Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00583
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1 3125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/04/2012
TIGARD Parcel: 2S 102AB04800
Jurisdiction: Tigard
Site address: 12460 SW MAIN ST
Project: Jeffery Alan Home Decor Subdivision: KINGSTON Lot: 2
Project Description: (1) 400 amp service
Contractor: VAST ELECTRIC Owner: CAPISTRANO, NICOLAS III & CRISTINA
1525 SEATTLE SLEW DR. SE REVOCABLE LIVING TRUST
SALEM, OR 97301 6646 SW 35TH AVE
PORTLAND, OR 97221
PHONE: 503 - 566 -7274 PHONE:
FAX: 503 - 585 -8828
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 201 to 10/04/2012 $133.56
Specifics:, 400 amps
1 crt Branch Circuits w /Purchase 10/04/2012 $7.42
Type of Use: COM Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/04/2012 $16.92
Electrical
Type of Const:
Occupancy Grp:
Total $157.90
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 O • ' 95 '01 -009'. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: P Permittee Signature: Di(/ "M,'L/ee9
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 mit Application RECEV
I 1
Per. Appllc WIL OFFICE USE ONLY
f Tigard OCT ■
City �1 ll "d 0 3 2 ' B y /o/02- Permit No.: Ec 0�ia -00383
Date/By:
13125 SW Hall BI d., Tigard, OR 97223 Review Phone: 503.718.2439 Fax: 503.598.1960 CITY OF T gv other Permit:
T I G A R D Inspection Line: 503.639 �(, dvlB ruri,- GI See Page 2 for
Internet: www.tigard- or.gov ���D II�Vt �7Nethod: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans wiitems checked below)
ID 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 10,0000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14.00(1 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ® Commercial/industrial ❑ Accessory building amps for all other installations_ buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation o175 KVA or
JOB SITE' IIvFORb1ATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ ° A 1 ", "1 -2 , "I -3 ",
Job no.: Job site address: 12460 SW Main Street IOOI IP or more occupancy.
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than
❑Hazardous locutions. 600 vas nominal.
Suite./bldg. /apt. no.: Project name: Jeffery Alan Home Decor ❑ service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Dr crtpllaa
I Qty. 1 Fee. l 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
Tax map /parcel no_ Ea. add'1500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
400 amp service residential (with above sq. fl.)
Services or feeders installation, alteration, and/or relocation
200 amps or l , 100.70 2
❑ PROPERTY OWNER I ❑ TENANT ? 201 amps to 400 amps 1 13356 133.56 2
■ 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
City/State/ZIP: Temporary services or feeders installation, alteration, sod/or
relocation
Phone; ( ) I Fax: ( ) 200 amps or less 59.36 l
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 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 1 7 42 7.42
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.11 2
Each add' I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/StateJ7_IP: I Each manufactured or modular 67 84 2
dwelling- service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 . 2
E -mail
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited- energy
Business name: Vast Electric, Inc panel, alteration, or extension. Page 2 2_
Each additional inspection over allowable in any of the above
Address: 1525 Seattle Slew Dr SE Additional inspection (I hr min) 66.25/ hr
Investigation (I hr min) 66.25i hr
City /State /ZIP: Salem OR 97317 Industrial plant (1 hr min) 78.181 hr �
Phone: (503) 799 - 5627 Fax: (503) 585 Inspections for which no fee is 90A0/ hr i
- specifically listedfhhrmin) i
CCB Lie.: 175531 Electrical Lie.: C -280 Suprv. Lie.: 5186S ELECTRICAL PERMIT FEES
•
Suprv. Electrician signature, r aired" i •
Su Subtotal: 140.9
P c � Z� t� C: Plan review (25% of permit fee): _
Print name: Tim Vander Stoep Date: 1 12 State surcharge (12% of permit fee): 1.6
i TOTAL PERMIT FEE: 157.90
I Authorized signature:
This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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