Permit v CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00703
Date Issued: 12/13/2012
f GARD'
T 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S1046D01200
Jurisdiction: Tigard
Site address: 13585 SW FERN ST
Project: Stubbs Subdivision: OBRS HEIGHTS Lot: 11
Project Description: (1) 200 amps or less panel change
Contractor: KALEO ELECTRIC LLC Owner: STUBBS
PO BOX 22104 13585 SW FERN ST
MILWAUKIE, OR 97269 TIGARD, OR 97223
PHONE 503 - 341 -0897 PHONE
FAX 503 - 653 -9041
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/13/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/13/2012 $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 OAR 52001 -00 You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: Permittee Signature: ► A h 11-417 D
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.
Electrical Permit A licatic VE
PP i ECEI * 6■ FOR OFFICE USE ONLY
City of Tigard Received D E 1 - .50/. — 00
,� g C 2 2012 Dare/Bv • /, I ►a— u Permit Ne : �
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
t9 Phone: 503.718.2439 Fax: 503.598 / OF TIG a D n Other Permit:
x+r Af71./ Date/B
TICiAhD Inspection Line: 503.639.4175 Date ReadyBy• tune ® See Page 2 for
Internet: www.tigard-or.gov BUILDING D Notified/Nledrod Supplemental Information
TYPE OF WORK PLAN REVIEW
Please all that apply (submit 2 sets of plans w/items checked below).
1:1 New construction ED Addition/alteration/replacement
❑ Demolition Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
® and 2- family dwelling ❑ Cammercial�ndustrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system
0 Addition of new motor load of ❑ "A "It ", "I -2 , "1 -3
Job no.: STUBBS Job site address: 13585 SW FERN ST 10014P or more occupancy
❑ Six or more residential units ❑ Recreational vehicle parks.
City /State/ZIP: TIGARD, OR ❑ Health - care facilities ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: STUBBS ['Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I Fee. I Toesl l •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Fa add' 1500 sq. ft. or portion 3392
Tax map/parcel no.: Limited energy, residential 75,00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy. multi- family
200 AMP PANEL CHANGE residential (with above sq ft) 75 00 2
Services or feeders installation, alteration, andror relocation
200 amps or less I 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 I 552.26 2
City/State/ZIP- Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( ) f 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, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. i 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,
each branch circuit 7.42 2
Business name: KALEO ELECTRIC LLC B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: KENT MIGUEL branch circuit
Each add'I branch circuit 7.42 2
Address: PO BOX 22104 _
Miscellaneous (service or feeder not included)
City/State/ZIP: MILWAUKIE, OR 97269 Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: (503) 341-0897 I Fax: • (503) 653 -9041 Reconnect only 67.84 i 2
E -mail: keleoelectric @gmail.com
Pump or irrigation circle . 67.84
Sign or outline lighttrtg 67.84 2
CONTRACTOR Signal ctrcuit(s) or limited - energy
Business name: KALEO ELECTRIC LLC panel, alteration, or extension. Paget 2
Each additional inspection over allowable in any of the above
Address: PO BOX 22104 Additional inspection (1 hr mm) 66.25/ hr -
City / State/ZIP: MILWAUKIE, OR 97269 Investigation (1 hr min) 662x /hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 341 1 Fax: (503) 653 - 9041 r Elcc1nCal `1 3 Inspections Mr which no fee is
specifically listed (IA hr mm) 90 00! hr
-
CCB Lic.: 192539�,Il Lic.: C688 I Suprv. Lie.: 4890S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , die - i Subtotal: 100.70
r i
Plan review (25% of permit fee). 25.17
Print name: DANIEL J MALLOY f . 12/12/2012 State surcharge (12% of permit fee)• 12.08
Authorized signature: / 4, 2 TOTAL PERMIT FEE. 137.95
�V1AJQ This permit application expires if a permit is not obtained within 180
Print name: KENT MIGUEL I Date: 12/12/2012 days after it has been accepted as complete.
• Number of inspections allowed per permit,
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