Permit �` n CITY OF TIGARD ELECTRICAL PERMIT
' ` `: a .'`- COMMUNITY DEVELOPMENT Permit #: ELC2012 -00678
TIGARD ' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/03/2012
Parcel: 2S112BA00800
Jurisdiction: Tigard
Site address: 14460 SW 80TH PL
Project: Hays Subdivision: WAVERLY MEADOWS Lot: 44
Project Description: (1) 200 amps or less to install ground rod and bond to existing
Contractor: MILESTONE ELECTRIC Owner: HAYS, JAMES E &
1281 NE 25TH AVE, STE. T SHELLEY P
HILLSBORO, OR 97124 14460 SW 80TH PL
TIGARD, OR 97224
PHONE: 503 - 645 -5323 PHONE:
FAX: 503 - 690 -4843
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/03/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/03/2012 $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 0 R 52- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or or 1.800.332.2344.
Issued By: J L 4_ Permittee Signature: D& IC►P Pi.-i C .4 T70&
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.
a, ;
ENED
Electrical Permit Applica . - . - FoR (1 r, t i e r ( 1\I \ - -
-
City of Tigard DEC 0 3 2012 Received PcraitN
Date/By: 1?-131(P- sr ELt b
,, • 13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
s Other Permit:
— Phone: 503.7182434 Fax: SO�Srrt�t'�'�(jA� Da[eBy:
1 . l ,„ > P El Inspection Line: 50363941 7 Date Ready /9y; tm+ Sex Page 2 for
Internet www.tigard- or.gov B UILDING DIVISION - (� ® Supplemental Information
''��'Cr.E''I°'�;S ��. �� -�: A 'r, J:V' ,' •"��,q� h RJ t�,l 7 BwJr'� �",9r�Y'�7�., 1� �, .. `.ti',�,,�k�'n,: br'�"� - + "V�ZE�.,h/�, , � �; �t�+�" �7'1�"� "�i''1
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Please mock all that appy (submit ?sets of wlum
es checked below):
❑ New construction Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current ❑ Marinas and boatyards.
r ry� 'q� �• ' •" r ;''�"' }: " i M"� 1 , exceeds 10.00() amps 150 volts or ❑ Floating build
1.° + x?r.7� ,w R X�1 i, �c ' may'' " a 0' p g mP•
less to ground, or exceeds 14,000
.f '` ` " "'�"" "�''' " "';` ` "' ❑ Commercial -use agricultural
IA 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
N�o ,/ /<r��r�. w �n• ,' R.' � w +. r r ,�, S ,, ❑ Emergency system. larger separately derived system.
f, r,w .� a.,,r �s�,ta OAddiro o no motor load of O "a,. "E", °1.2
1 � W � � ' t �� � L pi, SW or occupancy parks.
Job no.: Job site address: {. al Y l a ❑Six or more residential un7ts. ❑ Recreational vehicle
City/State /ZIP: �' ( � ❑ H azardous l facilities. ❑ Supply voltage for more than
1 .�� j � � V` ❑Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: tio,8 riP S.,, h r t ❑ Service or feeder 600 amps o more.
Cross street/directions to job site: Denpd° a I t "" Totall j -
fir- � Fee. � I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. add'1500 sq. ft. or portion - 33.92 1
Limited energy, residential
'n l . u r ,,. a 75.00 2
.w;...C!ch .. ; I. ":ti; i • r , . ,. % .. e r -? ' .)l ',. /r'' r. ,' "' ; k %',,, (with above ft.) �!���, , .. , ;K,` , t�•+5.��.;v �Yrv .f� ' � : . c r ;, ;. 3.^,� +;!r,..; Limited energy: multi - family
T I S ►0 t c I J ti r (44 ��, residential (vuuh above sq. ft.) 75.00 2
J ■�`' Services or feeders installation, alteration, and /or relocation
� �1 r : r ;i�4i.0 /' 200 amps 100,70 ` � 2
c � „'•, � � 4 r , ' \
`� 201 1 to 400 amps to 400 amps 133.5 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: ( ) I Fax: ( ) 200 amps or less 59.36 1
2 01 a mps to 400 amps 125,08 2
Owner installation: This installation is being made on property that I own which is not ' - 401 amps to 549 amps 168,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or ex tension, er panel
Owner signature: . . • Date: A. Fee for branch circuits with
zw� . y :� a "+� � ,�1,, m e "�cc" r ti' N/y, "r „te -C.,'; above service or feeder fee,
1 5.132 /= , ',0: r . t -:` :_ r each branch circuit 7.42 2
Business name: B. Fee for branch circuits wirhovt
service or feeder fee, first 56,18 2
Contact name: branch circuit
Each add'/ 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: ( ) I Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
rv'lii K Sign or outline lighting 67.84 2
3
, ,.rg,' ,`,p., ,M:'+ v . i„ . ; 4 1 'v I', . t ' :9li�," 4 A+b: c,', , ; "�l0J,�.±;,tie rj;lt0. , *,4 kY, f Signal cirui(s) or limited -energy
Business name: � _ Q `G panel, alteration, or extension. Page 2 2
•
Each additional inspection over allowable in any of the above
. Address: 15- q 1 D�6 Ave L;1 } - e T Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: 141 1 1 L 5 O& , f o ` i 1 10-`- ` Investigation t 1 hr min) 78.18 / hr
• Phone: ( min) 6625 / hr
d 1 Indushial plant (1 r J 3 ( o 7 P�� - L (�/� 90.00/ hr
dt � 645 Fax: t ` 1 Inspections for which no fee is
s • • 'Pica' listed IA hr min
CCB Lic.: + 0 Electrical Lic.: Suprv. Lic.: T -
111 ' . 1 Subtotal: IoOt 70 519
Suprv. Electrician : re, required: �a}Tir _ Plan review (25% of permit fee):
Print name: G r; s Date: /7/3‘ State surcharge (12% of permit fee): I.
Authorized signature:
TOTAL PERMIT FEE: l i g.,-7 g
This permit application expires If a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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