Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2012-00610
7110ARD" 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439
Date Issued: 10/25/2012
Parcel: 1 S134AC01000
Jurisdiction: Tigard
Site address: 11406 SW IRONWOOD LP
Project: Cuomo Subdivision: ENGLEWOOD Lot: 38
Project Description: (1)150 amp panel change
Contractor: ABC ELECTRIC Owner: AVERILL, MATTHEW N &KRISTINE N
135 NE 9TH AVE 11406 SW IRONWOOD LP
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PORTLAND, OR 97232 TIGARD, OR 97223
PHONE: 503-233-7551 PHONE:
FAX: 503-233-7552
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/25/2012 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 10/25/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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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 9 -001- 0. 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: Permittee Signature: OA/ .920, -fee-7 O 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:
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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.
10/25/2012 10:56 AM FROM: ABC Electric ABC Electric TO: 503-598-1960 PAGE: 002 OF 003
Electrical Permit A )1i EIVED FOR OFFICE USE ONLY
City of'rigor(' Received A 'crmit No,:
s 5 2012 tYtle/l3 :io Z5 �2. 4--. cZ-e.20/A—eV6io
/'r 13125 SW IIall Blvd.•Tigard.Oit r 3I .2 Plan Review -- --
3' - Phone: 503 718.243x) Fax• 503.59 . )60 iiateilly: Qtlicr Permit:
TIGARD hspection Lind 503.639.4175 TIGp Date Rcadyl0y: �� 6d.Sec Page 2 for
Internet: www,lignrd-or.gov- U� t 'loin - I supplementallnformadon- -
;:''-`) .
❑New construction �Ad<iition/alteration/replaaanent • — -Please check-all that apply(submit 2.scct'ofplans wfitems checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where me available fault current
...-.. ,..:.—' lye ds.
''...-4'-'''. r'- •; : r'i } x`. exceeds 10.000 arms ar 150 volts or ❑1 lolling buildings.
.:. ......::..�.. 'i�',=;Ci�'rCt; x_:or_�conts'�i�UCctbr °.,;.
::. .., _.:......:..... ,.,.._.: . its
0 less to r a r,or ns 14,000
❑Cnpmacml-use agncuhural�t-and 2-family dwellin g ❑Commercial/industi lal ❑Accessory building amps for all other installations
buildin{p.
0 Multi-family 0-Master builder ❑Other: ❑Firepmnp ❑installation of 75 KVA or
M1: ,::r'�.s , , 'r• ,:,;;.1; ..i. ❑Emergency system largersepamtelyderi wed sy em.
M..;` : ', n.• _ ...,..,' ' _, +._ l= ❑Additiunornewntoror load of-
Job no - Job site address: 11 ° ? f f
10011'or more; occupancy.
_�1_ r t,< ' 4J17,'yI>L•(r d Six or more residential units. ❑Rcerealional vehicle parks.
City/State/ZIP: id�,r r h P-12 (0, i r
t1 1 ()c^ ❑Health-care facilities.
❑llszardooc locations. ❑Supply voltage for moeihan
• 600 volts nominal.r
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps m umrc.
C 0 Y?l r;:1 ''...;::,•:. ::. ,tTL SCHHCDULI'. -::. :-•:•/_ •::,
Cross street/directions-to job site: neacri lion o . 1 pie. I Totot - ",_
New residential single-Or multi-family dwelling unit.
Includes.attached garage.
Subdivision: Lot n0.: 1,000 sad,.fl.or less_ - 168.54 4
7'ax map/panel no.: "'T-T la.add'I 500 so It or portion 33.92.: 1
m.:/par„;;no. ,_::.:_..;;.a ;,i`". ..... ,,T mited energy,residential 75.00 2
L1 c
o,
:� -,., f r,. `� = •'• ''•".•- '--'; C''`A- ' .�'�.; i "' •••ilk , Vii with above;molt
- _ ' - told-faittily
_ wi
Limiti�l'enuirgy;n 75.D0 2•
, Q0.4.}„1__� ` �'j�iu- 0 `I 6 j(i- yr residential(with above s .ft.
f f Services or.fecder•s installation,alteration,and/or relocation -2-200 amps or less - 100.70 ,,-tr 2
F
"`-' "®.,PRoPFFRTet-mi�ER;,r -t :..:-:::::,.,,,,,'4.....:.0''e NA3Q' ' ,':e•:r -;:)t 201.anipsto400amps 133,56 2
r
- 401 amps to-600 amps 200.34 . 2
Name:�•' ,
' 601 snips to 1;000 amps 301.04 2
Address: 1 v }n% - Over 1,000 amps oe volts. .-.552:26 2 .,
t n L t' ,� �' T� Temporary services or feeders installation,alteration,and/or
City/State/ZIP: �: ry j 1 •�
�' c 1 - 1' - T' relocation
Phone:( ) mss,L Fax:( ) 20D stops or less 52.36. 1•3 . 201 amps 10 400 antis$ .125,08 •: 2
Owner installation::'Phis insta tattoo is.lbeing made on property'tliat I:own which is net ---�-
401 amps to 599 amps.- 168.54;• ---_ . . - 2; .
•intendcd.for sale,lease,rent,or exchan;e according to ORS 447 449,'670 and 701
llraach circuits-new,alleratiory-or exteusiou;:per panel
'Owner signature. - "'- 'Date:; A.Fee for branch circuits with .. .
t�� p r y� a* :•:.='�.• above service or feeder fee;
i '0 r ??a�t$ �,' ' A !: FCi�Ti' �4 1 F Lr OLD •, - 7.42. 2
each brunch circus•
Busittess nalhC:. / ' 11] f ,,p .-.• B.•Fee for branchcireuttstwithout•Q1l s, P--' l ' �`,r• - Service or feeder:foe first SG.18 2•
Contact name: �' j Ir i 'i .. , brunch circuit
e Each add I brunch circuit '7.42 2-
Address :l 1. Miscellaneous serviceorfeeder hot
Cit'/State/�iP: f) 7 Farr h mwuifac(urcd or,modular
> L leer pI 9 q rC7' �jc�,_ dwelling service and/or fcedee 67:84 2
Phone:(r •,j) a 7`p ' Fax:,($3;13) e' ,1j 2 50, y -
c ::•lam:: : 7, Pump nett sal 67 84
I amp qr trngnuarurcle 2,84 2
E-mail: • ..0.,,..,,,,,:: i c {,c.!_ j. - oreuthne lighting 67.84 2 •
'>=;;• ,, .r't7Rw'Y ' •.r, «ike,,Q " �) 44.4,'=u ' �. i?r 14- r".;t :Signal circuit(s).or limitcd-energy, •,mac _- -c , ' '
- l3usinessnlameT -1: • I "':.�-' :�° -., - - :-: _:: : ffln0l;alteration Or-extensrgn. Paget - - 2.:.
Each additional.iuspectwn over allowable In any of the above ::
Address : ./- . '•441 y - •`Additional inspection(l.hrmin) _ 56.25/hr' .
lnvesUgation(.I_hnnin) 66.2S/M.:•- City/State/ZIP, ' 1 / .s! l .' "/ 'fC7`�v
.. ndustrialplant(I hr!rim 98.18/hr
:'hone (1j)J . . - ----,r = : 'Fax:-(- ? ) . -- Inspetiwg'orwhich ie : •
90.00/fes i specifically listed(vS m . - • -
t ,1, .I.OMOI 'III, r ,1 '�`M..., cry
CCI3 tic,:_ - �- E Iecfrtcal- ie,' !, . Supt-,l.ic: j ._ l" iyl
..
: =Subtotal: e
. . --..Soprv.Electrician Si_�- ury e owed:; - .—_ „ /Lt� 7�
. an view ( °/gfpormit fee);
Pl re v 25 0
4 Print name: �.(.,lw c 1 f a_ Hate: • "� t surcharge('2^la ofpemih fee):
• S ate sit
' TOfALF RIVITPE ' l L
E•.- AuthOriZed signature: •-•...__' r )r ,_... a �wi �
180� Thisµanvil appliwliun expires if a permit is not-edits nod within
Print�ariC� �� + atl7 e: Atop after It has been accepted as complete.
t J.I ) N ! 9 e,' !JO 'y Number of itlsl>rctiorc5 allowed per permit,
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l:Ulu/Iding,Pamii&RC.PumitApp.dor.07/01/10 445-46t5T(I t/asicom was •