Permit CITY OF TIGARD ELECTRICAL PERMIT
8 ' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00550
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/24/2012
Parcel: 1S135CC01800
Jurisdiction: Tigard
Site address: 10300 SW MEADOW ST
Project: Sudenga Subdivision: MEADOW, THE Lot: 7
Project Description: (1) branch circuit to install new grounding electrode
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: SUDENGA, CHARLENE M
PO BOX 3948 10300 SW MEADOW ST
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 09/24/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/24/2012 $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 OAR 952-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 / o � r / 1.8 80 000.3 f 32 2. .233444 4.t*L
1.800.332.2344. )�(
Issued By: J144.2. 7X �' L/I A13'��
Permittee Signature: D /li / l
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.
RECEIVE - 0:.. . , . •
Electrical Permit Application FOR OFFICE USE ONLY , -
SEP 2 g 2012 R ;,,� .
City of Tigard Date/By: 9fai44(.s- Sir Permit No.:g/X.,,1.p /2,,,-00SSO
.74 13125 SW Hall Blvd., Tigard, OR 97223 (� T %� AG F p ® �! r
' Phone: 503.639.4171 Fax 503.598.1 � " �s Da e1By: Review oilier Pen nit : p4 ;O1 �„ - 0 0,7-57
I G A R D Inspection Line: 503.639.4175 1LO!WC G' Moe Rm.-Ay/By: Jam: lid Sec Pape z for
Internet: www.tigard or.gov Notified/Mcthad: 77 t' I Supplemental Information
TYPE OF WORK PLAN REVIEW
DI New construction Addition/alteration/replacement Please check all that apply (submit z sets of plans svfitems checked below):
❑ Service or feeder 400 maps or more ❑ Building over three stories.
❑ Demolition
0 Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
lei to ground, or exceeds 14,000 ❑ Commercial - sue agricultural
,21- and 2- family dwelling El Commercial/industrial ❑ Accessory building amps far all other instillations, buildings.
1 ❑Multi- family 0 Master builder 0 Other: ['Fire pump. C] Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Atma ition Emergency cm. larger sepamklyderived system.
❑ Addition new motor load of ❑ "A ", "F', "I -2" "1 -3"
no.: Job site address: �+ y� (� 100HP or more. occupancy.
Job no
3s. ) �� 1 PrDOI/ t D ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /Stale/ZIP ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I QIv_ I Fee. J rata, I
New residential single- or multi-family dwelling unit.
I Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. tt or less 168.54 4
Tax map/parcel no.: 6a. add'I 500 sq. ft or portion 33.92 - 1
Limited energy, residential
67.84 2
DESCRIPTION OF WORK (wills above sq. IL)
---'!_ �-y� / ;yin Limited energy, multi - family 67.84 2
�/\ r r4d) I (\X Ce � Ott /J D,, �i(ec' 1 099 residential (with above sq. a.)
Services or feeders installation, alteration, and/or relocation
200 maps or less 100.70 2 -
PROPERTY OW BIER I 0 TENANT 201 amps to 400 amps 133.56 2
Name: Cam( 4. - ors 6 401 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
City /State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
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 sate, lease, rent, c f 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 , ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: B. Fee for branch circuits
Contact name: without service or feeder fee, [ 56.18 2
first branch circuit
Address: Each add'! branch circuit 7.42 1 , 2
Miscellaneous (service or feeder
m
City/Slate/ZIP: Etc a ufactured rmodunotinNudcd)
I dwelling, service and/or feeder G7 2 . Phone: ( ) Fax: : ( )
Reconnect only _ 67.84 2 _
E -mail: Pump or irrigation circle 67.84 2
_ CONTRACTOR Sign or outline lighting 67.84 2
Business name: ) � O C,I (kI` ail E 0-1(27-011-Z__ Signal p a nel t(s) or limited-
energy panel, alteration, or
Address: T.0 z Ri-t f extension- Describe: Page 2 2
City /State/ZIP: lijx._l5o 0,:yii1 e. o (1., T? 07 0 Each additional inspection over allowable in an of the above
r f, Per inspection 66.25
Phone: (91() ,5,3 gZ( Fax ( 565) 7.-1(0(0 13'1 C0c0 9 investigation per hour (I hr min) -
nin) 66.25 tr •
CCB Lie.: ( (r2 -L Electrical Lic.: - ( 47 0( L 0� Suprv. Litz: 5 0 industrial plant per hour 78.18 1
1 ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: 1 Subtotal: 519 r k
Print name mJE- A) A (ok Date: f 1 O ^22_- 0p Plan review (25% of permit fee):
1 State surcharge (12% of permit fee):
Authorized signature: TOTAL PERMIT FEE: (et r cl,
Print name: Date: lists permit application expires if a permit is not obtained within 190
, days after it has been accepted as complete.
• Number of inspections allowed per permit.
I: 5 Buitdins'Perrsils •LC- PerniApp.dae 10!01109 440- t6IST(I1105 /COMFWFD
Z'd 617f;1.99ZEO9 ouloe13 l!nano old d6Z :90 ZL OZ deS