Permit n CITY OF TIGARD ELECTRICAL PERMIT
111 $ COMMUNITY DEVELOPMENT Permit #: ELC2012 -00593
T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/15/2012
Parcel: 1 S134AD05800
Jurisdiction: Tigard
Site address: 10705 SW PONDEROSA PL
Project: Fagan Subdivision: BLACK BULL PARK Lot: 21
Project Description: (1) 200 amps panel change
Contractor: ROSS ELECTRIC INC Owner: FAGAN, WILLIAM R AND LESLEE A
2870 SE 75TH AVE #203 10705 SW PONDEROSA PL
HILLSBORO, OR 97123 TIGARD, OR 97223
PHONE: 503 - 642 -2800 PHONE:
FAX: 503 - 642 -5815
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/15/2012 $100.70
Specifics:, amps or less
1 ea 12% State Surcharge - 10/15/2012 $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 5 - 001 -0090. You may oobtain
a copy
L i4 opy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800,332.2344. , /
Issued By: 4 1..61._ 1/ Permittee Signature: ()kJ A 1- ` I t 77 Q /V
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.
Oct 15 2012 7:20RM ROSS ELECTRIC INC 5036425815 p.
•
Electrical Permit Anplicat EcEIVED , ,
rolcc�rrr�l u� irUlv[,t' c ',,.;.
City of Tigard Received
114
.- " 13125 SW I Intl rilvd., Tigard, OK 972 15 20 12 Dslol3y' ICI ( »ejDr PemNr uo,;�i(�' � I a r. 00.5-93 a Phtxtc: 503.639.4 171 Fax; 503.398.1960 Review
Dote Other Permit;
Date./By:
l is Gtion Lim: 503.639.4175 CITY f�T��p Ready/By: . 1 E! e eo an o2 for
1 C. A R U pe V1I �t ►► OF 11 NNffKK11tNJ Date Jun
I nternet Mwwt tigard -ur gov NoutF dtMethod
1
� s9* . ` t . v Supp]co,entelInrnrmotlon • 1 % : � •ak ` , •, ., 1,,,,.:t , n Sri 0] J ,t,.1 fN�1,N' . V '�+t i-ll E`+K .111 ER '�' ✓ 41. i . :5/U U 1�7,� 4 9. i i .15 +; Ter i1 ��Y r ,. 9•,:,!
•
• ` .- . - , F�:I.... •,. n„1skMatl{`.nd_,'444'.' 4,1 11' rl; :i.Wl 4 . ...:.w.,.flal...... , %..,. N
❑ New construction 7 Addition /alteration/replacement Ptesse click all that aunts (submil laces ofedens wlitcm: l
❑ Uclilulitin ❑ Other: ❑Sorviee or Il:oda400 amps or more 171 Outlet nu
where the available fault culroni C3 Marines o1,u '
t rte : r r u1i • •� '� ; k. Sul c.... 10,000 imps at 150 volts w C1 Floating lei::...
F� 1- and 2- !salt] tJwt lin lesaro ground, a exceeds 14,000 ❑ Conlmr•rri,•i •
Y h ❑ Commercial /M(4isrt'ial ❑ Accessory building aleps For all otherinstnllations. building.
❑ Mu Ili- filmily ❑ Muster b 144). OS 0 0 Firepomp,
.• - y, � ; �1; `.I, �,n r� ❑ ]nstnllalion or 75 K � i, v,
:J.C!.� ; 8.4:�?J* "j ',�� ;'.`r 4rA • At • �,�f! U'ufutt r Yl • S El A1T1erfettt:y system,
�+ large E", "1 dcrned system
•' ,.1. �•.t '- ,aar}6, � •�t ����� 0 gddhiun of new motor load or �^
Job rip.: 3L1 +y' % i MM.' {OOt�ar occupancy.
Pl C Q Sis or more reaiJuntiol antis 0 Rccreotiolml vehlcte pm t
L rv)Slulc /l,lY:_ , r 7 C) El fealties. I] Supply vollnyc P., •
�` - El Fhrzardow loontions, 600 w {t, r,...
Sui1e/hldg. /apt.no.: Project numc; ■ ��r;+ service or feeder 600am • sormord
1) {•IIEu N3,i� ��h�:„'r�l �� �:Itt+�R"hL . ti �t`'1
C'rVSS street/directions to site: manikin
44', see-
New residential single- or multi- family dwclline up''
Includes attached garage,
Subdivision: Lot no.; 1,000 sq, R. or less (68.54 •J
Tax rnnplptarct l no.: Ea. add'I 500 sq. ft. or portion _ 33.92 t
,• . r . r ,r-- ,,• - Limitedenergy residential '
MI ~ :• `t ,, . i 3 J1.. 5 t✓,( c1.. ;utS gl ' d n t1�s Rung 1 t w 'c pit r S 7 .84
�„ r L cs:l k.1.�, -1 to t� >r.:vy�.i�,._w...a. with nbova w. R,) 6 2
�/"%4Z:' Limited energy, multi - !Emily
residential wtµl above Est) 67,84
Services or feeders Installation alteration, a rld'r •
Utia, °° '7 W�;1 w u s �.� 1 _200 amps or less ) 100./0 ) 00.7
c�s' .at'a1 aid i> 4. i 1 x,. l i :fit 15. f '»•4, 1; 201 amps to 400 em i
!� 1 00.2.1 •
Name; 401 amps to 600 turps 20C,:.1 i
nddress 601 amps 101,000 amps 3(1].04 iI
Over 1,000 amps' or volts 552.26 1 2
Ciry /State/ZIP: Temporary services ur,feeders Instnllatlon, alteration, and/or
°' -' -" rel0Catlan
Phone: ( ) Fax: ( ) ^ 200 amps or loss 59.36 L r
Owner installation: This installation is being made on property that I own which Is not 201 turps to 400 amp, 1 125.08 i
intended for Yale. lease. rent, or exchange, according to OILS 447, 449, 670, and 701. 401 amps to 599 ar s i 65.5.1 -
Owner Signature: Branch circuits-
Ijaty, branch circuits w. alteration, or cxtenstotl, lr, .
y �r�t�gf� a • . ,, 4 a Foe fbr bran
� *--- - A. ch circuits with
"flb'f ":t a • 'f •: I ' ) , i it∎,� Isr a`I;v gal � t r ' V i above service or feeder the,
c.Na,. . . 11'n'L�dS• 7.42
Business name: each branch circuit
.- _ B, Fee for branch circuits
Corulct name; without service or feeder fee, SG, IS
-
first branch circuit 2
Address: Each w.ld'I brenoh circuit ' 7.42 2
City/State/ZIP. - Mtseelign as,(51F,vlce or feeder not included)
Each mantiair or modular
Phone: ( ) ` }'ax: ; ) dwelling, at 'ylee and/or feeder 67.84
Reconnect only 67.8 I
!a�1?"ai[g€.F �st` r . Pump or Irrigation circle 67.81
za�ac�e n�asr�,tax.'re'Mk ,:.a+ 4�J' •° u - . 7 , )mf ` , .e "r a .i.z,-. Sign or outline lighting 67.54
Rosiness mime; Russ Electric, Inc Signal oirculUs) or limirtd-
energy panel, alteration, or
Address: 28 70 SE 75 Ave, 0 203 r � extension. Describe: Page 2 I t 2
City /Stoic /21F: Hillsboro, Or 97123 Each additional Inspection over allowable In say of the above
Phone; (503) 642 -2800 Pax: (503) 642 -58I5 Per Inapeolitm 66,25 I
Mvestigation per hour f l to min) 66.25 • CCD Lie.: 157891 t Flectl'leal Lie,: 34 -436C "et uprv, Lie.: 4232SV Indtibpiut, ; , t t hpur 78.18 .
Su rv, Electrician signature, : i .�fJ , R...„‘"7--)
�•� +} �':r" ��17 ;;1 J is t"
P c, required l - ! ° "'L4' ' .r_:�i,.1'.-,•,,: ''
Subtotal; 00 ,')
' • t Print mine: Stephen Russ + _1. ]Oate: 2/8/2010 - Plan review (25% of perrnit fee): perm Stare surcharge (123 of it fee): °8
Authorized rigncture; 1 . � /
TOTAL PERMIT FEE: !
Print Ilirrine �- J p This permit application eiptre slfapermitIsnotabtatrteA 150
-
days after it has been accepttd as Complete
' Number of lnapeolfons allowed per permit.
I tilutlhtnitr'ur,ii; JLC•enrm Inrr OW IMiiilQ •Q.41jf( 11/05/(pS•pwr,g
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