Permit _ .t 1111 CITY OF TIGARD ELECTRICAL PERMIT
t' m COMMUNITY DEVELOPMENT Permit #: ELC2012 -00618 •
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 10/29/2012
Parcel: 1 S136ACO2500
Jurisdiction: Tigard
Site address: 10705 SW 72ND AVE
Project: Topping Subdivision: METZGER ACRE TRACTS Lot: 6
Project Description: (1) 200 amps or less for panel upgrade
Contractor: STUMPTOWN ELECTRICAL LIGHTING & DESIGN Owner: TOPPING, RICHARD
4804 NW BETHANY BLVD., STE. 1 -2 #169 10705 SW 72ND AVE
PORTLAND, OR 97229 TIGARD, OR 97223
PHONE: 503 - 267 -2081 PHONE:
FAX: 503 - 303 -8292
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/29/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 10/29/2012 $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 OA 52- 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. �1
Issued By: Permittee Signature: D/J 4 C PPU 4 1 Li
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.
To: Page 2 of 2 2012 -10-29 15:54:06 (GMT) 15037472306 From: Nicolas Valentine
•
Electrical Permit Applicatio IVE
City of Tigard 9 '"� !b1 apt I - K' PeruirtNo.:Gf.J�-�l�'t�G
A
•• : 13125 SW Ha11 Blvd.,Tig rd, OR 97223 OCT .2 9 ZU12 • E wcw
• Phone: 5033182439 Fax: - 503.598.1960 Date/By OtherPenn`t: • '
T I G A R D lospection.Line :. 5.03.639.4175 �/ /� T • � 1 • Date ReadyBy: - ®See Page 3 for
• Internet www.tigard- or.gov �� (1 VI ( t Vt iSed/Method: It i - ...,1 ..
TYPE OF w l-DiNG U Y IIIli� .. - PLAN REVIEW .. .
. ❑ Now construction ' A ddition/altoration/replaecmotlt ., .. . Please cheep all tint apply (submit 2 sets o.f plansw /items.checked below);' •0 Service or fee der.400,aop:ar Morn:: 0 suldiug over thr stories • ❑ Demolition ❑Other: . where the available 'fault current 0 Mantas and boatyards: •
CATEGORY OF - CONSTRUCTION exceeds 10 000 amps at 150 volts ar 0 Floating buildings
less to ground, or exceeds 14,000 0 Commercial -use a
and- 2,family`dwelling ❑Commegcial/industrtal ❑Accessory building amps,for5uotherinsranati0ns. buildings
❑ Multi- family. 0-Master-builder ❑ Other: ' - O'Firepuntp. ; .... 0 lnstahatrua of KVA
---- 0 Emergency system. ' larger sepnrntely derived system. ' .
JOB SITE INFORMATION AND LOCATION ❑Additionofnewmotor . ❑. "'A","E', "1 2 ", "1 -3 ",
. - �
- l 0U}IP or more.' :,'
Job no f�
Job site address: �° ��LJJ Q et.:4 ! . t ) , t -!' • O S ix o . m resi u , O Recreational vehicle p?r?.-.
City /State/ZIP �f
: L 0 /� !7 :O H ealth-care fac r m
. . ❑ Sunpl faorc:!han •: : , -
r �'7 L- /c - 0HazAdot ss lacatioas. 600 volts !l • -
S uite/bldgJapt no.: � \/ 1 1 rojectname: .F V » r i n "7 ✓LC1. 0scrvtcc o r feeder600 amps ormore.
• FEE SCHEDULE ., , .....
Cross street/directions to job site: ueaerrpbu = .. - 1 pry. I'' Pea.' I Tort ' '1 - ;
New reside si ngle- or-molti- family d welling u nit
Includ :
Subdivision: Lot no.: . 1,000'sq:'ft. or less::'': 168.54 1:4..
... 'Ea. add'l 500 sq.R•or portion ' 33.92.:
Tax map/parcel-no.: .Limitod cnorey, residential ' . . . T -
DESCRIPTION OF WORK'
(withabove sq. ft.) 75.00 2 . -
• Limited energy, multi- family 75.00 2 ; \
residential (withabovesq. ft) ' , ,, - -- Services or'feeders installation, alteration, and /or relatethin ` • "
.../ . 200 omits or less ' '':' - :.: " t i 400.70 106. 2 •
PROPERTY- OWNER ❑ TENANT - 201 amps to 400 amps 133.56 2
401 amps to 600 amps ' ' , • • 2 00.34' _ 2
N ame: t„���, ; 6Ul a mp s l o' t, 0 00amps - ` — 2
Address: Over : 1 ; 00 0 amps or volts S s2. 26 = 2
/l'TG'�f � �✓ `. •vim ✓Lr _ .
Tempprery services orfeeders installation, alteration, nod/or
. ' `City/State/'LIP: f/ 6, - f. �/1 /l relocation
200.amps or -less ..••• • ` •• • 59.36! 1; ' `-
Phone: (6 x3 ) - . ' Fax ( ) 400 sin s - . - : 125.08
Owner- installation: .This installation is.tieing made on,propertythattown, which is nat...: a01 amp to599 amps. _' ' . . "'. 168.54 •'+ 2,'. :
intended for sale; lease, rent Or exchange, according lit ORS 447,,449, :t570; and 9t)1: ,granc h'c ireitits - new' alteration, or extension, per panel -
' . - Owner signature: Date: • - -.A:rector circuits rvirn, - - :: . .
T.. APPLICANP 0 CONTACT PERSON above service or feeder fee, . ` 7.42 ? - ;
` each branch circuit
1 's - R Fee, f - b ranch'circuits ivi/hou[ -- ` •- -'
Businessnarne LA/ )\ . 7 'd ri' 4 3 - 1. De al serviceorfeeder.fec, first. :- - 56.18 . .
ute l /� /, _ - branch cut ult'. :: •.
Contact name: 4R /a'JiIT <- — . Each add'I branch circuit '7.42 2
' Address: G/�j/ • e y R l %,,0 ` s' / C / - 2 - /6'9 Miscellaneous (serytee or rreder not indudcd)_
7 . Each manufacturedormodular :84 2
City/State/ZIP: --7L N0 9771 7 dwelling, service and/or feeder - ` 67
/ Recorutect only
67:84 :1
Phone: (' ) ,? 6 7_ 70?r /. Fax :: (S0 ?) .30.3 -- 2 2 Pwiip •or ir r i gat i on circle '' - . 67.84
B ma ..01 c 5yar„jP„,,,, ,.'n.,' do >.o�J . L04'"i : ' 'Sigtoroutlmelighting 67.84° • `2
.CONTRA'CTOR' . ':Signal cirewt(s)•or limited -energy,
- - panel, alteration; n
n; or extei n: Page 2 - -'2
Business name: - / - .. (! ` + , i / Eac additional lns ecdon over allowable in any -of the above • .. -
Address c�: t 1 .. • 9 A Additional inspect (1 hr min) 662
- �nJesti (I min)' .66:25/
City/State ZIP t 78 :18 /hr .
-�' 0/I ; (`t 27.9 r lrrdustiialplant(I hr min)
r�� ,, Fax: l ' F C .� 7 w
Inspections for hich no tee is . 9.00 .
Phpne: ( ( 2( `,� ( j7j j'� ' c 3 a .. I . spec if i cal ly-l i ste dM in m i n ) -
CCB Lie.: 1 .0 I .. . .Electrical Lic.: - . , 'Suprv.:c.:3293 S .- ELECTRICAL PERMIr _
FEES. -
��\•] 1 -: -, Subtotal_: tOQ yc7
Suprv. Electrician ` tr ' • -. � ;2� • r I ii -- - - o
�� L 2rG. Pl anre Ji ew (25 /oofperinitfee):=
Print name: ' A ' C i- - IN .' _ -' . `6 1n 'Dat '-( O. - `2_i - .f Z - Stale surch (12 %efperelit:fee) :: , : (j g .
I;OTAL PERM FEE i 1 7, D^
Authoriaed`signature: � - gets : - 'This permit application expires if a permit rs oat obtained within 180
• - � - days after It has been accepted ae complete.
Print name : I�' .:••7,-1 . Dat j� �� . .lZ . • -Number of inspections allowed per peru tit .
I 9eddirtttlPamiis El C PutoaAppAOa 07/01/10 140 a615T(1 t, .. _ trn EB -
Nov. 12. 2012 7:57AM PGE -TCC QUAD A No. 4985 P. 1/1
- - Request to Energize an Electrical Installation
REQUESTING SUPERVISING ELECTRICIAN INFORMATION
Name of supervising electrician: x ;06,4 l)ef10.5n,) Date of request: to Iv I Zu (
Supervising electrician's license number: 3'1 Q3 f Date installation was completed: I 1 ��
Electrical permit no.: t r-;w;i 00( If a temporary permit is posted at the Job site, please include a copy gill with this form.
EMPLOYING ELECTRICAL CONTRACTOR INFORMATION
Name of electrical contractor: `? �, •. � . D145' no.: e /62 / �/3
Business address; 6 AA./ d nr� / %,wv J /`o , S re ..2 2 � /6 f
City: /� State: (32 ZIP: C /722 9
Phone: Fax: X03 -3 - 42 Z E- mail: /7,e j /, •:.✓ei'.us7rur>. ccn�
.• • , • •••CUSTOMER INFORMATION :.
Customer's name: y�,�n r' — . (0`'Nee1 _
Customer's address: /0 7O la 71 NO Ale- J .,
City: '7Z�,7c. State: n./( ZiP:
Address of installation if different than customer's address:
City: State: ZIP:
INSPECTING AUTHORITY INFORMATION
Authority having jurisdiction to inspect: Oy 7' Phone: 3'03 - 7/`�2
Address: /3 /ZS .5'4/ // 2 /,'a T��,�•�
City: 4 State: (,? ZIP: 9 711
RECEIVING ELECTRIC UTILITY INFORMATION
/-OR
Name of electric utility receiving request: 7c,o Vt na / j'%c're Phone: 5u,; - /Jrr S "wed
Address: /ii � r'u 9:�:�t�/ x e e r
C i ty : 7 67 V'sera -- . ' ._ State: a'z ZIP: 9770 `-
_ REASON FOR REQUEST -
A. Restoring electrical service that was inten•upted or disconnected because of either a:
Service change or ❑ Uncontrollable event, such as tire, flood, or severe weather;
or
B. Electrical service at a remote location needs to be:
initialized ❑ Restored
• COMPLETION INSTRUCTIONS AND SIGNATURE
Supervising electrician Electrical contractor
Note: After sending this form to the electric utility Note: By close of business on the first business day following
named above, you must send a copy of this form to: energizing of a completed installation in response to the above
(1) the electrical contractor, (2) the customer, and request, you must: (1) notify the authority having jurisdiction
(3) the inspecting authority. that the installation has been energized, and (2) request that the
authority inspect the completed installation.
Supervising electrician's signature t)nte Electric utility - — —
Note: Please consider notifying the inspecting authority
identified in this request when an installation is energized
:.. avi/j,01. I 01,2 .31 before inspection.
C r.P1RTME4,T E
440- 094e.COM t i oroBICOM