Permit CITY OF TIGARD ELECTRICAL PERMIT
a.: COMMUNITY DEVELOPMENT Permit #: ELC2012 -00658
•
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/19/2012
Parcel: 2519108
Jurisdiction: Tigard
Site address: 12559 SW 69TH AVE
Project: Bennett/Porter & Associates Subdivision: WEST PORTLAND HEIGHTS Lot: 23 -28, P
Project Description: (1) branch circuit for new receptacles
•
•
Contractor: PARKIN ELECTRIC INC Owner BENNETT /PORTER & ASSOCIATES
14001 FIR STREET 12559 SW 69TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE: 503 - 620 -3484
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 11/19/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - • 11/19/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
• Total $62.92
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 1.800.332.23344.
• Issued By: �NLC/)Q� OJ'kL2 Permittee Signature: rQ PPZ-l14 [ l IA-
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.
From: 11/15/2012 11:34 #757 P.002/002
Electrical Permit APPli O
FOR OFFICE USE NL1'
City of Tigard �CJ I V Received
I
• 13125 SW Hall Blvd., Tigard, OR 97223 Dates �I 1. _ /i
C Phone: 503.718.2439 Fax: 503.5 01 5 2012 i Review
a c Other Permit:
!ns lion Line: 503.639.4175 DateB
f I C; i1 k D Date Ready/By: runs: 12I See Page 2 for
Internet: www.tigard- or.gov Notified/Method:
�7 Supplemental Information
/ J ' [ PP
? �- 4 kft * , - � � a y 1 \` ,`- 1 s =x ,, y /, - ,, � - gig ` ! pp�7rp'{xr"'i�' �
; ��e ;t A - 1
3'S.n; - t...-, , , x �:r uE.' - 1 . Ii' / ', Visolit , x -�.. ;°�_ �y.�.1 -.. - it 6. ,4..a , iortir ;+riliG';. .:-
❑ New construction Additi t ra to replacement Please check all that apply (submit a sets of plans w/items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other:
where the available fault current ❑ Marinas and boatyards.
<fi ; rte',.; :s 'r:� ��- .n ;X -', �`: si';t. � _ _ - - ':x ;?: z.� 'i •`'% "' t '�
'''' ,exceeds 10 00 e at
ag; a y - s _". i R;' g.#f 1): . kl ; - [-,,yr - amps s1 volts cu min ia ildin
., ��:T "'{Y-1�;`��.�.:J.X.1.' ti %_`•�- ..`'Lt�_.'t .`• ✓.�s= .'�,.�( ±�:�:;a�_..:..xi � = a c` -. W1 - �: .'r:: "��''r.F'1�3�F:���:5%S`.-. .''.-��Y ri? P ❑ Floating B9.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ' Igt Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other ❑ Fire pew. ❑ Installation of 75 KVA or
aG.';i ;irk"' -fit - a`: ,' ..i: - `.�; ; x: < . . :, .; x _ :; . CI Emergency system. larger separately derived y
.,fi - „y' s IOB*,S1 7 :10:2 ;:1314 iT' PP.I- l : :'s. g:f w i clii,.t'"`t system.
r :.
. >„ ,� _ .,r..- •..,,�T'h.:.:.1� a ;"�'.v. =,.��: ❑ Addit o f new motor load of ❑ „ A „ '•E• •
: a ; ... �,'...Ye ��- � - .', ,' .. ,._ ..,.,.,. �.. l: a,:.. w.. ,..,.:..+_..�..r.... «.. .,s: -ter. . +..:,: �..
Job no.: I Job site address: / , 2559 S_) b' 9' 0--e, 100HP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: T/ 40 l-,Q O 12- 9 7;2_3 ❑ Health -care facilities. ❑ Supply voltage for more than
U ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: '` ': 6I f i ` `' " '`:"F'Y E' .tUi `'ge: -ii, : i2i":
Description 1 oty. I Fee. I Tow 1 •
New residential single- or multi-family dwelling unit
Includes attached garage.
Subdivision: I Lot no.: 1,000sq. it or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.:
Limited energy, residential
., �; (T . S''- �'a�r� (with above sq. 75.00
, �. ;11tk, late 01.31/1. FOO,g ^. �„ ' '.,... g } f,e'li 'e . ft.) 2
.
l i/ / L.� lh ^ f Limited energy, multi-family 75.00 2
V/ ✓`e residential (with aboove e sq. q. ft.)
Servi or f eeders a installa tion , alteradon, and/or relocation
200 amps or less 100.70 2
� PRikit .V10, .B ", ."iiµ �,_ - : Mf li. ' �5 :'S 201 a
'.: S (o 400 amps 133.56 2
J°�- ... it . _ ,.... _ -,.r- ,WIVE -5 '. .., ,, , .- I c �.�- ., �=: s • I� F T$NANT, �) 1 , .:• �Y P 6.0 /Po�7 tl #. �Sr a G i G-q�
401 amps to 1, 0 amps amps 30 2
Name: Fen i p,
/_ 9______„„/„..e.... 601 amps to 1,000 amps 301.04 2
Address: /) 55? ..‘ 6 L Over 1,000 amps or volts 55226 2
City /State/ZIP: 7'nii&' a 9 relocation
services or feeders installation, alteration, and/or
Phone: (503 ) 45 3 y p ) y Fax: ( ) 200 amps or less 59.36 1
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 dreuits - new, alteration, or extension, Ear panel
Owner signature: Date: A. Fee for branch circuits with
'"�; rnz'; .,5 545 .1 .� -< c = ICS ;, ! O fit =e : e ;� a
; bory or
,.. _ - d 1. -1 111 �[1ir1J1Vt �. i 's i � >Y. 1. G�I�:I a�:� y �; �; y ! ` +�� ^ rri4lY1QJ \�T.,M; .42 2
fach ve b ice ClrC feeder fee, 7
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 5C• /B 2
Contact name: branch circuit
Each add'i branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: Signor outline lighting 67.84 2
• \. ',CONTRACTOR, ., ' . ,.,, Signal circuit(s) or limited-energy
Business name: Parkin Electric panel, alteration or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Oregon City, OR 97045 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 657 - 4958 Fax: (503) 557 - 1059 Inspections for which no fee is 90 00/ hr
specifically listed (d hr min)
CCB LiC..
3515 Electrical Lic.: 34-4C Suprv. Lic.: 4241-S ; ?;.:= .7,Ainit1guCu pj VIEESg "
Suprv. Electrician signature, required: ,
�� Plan review (25% of permit fce): 56. , /6
Print name: David B Parkin Date: State surcharge (12% of permit fee): 6 , 7 y
TOTAL PERMIT FEE: //,!� A.
Authorized signature: This permit application expires if a permit Is not obtain 180
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
I: tBuitdingtPamir .stEC- PermitApp.doc 07,01/10 440- 4615T(11,05,COM/WEB