Permit n CITY OF TIGARD ELECTRICAL PERMIT
1 • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00738
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/31/2012
Parcel: 2S102AA01200
Jurisdiction: TIGARD
Site address: 8915 SW CENTER ST
Project: Luke -Dorf Subdivision: KINGSTON Lot: 6
Project Description: (3) branch circuits for toaster, refrigerator and alteration
Contractor: SUNLIGHT ELECTRIC INC Owner: LUKE -DORF INC
2800 NE 65TH AVE SUITE B 10313 SW 69TH AVE
VANCOUVER, WA 98661 TIGARD, OR 97223
PHONE: 360 - 772 -3877 PHONE:
FAX: 360 - 694 -9728
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 12/31/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 12/31/2012 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 OAT 9 2- 001 -0690. 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: OM A r1 PLfC.4n0ill
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 Application, RECEI
VE
City of Tigard :DEC 31 20 I : ' r . 1'er®twod. aipl� - dv7 3 •
j • a 13125 3W Hall Blvd., Tigard, OR 9 7 223 , . Plan• Review
otherPetmit
P ho ne : 503.718.2439 Fax: 503.598.1960: �+ Deter
? ! C; .n t;1� Inspection Line: 503.639.4175 CITY (*pip Ready/BY lari ,. fief See Page 2 for
Internet: vvww- tigard-or.Bov : I Supplemental Information
BV UIN.G nw1S1A
TYPE OF WO -1 - - . r •
❑ New construction Addition/alteration/replacement Please clink all that apply (submit j sets of plans items cheelmdbdosr
0 Service or feeder 400 amps d more ❑ Build over three stories.
❑ Demolition ❑ er: T • . where the available fault cuncat CI Mariam and boatyards. •
CATE KY : OR Ct7NSTI IIC17t'lNl exceeds I0,000 amps at 150 volts or CI Floating buildings.
❑ 1 - and 2- family dwelling Commercial/industrial 0 Accessory building �' amps to gr all of or i nsects ons ❑ Commercial-use ildin agricultural ������ ry g 87np5foralForllrrmeallatinnc . buildings.
❑ Multi- family Master builder ❑ Other: ❑ at Pon • ❑installation of 75 $VA or
JOB SITE INFORMATION AND LOCATION of ow • 0 Emergency sy stem. larger separately derived system.
❑ Addition n motor load of 172 "A ", "E", "1-7,9-3",
• � 10011P armors. occupancy.
Job no.: ...Mg S' ' : ��,, .er • , _ , di a • ' , 1:1 Sec or more residential units. El Recreational vehicle parks.
Clt�t/St> ZIP: e � / El Health oacc facilities ❑ Supply voltage for mote than
1 � �� r ❑Ha�rdovs locations, 600 volts nominal
I
Suite/bldg. /apt. no.: t/ Project name: - ❑ Service or feeder 600 amps or more.
FEE' SCHEDULE • . •
Cross street/directions to job site: nestrietion I oi, 1 Pee I anent 1 •
' New residential - single: or multi -family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1,000 sq. ft. or less I68.54 4
Es. add9 500 sq. ft. or portion 33.92 1
Tax m arcel no.:
p Limited energy, resid ential 75.00 2
D ON OF Wt.»tK. (with above sq. ft:)
"� a Limftedetrx8Y. mdY •
'14 1 01,/ N _ 4 r r e. r / /O4.5 /cc, residential (with abovesq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
re re-. ;r a Ave, i 41 f f " r1 200 amps or less 100.70 2
❑ PROPERTY OWNER I • 1 .0 TENANT 20I amps to 400 amps I33,56 2
401 amps to 600 amps 200.34 2 .
Name:
601 amps to 1,000 amps 301.04 2
• Address: Over 1,000 ants 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 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps t25.08 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: v A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
each branch circuit 7.42 2
Business name: tr- B. Fee for branch circuits without
service or feeder fee, first t 56.18 56,1g 2
Contact name: _ branch circuit
. Each add'I branch circuit 2_ 7.42 7, 0 12. { 2
. Address: Miscellaneous (service or feeder not included)
Each manufactured ornodular
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
Sign oroutline lighting 67.84 2
• CONTRACTOR i Sigma] circuit(s) or limited- energy
Business name: v (it // j, L J • 1--; panel, alteration, or extension. Page 2 2
� r ✓!7 [ �� C- &2G Each Each additional inspection overpltnwable in any of the abov
Address: 226 tic 6c a Additional inspection (1 hr min) 66.25/ hr
A/ Investigation (I hr min) 6635/ hr
City/Statc/ZIP: Va. kl C o 14 U.z 1/1/79 V ✓ 3 e 67 I plant hrmin} 18.I6i br
Phone: (3,Cta 579- 7- 1 Fax: %C,67) £etc— ,966 p Inspections for which no feels
specifically listed ('h ht mm) _ 90.00 / hr
CCB Lie.: l - 14 1 Electrical Li.: C 3 0 f Suprv. Lie.: / 9s s ELECTRICAL PERMIT FEES ..
/ y� Subtotal:
Suprv. Ele slit [der L'i e, required: �•
Plan review (25% of permit fee): •
• Print name:a �1 / /( / j '/ 2 � - Date: / o? /,; i'l/ • ,Z State surcharge (I2'! ofpermit See) x,52
Authorized signature: ��il� / . TOTAL PERMIT FEE: 7. c. S!�
Li This permit app5catton expires if a permit is not ebtaiincd within tear
/ days after it bas been accepted as complete.
Print name: �iiY Hate= f2--/Z I Z
� . _ y Nnmber of inspections allowed per permit
1:uuildiog\PermitrSl.c-PermitA 440.46101111.105/COMIWFB