Permit II/ CITY OF TIGARD ELECTRICAL PERMIT
IN a - -- COMMUNITY DEVELOPMENT Permit q: ELC2013 00011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/08/2013
Parcel: 26114BB09900
Jurisdiction: Tigard
Site address: 10374 SW PICKS WAY
Project: Pion Subdivision: SWANSON'S GLEN Lot: 40
Project Description: (3) branch circuits
Contractor: BOONES FERRY ELECTRIC INC Owner: PION, ALBERT L
PO BOX 628 10374 SW PICKS WAY
WILSONVILLE, OR 97070 TIGARD, OR 97224
PHONE: 503 - 682 -4936 PHONE:
FAX: 503 - 682 -7946
FEES
Quantity Description . Date Amount
3 crt Branch Circuits wo /Purchase 01/08/2013 . $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/08/2013 $8.52
Type of Use: SF • 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. ATTENTIO • -•:P law re•uires you to follow the rules adopted by the Oregon Utility Notification - ,er. Those. rules are set forth in OAR
952 - 001 -0010 t• oueh OAR 95 0 9 -'09'. Y: • ay obtain a copy of the rules or direct questions to OUNC by calli, • .:. ;F._ _ 987 or 1.800.332.2 . ..,
/ �
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Issued By: / ' i / 1_
I � 1 Permittee Signa = �- L —� 2 r r i
i
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' Q , C ._� 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.
Jan. 7. 2013 3:37PM No. 0154 P. 1
- Electrical Permit Application 1•1_)R O FFICE USE ONLY
• City of Tigard JAN 0 7 Rece1Ved � � &A
3 Date/B . r , Permit r m.: 06,..y/
q " 13125 SW Ball Blvd., Tigard, OR 97223 Plan Review
_ : • Phone: 503.718.2439 Fax: 503.598.190M pp TIGARD Date/By: Other Permit.
T I C; n x I ) . . Inspection Line: 503.639.4175 BUILDIN D NISIO i a,fie dy /EY:: lur„` 85 Sea Page 2 for
Internet www.tigard-or.gov Supplemental information
-.� - yy u u y ,,, r. z , , I ' s- t 1° „ �. _' _.r. te n ,° 1 a. , ,r -,?w Pt.. od • 1 % J �liS ill ` , i n' ` , , '. -r. .L,.. • V. • •
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❑ New construction ® Addition/alteration/replacement Please cheek all that apply (submit 1 sets of plans w /items checked below):
❑ Demolition ❑ Other. ❑ Service or feeder 400 amps or more ❑ Building over three stories -
�;It l e r :� '71.'i,ia where the available fault current ❑ Marinas and boatyards.
Y ,a�5 crap :x,- F``T�i"r - ^, 'T=-= = 1 •, " : :Tilia lI
: -- = -... E .. in s 3; y_ : ' 2 - .:.i` , •%! i ; y h � o c• -. ra exceeds 10.000 em at 150 volts or ❑ Floating buildin �r..c::ii 41,3, tl , r, � = %rS_ �:_ __ ',_ s_: i_, - 1 9 _; = ?;;i :.;sit•.: _c >•u r +,L:_� �: i ; . i :!:t,,� less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
® I - and 2 - family dwelling ❑ Commercial/industrial ❑ Accessory building
ads for all other installations. buildings.'
❑ Multi family ❑ Master builder ❑ Other ❑ Fire pump. ❑ Installation of 75 KVA or
. ��.: ❑ Emergency system. a separately derived to
f i . _, ,; •:r -np 8e Y ys larger arale yd ve system.
fr4rif• rr = - rly ,r, ,r � � _ •- "� s �5 , �.-z; h ;$:
- _. LTJ S F :Iti. - , ,: av�.•a� r: >.x� - �: : r...�.= s:.v. 1�. r i�F - ❑ Addition of new motor load of ❑ "A ", "E". "1 -2°. "1.3 ^.
Job no.: 21691 Job site address: 10374 SW Picks Way 10013P 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: Pion ❑ Service or feeder 600 amps or more. f ,rr p • e £ , t 7If 7ml i ins1 �,{ : r`.t tiT: 5 � I1st1^L�
7,,tii ,.iy.
Cross street/directions to job site: Description Qty. Fee. To ns •
New residential single- or multi- family dwelling unit.
Includes attached garage -
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Es. add'l 500 sq. ft: or portion 33.92 1
Limited energy, residential
:,'"211 00
` .. a - : �1". c€r y-Ti- r-r ,7 9 F`F'Sn 9 1 f ` t; .. -w . , ,.'� -- • - 5 .._ r,.- __- -T (with above S 2
. il~:t . -'. ._ t -.L': .tta:: `. $Etii.n.1:,R`: =:Li st -- Y ': -- - 4' ft )
75
L energy, multi- family 75.00 2
Micro Hood, Crkt for Track light, Exterior Crkt residential (with above sq. ft)
Services or feeders installation, alteration, and /or relocation
200 amps or less . 100.70 2
r; 7 '; . , -T 'r:_., , '7roar -r=' -_ , x v . c .. ci ._ r . t _
tr ri 7 sr ' a 1 : -- 1 ;I 1, Y „•' rr € 201 amps to 400 amps 133.56 2
`t.^ - ts um � . L�cs4rr�„ t�i� !3.t � �:...�1�• '-• l� `.�• : �u.F..�. I . �C U4-11.[: .
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 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not 401 amps to 599 amps t68.sa 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
mps -
Branch circuits new, alteration, or extension, per panel
Owner B8 signature: ?YY Date: A. Fee for branch circuits with
i 7" c: T 1 ?'% °., ! R.Ti 1 ` ` 41 4 sf i i r i 1 i , Y 4 P , t i t +i{ , above service or feeder fee,
a. ••.•..d 1.5s-isirl dlist;.id..
...,�li. : ,s. :! , in, i, i ila .: ',,.C_l..l.,•. {ibt :, each branch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first I 56.18 56.18 2
Contact name: , branch circuit
Each add'l branch circuit 2 7.42 14.84 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP! dwelling, service andlor feeder 67'84 2
Phone: ( ) Fax: : ( ) Reconnect Only 67.84 2
Pump or irrigation circle 67.84 2
E- mail: t
i , c� 3° e F Y E ' f' I r t + l r i � r t# 3 • it t rrr t - -. Signor outline lighting 67.84 2
i
- � » r $, .l (, I f l l r a ?! 7, i rf - . 'vr.i r�il?dl . N.Fri- ` _a _ Signal circuit(s) or limited- energy
Business name: Boones Ferry Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable it t of the abov
Address: PO Box 628 Additional inspection (1 hr min) J 66.25/ hr •
Investigation (1 hr min) 6625/ hr
City /State/ZIP: Wilsonville OR 97070 Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 682 - 4936 Fax: (503) 682 - 7946 Inspections for which no fee is 90.00 / hr
specifically listed (iS hr min
CCB Lic.: 88482 Electrical ► - c.: 3 -223C , Suprv. Lic.: 3170S ' z r,; '"r" , r'E°i`{ 1 ' 4 ' I- ,°•"-"•r ''i ,i
I �. �,,:,,,.1ir.,,.'• - �. gut, �: �,.:_.:.�:�_ .... .:
Subtotal: 71.02
Suprv. Electrician signature, requ' • op 411;1 t
VI Plan review (25% of permit fee): N/A
Print name: Jan Herron Date; 1/7/13 State surcharge (12% of permit fee): 8.52
TOTAL PERMIT FEE: 79.54
Authorized signature: This permit application expires if a permit is not obtained within 180 r/
Print name: Date: days after it has been accepted as complete Y )' . ►{/
• Number of inspections allowed per permit.
l:\ Buitdieg \Perraia\ELC- PerrnihApp.doc 07/01/10 440- 46isi(tIro5/COMIWEB