Permit •
CITY OF TIGARD ELECTRICAL PERMIT
a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00520
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/11/2012
Parcel: 1S136ACO3801
Jurisdiction: Tigard
Site address: 10820 SW 74TH AVE
Project: Pearce Subdivision: METZGER ACRE TRACTS Lot:
Project Description: (1) 200 amps or less to replace the mast/weather head and add a guy wire for support
Contractor: RENTAL HOUSING MAINTENANCE SERVICES INC Owner: PEARCE, CHRIS
PO BOX 317 10820 SW 74TH AVE
DONALD, OR 97020 TIGARD, OR 97223
PHONE: 503 -678 -2136 PHONE: 503 - 209 -6662
FAX: 503 - 678 -2138
FEES
Quantity, Description Date Amount
1 ea Services or Feeders - 200 09/11/2012 $100.70
.Specifics: amps or.less
1 ea 12% State Surcharge - 09/11/2012 $12.08 '
Type of Use: SF Electrical
•
Class of Work: OTR •
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 OAR 95 -001 -0090. You may obtain a of the rules or direct questions to OUNC by calling 503.23 /� 1.800.332.2344.
Issued By: • IY -fC,i' Permittee Signature: D ^+ i4riLI 2 -�`r f 1
O& .
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.
Sep. 7. 2012 2:29PM RHMS No. 4718 P. 2
Electrical Permit Application REcovE, Filll, Ol'r[CE USE ONLY .
I a
City of Hall e OR 97223 S E P 1 0 2012 b awB y 4ll ► l Sr Permit No. ,D12 . f s' 5;'
Plan _ teJ - ew Other
Phone: 503.718.2439 Fax: 503.598.1960 Date/By. L aaol a - devo
Tit ; • Inspection Line: 503.639.4175 CRY OF T tEARO Date Ready/Br Juin: ' El See Page 3 for A RD • I nternet: ww.tigard -or.gov A 1 �, Notified/Meihod: ' (l(.O Supplemental L. w
, »_ V _�F_: : of ,y u , t ,;y 1 T ,•:; z } . x( • - .,„
is ; ,r n�,. ` <ksve - = ;= .1 . [� ,� � � }e ,era „, ', 1 : A >v z• =.• .. -. '� � _s:_A�� �• -�.. 9'. .,._ • - • �: ( ° r : � -° . ^ - . •
❑ New construction id Addition/alteration /replacement Please check all that apply (submit 2 sets of plans w /em checked below):
0 Service or feeder 400 amps or more ❑ Budding over three stories.
❑ Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
i'' '.:_ F' _ • : f 6 ' ” •' _ . `a' f '. exceeds 10,000 imps ac 110 volts or ❑ Floating buildings.
: ,., r 7 �h. • '' , • • c — :. i :, - , ...4 - . . . •.._, ..L-.7- . .. ..r -or .:. _':' : - less to ground, or exceeds 14,000 ❑ Comfaercial-use agricultural
al -and 2- family dwelling 0 Conunerciallindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: Pray pump. ❑ Installation of 75 KVA or
" f a t y u n �e} r�i 7v f fro S "Yfp a 9 t: f 1; u 1' T ' , ❑Emergency system.
tamer separately derived system.
, + jar , l ,, ri 5 ,,,,,,.+a �;, fi _ - I ' ., ❑Addition chew motor l oa d o f ❑"A". E'. 1-1' , "1-3' .
{
'Job no.: Job site address: f L7�/�� DQ (_• l A wow or more. occupancy.
1 ❑ Six or more residential wits ❑ ltemeatioail vehicle parka.
City /State/ZIP :� (l.lt { J l xt G ", L �- Olteal(b�emre facilities. ❑Supply voltage for more than
1 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg, /opt no.: 1 Project name:
0 Service or feeder 600 amps or more.
Cross street/directions to job site: oncrictnn COS vow Total
New residential single- or multi family dwelling unit,
Includes attached garage.
r
Subdivision: I Lot no.: 1,000 sq. ft. or less - 168.54 4
Fa edd•1 sq. It or portion 73.92 1
Tax map /parcel no.: Limited energy, residential
"°•',, y , �, . s. , 1 v 75.00 2
.4:742.„.9:-77:1.,..,:.r. r ` a - c4,.h : > . 4 H , 0.� f 9 - ' L. - : ix `-, (w ith a an,. b -)
i - w' T, - ! i ,'�T?r � x- c• "[t4�_IT.itf °{ . -- >= . ,.,. + '',: ' .fL �w� + ��jSLj'..w ..
,. �'� Li mited energy, (with above sq 75.00 2
���� � , • l J � � residential (with abve s R.)
`' Services or feeder& installation, alterafion,.and/or relocation
,rj1A� MI �....� _ .t� 200 amps or less y 100.70 2
:�__�:- r, ' +�5' 't ., ; q - , g , =: _ 15' ;;T — ' t s '�-:f ! 20l amps to 400 amps 133.56 2
` :7r Y �` - >.� ..�, • f l
d4 1/,t d .rSi;P _ '��:•- , . -2 ,. v . n f (' '.n._
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
City/State/Mk Temporary services or fccdera installation, alteration, and/or
Phone: ( ) I Fax: ( ) 200 amps or less ( 59.36 I 1
•
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for Sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. Branchcircuits - new, alteration, or extension, er panel
Owner signature: Date: A. Fee for branch circuits with
r :Y`' fti . • ` 4 .W il ii ,. s73
1 '�.• { ciiitc �ru' e� 4'? =Y above service or feeder fee, 7.4z
... : a M , xr `..'Y" • IC l : -�•r ...,._ \ I � ? each branch circuit 2
Business name: B. Pee for branch circuits Wi/hom
/ y s ervice or feeder tee, first 56.18 2
Contact name:
C
, � ` . \' e ft f C '�
branch circuit
Y� �� 1 •C
E ach add'I branch circuit 7.42 2
Address: miscellaneous (service or feeder not Included)
City/State/ZIP: /Slate/Z)P Each manufacnued or modular 67.84 2
CY : dwelling. service and/or leader
Phone: SD3 deg.( o Fax: ( ) Reconnect only 67.84 2 •
Q Pump or miss lion circle 67.34 2
E-mail:
rte— =F .:�. '= ':fat.; r . �n itl �'0i1 A .. f1'� iii [? I�:N,i ? .. �., 1 S i gn aroutlineli�ting 67.$4 2
(. : : Q4 •',; .. .• _` ,:?r ..ru. q. 'I 1 Signal (ircuits) or Wnited•energy
Business name `` _ h /► r - panel, alteration, or extension. Page 2 _ 2
`etC1.)1 `'V `u W1y f ..'t'M 1i- Each additional inspection over allowable In any of the abov
Address:ct .., / lot° n ( 0 \ J,. Additional inspection (1 hr rain) 66.25/ hr
City /State2lP� ` /11 f �\ 1. Q /� /� J r Investigation (1 hr min) 66251 hr
\:I L ` — Industrial plant (1 hrmin) 78.18/ hr
Phone: ( -� (J I Fax: ) urn t ) ( g7 Inspections for which no fm is 90.00/ hr •
` U s , ,. Wall listed (K hr min „
\ Lie.: Electrical _ a:� S ;; i t 11 C=t ( i Hc:� d l' 1 9 1F , k� ,-, - ,': p::
� CCB L : ��� ectrical Lic.: Su rv, Lie.: I � -�: �. � `• :- , ;a: �i �.i. ' ,..
V t Subtotal:
Suprv. Electrician signature, required:
....I.40 Plan review (25% of permit fee):
Print name: � a( 1 / Date: ci ( State surcharge (12% of permit fire):
TOTAL PERMIT FEE: / !d. ) 8'
Authorized signature: This permit application expires lt a permit Is not obtained within 180
Print name' I Date: days after it has been accepted as complete.
: • Number of inspections allowed per permit.
InnuadineWermitsl6LC •eennhAnn.doe 07/01/10 a0 4615rt11103/COMIWBB
Sep. 7. 2012 2:30PM RHMS No. 4718 P. 3
Electrical Permit Application - City of Tigard
Page 2 Supplemental Information
LIMITED ENERGY PERMIT FEES:
iliktritRTAXENORKOWEVi:IngiRMill,Olgqii!,:AtigiV
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
O Audio and Stereo Systems*
D Burglar Alarm
fl Garage Door Opener*
El Heating, Ventilation and Air Conditioning System*
O Vacuum Systems*
D Other:
7, ...............................................................
Fee for each commercial $75.00
system
(SEE OAR 918-309-0000)
Check Type of Work Involved:
p Audio and Stereo Systems
0 Boiler Controls
Li Clock Systems
O Data Telecommunication Installation
El Fire Alarm Installation
O HVAC
O Instrumentation
O Intercom and Paging Systems
O Landscape Irrigation Control*
D Medical
0 Nurse Calls
171 Outdoor Landscape Lighting*
O Protective Signaling •
Li Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installationa
1:13iiihringTermits\ELC-PtimitApp.doe 07101110