Permit ,� CITY OF TIGARD ELECTRICAL PERMIT
l: • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00681
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 1 S 134AD04400
Jurisdiction: Tigard
Site address: 10670 SW BLACK DIAMOND WAY
Project: Kinsey Subdivision: BLACK BULL PARK Lot: 2
Project Description: (1) 200 amps or less for50A feeder, (2) branch circuits for connection to hot tub
Contractor: MCCOY ELECTRIC CO INC Owner: KINSEY, ROBERT R
2014 SE 9TH AVE 10670 SW BLACK DIAMOND WAY
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 234 -7521 PHONE:
FAX: 503 - 234 -9473
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/03/2012 $100.70
Specifics: amps or less
2 crt Branch Circuits w /Purchase 12/03/2012 $14.84
Type of Use: SF Service or Feeder
Class of Work: OTR 1 ea 12% State Surcharge - 12/03/2012 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 0 952 - 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. r
Issued By: Permittee Signature: okl 4 PP e... ( l //� " l r ( 0 ^1-
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.
Dec. 3. 2012 7:03AM McCoy _ No. 0313 P. 1
Electrical Permit Application ��� F011 OFFICE
ESE ON1,1'
City of Tigard • eceived
. ty g Date/By: / 3 ' off- % Pem,it lIO.:E( e )01 a' JD (o Ed
q 13125 SW Hall Blvd., Tigard, OR 97223 DEC 0 3 2012 Plan Review
° Phone: 503.718.2439 Fax: 503.598.1960 Date/13 : Other Permil,
l'1C;e111.13
Inspection Line: 503.639.4175 (� /1 len
s: See Page 2far
Internet: waw,tigerd- or,gov CITY � /1r� �� Date Re olired/Method: 11 Co Supplemental Information
1��.(❑ N G DIVISION
" "`Ii.:4;• •;' -••••:': TYPE OF Vifora ?':"' . . _ • y ;0,41,7 ...x. ;t :' - ; , .. `� .; % PLA ]tEXIBW.,:,;
El New construction Ei Addition/alteration/rcplaccment Please check all that apply (submit 2 sets o plans w/items checked below):
❑ Service or feeder amps or more 0 Building over three stories.
❑ Demolition ❑ Other:
_ where the available fault current ❑Marinas and boatyards.
`'' `1TBGQ1tY OF CONSTRUCTION ' _ , exceeds 1%000 amps at 150 volts Or 0 Floating buildings.
•
im dwelling loss to ground. or exceeds 14,000 ❑ Commercial -use agriculn,ral
1- and 2-family g ❑ Commercial /industrial ❑ Accessory building amps for all oiler installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: GI Fire pump. ❑ Installation of 75 KVA or
❑ E,nergency system. larger separately derived system.
JOB SITE INFORMATION.; AND tQCATION
0 Addition of new motor load of 0 "A ", "L ", "1- 2 ", "1.3 ",
Job no.: B4971 Job site address: 10670 SW BLACK DIAMOND WAY 10011P or more, occupancy.
[] Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD OR 97223 ❑ Health.care facilities. ❑ Supply voltage for more than
• ['Hazardous locations. 600 volts nominaL
Suite/bldg. /apt. no.: Project name: HOT TUB ❑ service or
feeder 600 amps or more.
Cross street/directions to job site: . 6 0 4 1. .r > ..• . FEE 3CREDIJLE " % t t , P e.e, '.;;: <.
� besetl � man er, Total •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot Ito.: 1,000 sq. ft. or less 168.54 4
Ea. add 500 sq. IL or poniou 33.92 1
"fax map /parcel no.: Limited energy, residential !
_ .. : - . 7500
DESCRIPTION OF WORK (with above sq. IL)
Limited energy, multi family 75.00 2
ONE 50A FEEDER AND 2 BRANCH CIRCUITS TO CONNECT HOT TUB residential (with above sq. R.)
Services or feeders installation alteration, and /or relocation
200 amps or less 1 100.70 100.70 2
.:,. 9 �1ROPERTY OWNER j _201 amps to 400 amps 133,56
=,TEi�T11T1. Ps P 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
Temporary services or feeders Installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36
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, least, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 f 2
Bra uch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for breach circuits with
• :0 APPLICANT _ ❑ CONTACT. PERSON above service or (beder fee, 1
7A2 7.42 2
'�''' each branch cirenit •
Business name: B. Pee for branch circuits without
service or feeder feo, first 56.18 2
Contact name: branch circuit
Each add'I branch circuit 1 , 7.42 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
E -mail:
Pump or irrigation circle 67,84 2
Sign or outline lighting 67.84 2
• CONTR4crOk": ' Signal circa it(s) or limited-energy
Business name: MCCOY ELECTRIC . nel alteration or extension, Pa: e 2 2
- Each additional inspection over allowable In arty of the above
Address: 2014 SE 9 AVENUE Additional inspection (I lir min) 6625 / lit
City/State /ZIP: PORTLAND OR 97214 Investigation (1 hr min) 66.25/hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 234 - 7521 I Fax: (503) 234 - 9473 Inspections for which no fee is
z I ' 4 specifically listed (y5 hr min) 90.00 / In
CCB Lie.: 8277 i !/r E lectrical Lie.: 2 Suprv. Lic.: 5208S .::.ELECTRICAL PERMIT FEES
Subtotal: 115.54 •
Suprv. Electrician sigllanlre, required: Plan review (25% of pennit fee):
Print name: ZACK ARMSTRONG Date: 12 -3 -12 State surcharge (12% of permit fee): 13.86
TOTAL PERMIT FEE: 129.40
Authorized signature: This permit application expires If permit Is not obtained within 180
days after It has been accepted as complete.
Print name:
Date: • Numher inspections allowed per permit.
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