Permit v CITY OF TIGARD ELECTRICAL PERMIT
. COMMUNITY DEVELOPMENT Permit #: ELC2012 -00596
-TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/17/2012
Parcel: - 2S110DD90152
Jurisdiction: Tigard
Site address: 10955 SW MEADOWBROOK DR 15
Project: Wolfe Subdivision: SUMMERFIELD BROOKSIDE CONDO Lot: 15
Project Description: (1) 200 amps or less to replace panel
Contractor: WILLAMETTE ELECTRIC INC Owner: WOLFE, SANDRA
PO BOX 230547 10955 SW MEADOWBROOK DR #15
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 -624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/17/2012 $100.70
• Specifics: amps or less
•
1 ea 12% State Surcharge - 10/17/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
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 952- 001 -0090. 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: d ��LC_fU Permittee Signature: 7AJ 4rPLic Ilr�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.
•
10/17/2012 WED 8:24 FAX 5036242938 Willamette Electric a1002/002 . . ,
Electrical Permit Applica
• - - ,_.:. FOR'OFFiCE U SE ONLY.:; - s`: > . -
III City of Tigard CEIVED Datee/By Oh 1 1/ a If •' PermitNo. : C[.C2.0ig.`0OS4
in 13125 SW Hall Blvd., Tigard, O Plan Review
Phone: 503.639.4171 Fax: 503.5980 l 1 7 ZO12 Date/By: Other Perm
Inspection Line: 503.639.4175 Date Ready/By: Juno' 11 S ee Page 2
T1GARD intInternet: www,tigardor.gov T NotNotified/Method: tl( Sup Information rot
. , � t i. 'P IH:REVJEW'r- ` - }', "
r�± "y ement Please check all that apply (submit mit 2 sets of plans w/items checked below):
[] New construction ,Q`Addition a e '• o p acemr en�
El Service or feeder 400 amps or more El Building over three stories.
❑ Demolition ❑ Other: , where the available fault current ❑MaFlorines ting and boatyards.
, iti ' tS exceeds 10000 amps at 150 volts or ❑ buildings.
_ CA. . .. GibN '1'11U"� iv e
1 • :..._ �..:. ' less to ground, or exceeds 14,000
� - and 2 - family dwelling Commercial /industrial 0 Accessory building amps for all other installations. ❑ Commercial-use ili u agricultural
Pimep zap system.
allati f 75 KVA or
❑ Multi family ❑ Master builder ❑ Other:
❑ Installation o
A.• ., _ • - ❑ g Y largraseparatelyderivedsystcm.
_'3r9s` tfE'; F F[O 1�T AN iACit3?IG1�I.' • Add i ti tmo f newmotor
..: _ - • -- - .. ... load of 1
100HP or more. occupancy.
Job no.: 5 4 / Z I Job site address: / o 9, f`, f - SC... Ai c . 2 ,9,, ,Q, u +/c ❑ Six or more residential )mils. ❑ Recreationsl vehicle parks.
City/State/ZIP: T / , y e'7 K ❑Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: /5 I Project name: (. t. y/ f e ❑ Service or feeder 600 amps or more.
- 3 t
Cross street/directions to job site: Description . QN• I Fee. I Total ]"+`
New residential single- or multi - family dwelling unit
Includes attached garage. _
Subdivision: I Lot no.: 1,000 sq. R. or less 168.54 i 4
Ea. add'! 500 sq. R. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
1 )ESC TIO UF WORT (w ith a R 75,00 2
. .... .
' Limited energy, multi- family 75.00 • 2
a c /it c e p 9 4 residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ( 100.70 / ' a 2.. 2
0 PAOPE 'RTY :OWNER , : VEPIANt • 201 amps to 400 amps 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
Temporary services or feeders installation, alteration, and /or 1
City/State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 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. - —
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with • about service or feeder fee, 7 42 2
)3•.APPLICA1 �: '
, 0 'CONTIC` ERSbN - each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, lust 56.18 2
Contact name: branch circuit
. . Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) _
Each manufactured or modular 67 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: 67.84 2
Sign or lighting . , > , • r aut me
• ' !', " ° - ' - = Signal crwit(s) or limited - energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
Investigation (I hr min) 66.25/ hr
City/State /ZIP: Tigard, OR 97281 Industrial plant (I hr min) 78.18/hr
Phone: (503) 624 -3631 I Fax: (503) 624 -2938 Inspections for which no fee is 90.00 / hr
- specifically listed ('ti hr min) � —
CCB Lic.: 75059 Electrical Lie.: 34 -283C Suprv. Lic,: 4226 -5 .; F ���;":-
Subtotal: /v
Suprv, Electrician signature, required-7' Plan review (25% of permit fee): v�
Print name: David Fife Date; / .../ T , / t, State surcharge (12% of permit fee): /'2
TOTAL PERivIIT FEE: / / Z
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days atter it has been accepted as complete.
N um b er of inspections allowed per permit.
r: lauildinglPermiu \ELC- PetmitApp.doe 07/01/10 440.4615T(11/05/COM/WEE