Permit CITY OF TIGARD ELECTRICAL PERMIT
4
a COMMUNITY DEVELOPMENT Permit #: ELC2012 00514
T [ G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/04/2012
Parcel: 2S110BC01900
Jurisdiction: Tigard
Site address: 11981 SW ASPEN RIDGE DR
Project: Fowler Subdivision: ASPEN RIDGE Lot: 31
Project Description: (1) branch circuit to reconnect NC
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: FOWLER, ROBERT
PO BOX 3948 11981 SW ASPEN RIDGE DR
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 09/04/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/04/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 0 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1 .8�
800.332.2
Issued By: Permittee Signature: l //11' ,4Pf K Ci"t
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.
Electrical Permit Applica i,. F FOROFFIGE US ONLY USE .
i . . � P E l V Received
1 City of Tigard c/B 9 l s, G� y PermitNo.: ,2DI -0O515/
■ 13125 SW Hall 13lvd., Tigard, OR 9 7 P Review
2 > Phone: 503.639.4171 Fax: 503.59814b0 0 4 2012 Date/By: Ma Palen:
1 D Inspection Line: 503.639.4175 Datc Ready/By: mi.: 65 See Page z for
71 G n 1
Internet: www,tig:. T
rd•or.gov CITY OF TIGARD Notified/Mean:eh 1 I k:. I Sopptemcntat Information _
r� TYPE V f" Please er PLAN REVIEW
C] New construction fJ Addition/alteration/replacement Please check all that apply (subunit z sets of places wfaans checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: • where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 1D,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial - use agricultural
,a1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
❑ Emergency system. larger separately derived system.
JOB Sf1'E INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E "l -2 ",' t -3"
A C 1 Q.(� 'l�Q
lOOM? or more, occupancy.
AS'e
Job n0.: Job site address: I (C1 8 ( 3tn) f 110 N ❑ re
Sixormoresidcntialunits. ❑ Recreational vehicle parks.
City/State/ZIP: - �1
[3 Health-cam facilities. ❑ Supply voltage for more than
(, , , cD ❑ Hazardous locutions. 600 volts nominal
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: owwspitaa I Qty. I Pte. I Tao! I ' ,
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" 500 sq. It. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
67.84 2
DESCRIPTION OF WORK (with above sq. fl.)
Limited energy, multi family 67.84 2
1.C.P ` residential (with above sq. tL)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
P ROPERTY 0V4 NER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: " 401 amps to 600 amps 20034 2
-
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Ci /State/ZIP: Temporary services or feeders installation, alteration, and/or
ty _ relocation
Phone: ( ) — 1 Fax: ( ) 200 amps or less 59.36 l
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— new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits wide .
❑ APPLICA N "f — 1 0 CONTACT PERSON above service or feeder fee,
7.42 2
each branch circuit
Business name: • B. Fee for branch circuits (( Q
Contact name:
without circuit
feeder fee ( 5618 �b' �t/ 2
Address: Each addi branch circuit 7.42 2
Miscellaneous (service or feeder not included)
•
City/Statc/ZIP: Each manufactured or modular
67.84 2
dwelling, service and/or feeder
Phone: ( ) — 1 Fax:: ( ) Reconnect only 67.84 2
E -mai l _ Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business (� lam^ _ Signal circuit(s) or limited-
usiness name:
!' \0 •1� C Uri E C�� 1 �- energy panel, alteration, or
Address: P, D . 44)1 extension Describe: Page 2 2
City/State/Z1P: tfaLbo NYI lI C. D o l Q Each additional inspection over allowable in an of the above
Per inspection 66.2
Phone: ('J 1) S 5 �F Lj I Fax: ( 515) 24 (34 q Investigation per hour (I la min) 66.25
CCB Lie.: ( Electrical Lic.: -o( `[Suprv. Lie.: 6 (57.5 Industrial plant per hour 78.18 f
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1 q .-7 _ l2 Subtotal: 56 , f 9
Print name: Q f� �� • Date: _t Plan review (25 %ofpermit fee):
✓� State surcharge (12% of permit fcc):
Authorized signature: TOTAL PERMIT FEE: 6: 1 Z
This permit application expires if n permit in not obtained within ISO
Print name: Date:
days after it Las been accepted ms complete.
• Number of inspections allowed per permit.
I lnoitdia\ r:mb,tr ,I.C- rcrmirApp. I muI739 440-4615T(l t/05/COMAVEn
Z'd 6b£1,99Z£09 ouloeu i!no.J!D Oid 0 61.80 Zl. ZO des