Permit n CITY OF TIGARD ELECTRICAL PERMIT
1:111 i " -, COMMUNITY DEVELOPMENT Permit #: ELC2012 -00671
T W ARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/27/2012
Parcel: 2S 112CA07900
Jurisdiction: Tigard
Site address: 7712 SW ASHFORD ST
Project: Knudsen Subdivision: RENAISSANCE WOODS Lot: 5
Project Description: (1) 200 amps orless and (1) branch circuit to change 200a panel
Contractor: AMP ELECTRIC Owner: KNUDSEN, BRUCE A 1999 LIVING TRU
8152 SW HALL BLVD # 325 KNUDSEN, THERESA M 1999 LIVING TRUS
BEAVERTON, OR 97008 BY KNUDSEN, BRUCE A & THERESA M
7712 SW ASHFORD ST
TIGARD, OR 97224
PHONE: 360 - 910 -5805 PHONE:
FAX: 503 - 643 -6798
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/27/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 11/27/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 11/27/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 952 -001- 90. You may e obtain a copy of the rules or direct questions to OUNC by calling 5033 232.1987 or 1.800.332 2344.
Issued By: Cb?.G�' Permittee Signature: S7kt Ar9Pat#PrIAL
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.
11/26/2012 18:38 FAX 5036436798 AMP ELECTRIC INC al 001
Electrical Permit l Applicatio O
t oft fl ac 1, USE oN1,1
City i � I . I R ece i ve d
ty o f Tigard Date/By: It 1 e-.1 I 1 ?—`+i PermitNogi ,/ •t a. 0 (27
i
• 13125 SW Hall Blvd., Tigard, OR 97223 I N o v • 2 6 2012 Plan Review
g Phone: 503.718.2439 Fax: 503.598.196 Date/By: Other Permit:
TIGARD
Inspection Line: 503.639 Date Ready/By: x;' H See Page 2 for
Internet: www.tigard -or.gov CITY OF TIGARD Notified/Method: Supplemental Information
TYPE OF &DING DIVISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please cheek all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1 and 2 family dwelling ❑ Commercial/industrial ❑ Accessory building . amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVAor
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "1-2", "1 -3 ",
Job no.: Job site address: 7712 SW Ashford St t00HP ormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/ State/ZIP: Tigard OR 97224 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Knudsen ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 79 Ave Description I Qty. I Pee. I Total I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea add'l 500 sq. R or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
DESCRIP'T'ION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi-family 75.00 2
change 200a panel residential (with above sq. R)
Services or feeders installation, alteration, and/or relocation
200 amps or less 1 100.70 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
City/ State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) 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 circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 1 7 42 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City / State/ZIP: Each manufactured or modular 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited-energy
Business name: Amp Electric Inc panel, alteration, or extension. Page 2 2
_ Each additional inspection over allowable in any of the above
Address: 8152 SW Hall Blvd #325 Additional inspection (1 hr min) 6625/ hr
City/State/ZIP: Beaverton OR 97008 Investigation (1 hr min) 6625/ hr
0 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 896 - 3171 t ,4 111 F ax: ( 643 -6798 Ad I i3 Inspections for which no fee is 90.00/ hr
1 specifically listed (A br min)
CCB Lie.: C179 A , % E lectrical Lic.: 169591 Suprv. Lie.: 3869S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 108.12
Plan review (25% of permit fee):
Print name: Jeremiah M. Faught Date: 11 - - 2012 State surcharge (12% of permit fee): 12.97
Authorized signature: TOTAL PERMIT FEE: 121.09
This permit application expires if a permit Is not obtained within 180
• days after it has been accepted as complete
Print name: I Date: • Number of inspections allowed per permit.
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