Permit CITY OF TIGARD ELECTRICAL PERMIT
- 13 ''. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00579
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T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/03/2012
Parcel: 2S104DC06900
Jurisdiction: Tigard
Site address: 13757 SW FERNRIDGE TER
Project: Simpson Subdivision: MORNINGSTAR Lot: 10
Project Description: (1) service and (10) branch circuits for fire repair, outlets, lights & reconnect service.
Contractor: COHO ELECTRIC INC Owner: SIMPSON, GEORGE W & JANIE M
PO BOX 40 • 13757 SW FERNRIDGE TERR
WILSONVILLE, OR 97070 TIGARD, OR 97223
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PHONE: 503 - 582 -9774 PHONE:
FAX: 503 - 582 -9840
FEES •
Quantity Description Date Amount
. 1 ea Services or Feeders - 200 10/03/2012 $100.70
Specifics: amps or less •
10 crt Branch Circuits w /Purchase 10/03/2012 $74.20 ,
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/03/2012 $20.99
Electrical
Type of Const: .
Occupancy Grp:
Total $195.89
Required Items and Reports (Conditions)
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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. ATTENT : Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 rough OAR 952 Si 1 s 9i'. ou may obtain a copy of the rules or direct questions to OUNC by calling 503.23 1987 or 1.800.332.2344.
Issued By. _ I 4�C4�� 4/IAA-IL/ Permittee Signature , ! �iL �� '
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
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SIGNATURE OF SUPR. ELEC' _.Le_ ,, 14 ,. i �_� Date:
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LICENSE NO.
1..
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 she at the time of each inspection.
Oct 03 12 12:33p Coho Ele0Fiant N , _ 503-582-9840 p.1
r i'
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Electrical Permit ApplicaAkon „ FOR OFFICE USE ONLY -
UL 1 t .1) 2' c?
0 u , . Received h,.,
City of Tigard
Datc/By: e 1, ..' .2 /A ,
11, a 13125 SW Hall Blvd., TigarCOX:9,7223 ',. - Plan Review
: 2 • Phone: 503.639.4171 Faxt: g ;P 3.A*1940 7,4 .',`:',: Date/By: Otl Permit:
TIGARD Inspemion Line: 503.639,417' ' .: '' 0 'r ;7' -, Date Ready/By. Juris: el See Page 2 for
Internet: www.tigard Notified/Method: Supplesneotal Information
V ';'..•!.,. .;ii 441VOIL
El New construction z[ Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over three stones.
.. 0 Demolition E] Other: where the available fault current 0 Marinas and boatyards.
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g!Z .. 1.... I: . , .:14.:.z. , ,. , 7:7 - . T.. exceeds 10,000 amps at 150 volts or 0 Floating buildings.
'..' I 11tr -' .. ;.:r. ':.e7=.`..i:••.;;-:;:.:t less to ground, or exceeds 14,000 0 Commercial-use aericultural
1711 and 2-family dwelling El Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
lager Sepanite:y &rived systcm.
.P 4 IA 8 m :n E ad7o YsYm
fne tor load of 0 A - 1-2'',"1-r,
• A — 100HP or more occupancy.
Job no.: ; Job site address: ‘1 5 ..S\N) 0 six or more residental units.
35' 0 Recreational vehicle parks.
0 H=ltIrcare faciliries. D Supply voltage for more than
City/State/ZIP: t 1 A. o Q 't
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.3 Ctr - 3 CI Hazardous locations 600 molts nominal.
Suite/bldg./apt. no.: Project name: lik S. m i :), Str. \ 0 Service or feeder 600 amps or more.
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Cross street/directions to job site: Description I ors. I Fee. I Total
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 1 168.54 1 4
Ea. addi 500 sq. ft or portion ! 33.92 I 1
Tax map/parcel no.:
Limited energy, residential ;
6714 2
' ..--;! : : :: : ' 1 1fi.: -": . -" t. °: i 1: -;! ,1,7. ::• -•; •... --::- : . 1:*.S . .0ti.eitst*Fiji i -Nf0)*.- - j:'7'.: 1 ::..C 1 : 7 r-' It (with above sq. "
A _ p y ,_.,_.- I Limited energy, multi-family
6714 2
re., acarna a.,.e. •t ‘"Ift- ) Q\-4 t W.-C-,- residential (with above sq. R.) 1
Services or feeders installation, alteration, and/or relocation I
R%-e....neYne.......4 ezr_e . cm,„ CS,,%........ 4* '4.irs- 200 amps or less . ti 100.70 i ()Iz t 2
!.:'.-:'..:::•-tr,q:,.'44A0PBli.W.OWI*1::, .!: ...... 201 amps to 400 amps ! 133.56 2
N 401 amps to 600 amps 200.34 2
ame: -
c V\ e)..2-,
601 amps to 1,000 amps 301.04 2
Address: sz:crcN,e._. Over 1,000 amps or volts 55216 2
City/State/Z1P: Temporary services or feeders installation, alteration, andfor :
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
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 with
above service or feeder fee, ;.,,,... 7.42 -1 a 2
' each branch circuit
Business name: B. Fee for branch circuits
without service or feeder fee,
Contact name:
first branch circuit 56.18 2
Address: Each add'l branch circuit I 7.42 i 2
Miscellaneous (service or feeder not included)
City/StateJZIP: Each manufactured or modulm I
V.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
,Iili.VE -Z - 1 `1.'. :5A:', siP or outline lighting 67.84 - 2
Signal cirouit(s) or limited-
Business name: Cj — l e..c.... .k. t .: 1 ,... 'J'<....
energy panel, alteration, or
)
I Address: cp
c) Lk Q. extension. Describe: Page 2 2
I 1
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City/State/ZIP: t .„, ki c3 p, (A-- — Each additional inspection over allowable in any of the above
l ,, Per inspection 66.25
Phone: tk,.._ ) Sea_ Qv-1-N ''' ( ) SEO.— '15:2.‘4 (3 Investigation per hour (1 hr min) 66.25
CCP. Lic.: ‘ 5 - 1 i l Electrical Lic.: - 5 1 5c l Suprv. Lic.: 5 S , Industri al plant per hour 78.18
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2 7-..:.'3' 1
Suprv. Electician signature, required: .. ' .," f,-(:./ Subtotal: t - 1 , -.k. . o
, Plan review (25 of permit fee): I
Print name: In/I (-)u Q. .._.p Date '' '''' %C3 State sur %
th charge (12 of pemnt fee): tO . 1:- i k __1
Auorized signature: Q C.4 , TOTAL PERMIT FEE: 1 , A5. t ° I
c...., 1 R . This permit application expires if a permit is not obtained within ISO
Print name: fl r> * i <' 1 a Date: e, — .. - days after it has been accepted as complete.
• Number of inspections allowed per permit. 01/
1 10101/09 440-4615TO I/05/COM/WEB