Permit n , CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2013 -00016
Date Issued: 01/09/2013
T FGARL� 13125 SW Hall Blvd , Tigard OR 97223 503 718.2439 Parcel: 2S104CD02300
Jurisdiction: Tigard
Site address: 13698 SW HILLSHIRE DR
Project: Ping Subdivision: HILLSHIRE ESTATES Lot: 23
Project Description: (7) branch circuits to add clothes washer, dryer, range, microwave and dishwasher
Contractor: OWNER Owner: PING, VANLOEUN
13698 SW HILLSHIRE DR
TIGARD, OR 97223
PHONE.
PHONE 503 - 560 -6596
FAX:
FEES
Quantity Description Date Amount
7 crt Branch Circuits w /Purchase 01/09/2013 $51 94
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/09/2013 $6 23
Type of Use: SF Electrical '
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $58 17
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law All work will
be done in accordance with approved plans This permit will expire rf work is not started within 180 days of issuance, or if work is suspended for more the 180
days ATTENTION Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center Those rules are set forth in OAR
952- 001 -0010 through OAR -001 -0 90 You ma obtain a c py of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: Permittee Signature:
f OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
RECEIVED
Electrical Permit Application JAN 0 9 2013 FoR OI'Flc :I': USE OtNIX
City of Tigard at B (cj 1 eta' c I1.3 col -
Permit No.:
a 13125 S50 Hall Blvd., 75g OR ^ Y� `+' Tf V A Dn Plan Review
Phone: 503.718.2439 Pax: x: 503.591-1960+ CIiW HamB Other Permit:
i _ tt D Inspection Line: 503.639.4175 BUILDING DIVISION Date Ready/By: B See Page 2 for
Internet: www.ligard- or.gov Notified/Method: gt O Supplemental Information
TYPE O$ WORK PLAN: RF '
❑ New construction ® Addition /alteration/replacement Please check all that apply (submit g sets of plans w/Items checked below):
❑ Service or feeder 400 amps or mom ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY 01? CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 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
, ❑ Emergency system. larger separately derived system.
JOB' SITE INFORMATION' AND; LOCATION _ - ❑ Addition of new motor load of ❑ "A ", "E", "1 -2 ", "1 -3 ",
Job no.: I Job site address: 13698 SW Hil)shire Dr. 100P or mere' occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard, OR 97223 ❑ Health facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: I Project name: Basement Addition ❑ Service or feeder 600 amps or more.
FEE, SCHEDULE
Cross street/directions to job site: Description I Op. I Fee. I Tohrl I •
SW Hlllshire Dr. and SW Boxelder St. New residential single- or multi- family dwelling unit. 1
Includes attached garage.
Subdivision: Hlllshire Estates I Lot no.: 23 1,000 sq. ft. or less 168,54 4
Tax map/parcel no.: 2S14CD Ea. add'1 500 sq. ft. or portion 33.92 1
Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 75.00 2
Limited energy, multi- family 75.00 2
Add clothes washer, dryer, range, microwave, and dish washer residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ° 11 ❑ TENANT ' 201 amps to 400 amps 133.56 2
Name: Vanloeun Ping 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: 13698 SW Hillshire Dr. Over 1,000 amps or volts 552.26 2
City/State/ZIP: Tigard, OR 97223 relocation Temporary services or feeders installation, alteration, and/or
Phone: (503)560 - 6596 Fax: ( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This inatalla • n is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale, leas t, or change, according to ORS 447, 449, 670, and 7 1.
q ( :g �r ' '> Branch circuits - new, alteration, or extension, per panel
Owner signature :!: Date: 1 A. Fee for branch circuits with
above service or feeder fee, 7A2 2
® APPLICANT I ❑• CONTACT "P N each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: Vanloeun Ping branch circuit
Each add'I branch circuit 7.42 2
Address: 13698 SW Hlllshire Dr Miscellaneous (service or feeder not included)
Cl City/State/ZIP: OR 97223 Each manufactured or modular
tY Tigard, dwelling, service and/or feeder 67.84 2
Phone: (503) 560 - 6596 I Fax: : ( ) Reconnect only 67.84 2
E vanloennitiaDyahoo.com Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
-CONTRACTOR- _ . Signal circuit(s) or limited-energy
Business name: panel, alteration, or extension. Page 2 2
Each additional inspection over allowable In any of the above
Address: Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Investigation (1 hr min) 66.25/hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) I Fax: ( ) Inspections for which no fee is 90.00/ hr
specifically listed (r hr min)
CCB Lic.: I Electrical Lic.: I Suprv. Lie.: } . _ ,EIACTRICAL.PERMIT FEES' • '
Subtotal:
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Date: State surcharge (12% of permit fee):
Authorized si ture TOTALPERMi
� �� / • This permit application expires If a permit FEE: 5�, 1
h not obtained within 170
Print name: I + 1 -%1-1 S (,. r ' I Date: (/ el / I j days after It has been accepted as complete.
A. • Number of inspections allowed per permit.
1: 1Huadiog\PamasdEl.C-PennlApp.dae 07/01/10 440-4615T(I I/OS/COM/WEB