
%t• *� - �'^?�� multi- 11n1n1 Y 75.00 2
Limited energy, I
• �,A naim� -it- 2 (fCU(/�. i k Xi residential (with above so. ft.)
Services or feeders installation and/or relocation
` - i 200 amps or less / 100 /(),0 2
q• rw ,.:� a +:i ,, f . --•-r a� p a . , ); � ��G 2f11 am to 400 133,56 2
ale! ` {� : ' a 5 401 amps to 600 amps 200.34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City /State/ZIP: relocation
Phone: ( ) I flax: ( ) 200 amps or less 59.36 F 1
201 amps to 400 amps 125,08 . I 2
Owner installation: This installation is being made on property that 1 own which is not 4p1 turtpa to 599 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits _ new, alteration, or emension, per panel
Owner signature: Date: A. Fee for branch circuits with
" .
. yr .., C' r „ . .,�; �,� ..y'"C' r 4 "b --L t - Y 1. . 1 i . a r 4 . f , 1: 1 +---cv e Z-,r above service or feeder tee, 7.42 / r g 2
::7 r ,
" A-,,•5- .., X ....:. • r.ri . • rA i.: f. tL ,oe 1:- .!. . .i.zitki, each handl circuit
B. Fee for branch circuits without
Business name: s ervice or feeder fee, first
- 56.18 2
branch circuit
Contact name: 7.42 2
Each add'1 branch circuit
Address: Miscellaneous (service or feeder not locluded)_
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder ,
Phone: ( ) I Fax: = ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 ., 2
E -mail: - sigh or outline lighting 67.84 2
L : , •: r : -?, r : `t' r _: : : - ` �' , Mti . � -.., thy R ? ., Si suet' t(s) Or l energy
�•$;�� ;.. �+'- iM„4,�» �,�i ! .., r_r.ttrJ,i
panel, alteration, or extension. Page 2 .2
Business name: West Side Electric Each additional inspection over allowable in any of the abov
Address: 1834 SE 8 Ave. Additional inspection (I hr mat) 66.2 hr
Investigation (t hr min) 66_25 / hr , .
City/ State/ZIP: Portland/OR/97214 Industrial plant (I hr man) 78.1W hr
Phone: (503) 231 -1548 Fax: (503) 736-0677 inspections for which no 'A fee is 90.00/ hr
_ , 'fits] listed hr thin)
,1 Lie.: , 13 . S -rv. is 56984 .... _ ek 7 . 7 )'M1 ,..; - ;
CCB Lie.: 13306 fllc � ; "y,` :: f z:' . .a z ,,,:,::-1':,. . ;ew ,
r W - / :w Subtotal: )/ .- .r—
Suprv. Electrician signature, requir � Plan review (25% of permit fee):
- - - •• - Pate: i3! ('I /K/4 - State surcharge (12% of permit fee): / .3 �—
Print name: Broth G Wall
TOTAL PER r
MIT FEE : J_
Authorized signature: 'Ebb permit application expires If a permit is not obtained within 180 6,
days after It has been accepted as complete. q
Print name: f Date: • Number of inspections allowed per permit,
I tB ,,;ldi PermitApp.doc =auto .uo.e6tsro lirdiCOMM2B
- NI CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00513
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S103DC00500
Jurisdiction: Tigard
Site address: 13705 SW 110TH AVE
Project: Rogers Subdivision: FAIRHAVEN COURT Lot: 4
Project Description: (1) sub panel and (2) branch circuits for water heater and dryer.
Contractor: WEST SIDE ELECTRIC CO INC Owner: DAVIS, JANET E
1834 SE 8TH AVE ROGERS, MARK W
PORTLAND, OR 97214 13705 SW 110TH AVE
TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 09/04/2012 $100.70
Specifics:, amps or less
2 crt Branch Circuits w /Purchase 09/04/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 09/04/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
Required Items and Reports (Conditions)
•
This p is issu-• bject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be •one in accordance wi • 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
• - ys. ATTENTION: Oregon aw •uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 95 • •1 - 1. 0 You may obtain a copy of the rules or direct questions to OUNC by callin . 32.1987 or 1.800.332.2344.
Issued By: . / / Permittee Signatu :
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 603.639.4175 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.
•