Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 00523
T IGARr) 13125 SW Hall Blvd.. Tigard OR 97223 503.718.2439 Date Issued: 09/11/2012
Parcel: 1 S134ACO2619
Jurisdiction: Tigard
Site address: 11225 SW WILLOW WOOD CT
Project: Brooks Subdivision: ENGLEWOOD NO.3 Lot: 176
Project Description: (6) branch circuits for kitchen remodel
Contractor: WIRE NUTZ ELECTRICAL SERVICES Owner: BROOKS, JERRY D & SUSAN P
13023 NE HWY 99 STE. 7 11225 SW WILLOW WOOD CT
VANCOUVER, WA 98686 TIGARD, OR 97223
PHONE: 360 - 609 -2714 PHONE:
FAX: 360 - 258 -0516
FEES
Quantity Description Date Amount
6 crt Branch Circuits wo /Purchase 09/11/2012 $93.28
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 09/11/2012 $11.19
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $104.47
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 52- 001 -0090. Yo 3 _. i. a f y obtain a copy of the rules or direct questions to OUNC by calling 503.2 or 1 ` / Issued By: ,( Permittee Signature: Did 4 ,ar C�[tvi I t0 AL
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 10 12 09:53a Wire Nutz Electric 360-258-0516 p.2
Electrical Permit Appli 1.74i ; . EIVED FOR OFFICE USE ONLY
City of Tigard a
Date/B 1 Permit No.ii ezUt / X ..-
I • 13125 SW Hall Blvd., Tigard, OK, 97323
1 0 2012 Plan Review
• B - Phone: 503.718.2439 Fax: 503.590 .19 Date/By: Other Parnit:
TiCiARD
Inspection Line: 503.639.417A d‘r inn Date Ready/By: 3,, :„ ,4 Rl See Page 2 for
Internet; www.tigard C ITY i vi' 'WARD Not ifiollMeth ---/ / lt. Supplemental Information
'..". - - • . . .:".. _ .:.-.- . • -.. - ..: • . - .:...-1,41114-AMPIVISION . .. .' ' - ...:1 "i' - . '-' '.. :. .j - .
..-- : .'.'_. .-:,.., .:-..: -..• ::: ' . 'F". •
0 - New construction 1 , _ H-I• •AdditionIalterationireplacement : .. - . • • .
Please check all that apply (submit 2 sets of plans wilt= s checked below).
7
0 Service or feeder 400 amps or more El Building over three stories.
0 Demolition 0 Other: where the availabk fault current 0 Ivlarinas and boalYards-
- •'' :... : . : 1- - . '- i'''' ':--- ' .7 C4TEGORV - - - - - ort•SirsrstucTtoN - exceed; 10,000 an at 150 volts or 0 Floating buildings .
less to gratin& or exceeds 14.000 0 Commercial-me aricuhural
• and 2-family dwelling 0 Commercial/industrial 0 Acce building amps for all other installations buildin
74
Multi-family 0 Master builder El Other: 0 g Fi-c p CI gs.
Insiallation of 75 KVA ar
riEmcrgency of
system. larger separately derived sysrem.
4011 . SITrDIFOIIMATION AND - LOEATION .
._ . 0 Addition of new motor toad
Job no.: Job site address: 112 25 SW Wi• U livo C re. 0 vehicle parks.
City/State/ZIP: '16 frjk br. giz--2,3 t., 0 Health-care facilities. 0 Supply vol:age for n than ,
0 Hazardous locati3Thi. 600 volts nominal
Suite/bldg/apt. no.: Project name: 0 Service or feeder 500 amps or more.
Cross street/directions to job site: Deserlpiion 1 Qn. l Pee. I Twat I •
New residential single- or multi-family dwelling unit.
Includes attached garage. •
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited maw, residential
75.00 2
7 ;' . : - r' ''.• : l;fi _ • •::',1'.:-.:- 2:: . : 7 . :•"1;0 • . 7;Y ORk . .. . . . . with above sq. ft.)
Limited energy, mLlti-family
(161Aik 1 lo artucks .ftir M.-Ed/tem residential (with above sq. ft) 75.00 2
Services or feeders installation, alteration, and/or relocation
r t IAA OCILI 200 ainps or less 100.70 2
' .:' - •:::: - 4 tiO:kilarrV ei**E - -- . I . ... . 0. TENANT 201 amps to 400 amps 13336 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or VOILS 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 CO 599 amps 168.)4 2
Branch circuits - new, alteration, or extension, r panel
Owner signature: Date: A. Fee for branch circuits with
-
.'.- . 0. eortrAcr pERso N ... above service or feeder fee.
7.42 2
cach branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56 18 2
Contact name: branch circuit
Each add'l branch circuit 5 7.42 2
Address: Miscellaneous (service or feeder not included)
I Each manufactured or modular
City/State/ZIP: 67,84 2
! dwelling. service and/or feeder
Phone: ( ) Fax: : ( ) , Reconrect °ay 67.84 2
' Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
..... '-' ...-' . -'. - ',4 :::: -':!" - '- : ----: ' 'CONTRACTOR •
• .
Signal circuit(s) or limited-energy -
Business name: Wit N 1,44 2- C111..-triCat .firviet-C panel, alteration, or extension. Page 2
Each additional inspection over allowable in any of the above 2
Address: 1" A,/ 140,A4 qf si 7 fp 802. 4, y Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: v ' WA- err IfiL Investigation (I hr min)
Indusuial plant (1 hr min) 66.25/hr
78.18/ hr
Phone: (3( o ) 0 oq ... 2 ( y Fax Up D ) ISO- 05i (4, Inspections for which no fee is
90.001 hr
scecifically listed hr min)
CCB Lic.: 1 fqg f 3 i i Electrical Lie.: C 41 lii i ‘ Ni
1 prv. Lic.: til Li . : ELECTRICALT TEES_ • .: . - .:. • .. .
I 14 'X
Suprv. Electrician signAtte, required: /PI '', . Subtotal: 1 1.-
• Plan review (25% of permit fee):
Print name: AIN Sa hd / 4, I Date: 6 1 il ii 2 State surcharge Om of permit (ee):
Authorized signature: 0
-- 6,L ,
TOTAL PERMIT FEE: / 04 4/ 1 7
Al
This permit application expires if a permit is not obtained within 180
days after it has been accepted
Print name: a it t' li
t LOC ( Date: 41/1 h • Number of inspetio
cns allowed pm:permit. as complete.
1:\Buildint.Permite,EL.C-PernicApp.doc 07;0110 440461 5T.:11 NS/COM:WEB