Permit a
' CITY OF TIGARD ELECTRICAL PERMIT
' a COMMUNITY DEVELOPMENT Permit #: ELC201300018
.,,. Date Issued: 01/10/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439
Parcel: 1 S134CB11500
Jurisdiction: Tigard
. Site address: 12241 SW MILLVIEW CT
Project: Bean Subdivision: MILL VIEW Lot: 15 .
Project Description: (1) branch circuit for upgrade electrode system
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: BEAN, STEVEN JAY & TERESA LYNN
PO BOX 3948 12241 SW MILLVIEW
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE 971 - 563 -8211 PHONE:
FAX 503 - 266 -1349
FEES
Quantity Description Date Amount
. 1 crt Branch Circuits wo /Purchase 01/10/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/10/2013 $6 74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62 92
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 A '9 -000 -0090. Y obtain a copy of the rules or direct questions to OUNC by calling 503 2322 or 1 800 / 3 3 2344
.( J
Issued By: i v l.t.(' ?/ Permittee Signature: at 4 PP`-'r MT ' 0 A
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 RECEIVE .- F OR OFFICE USE ONLY
14 . City of Tigard JAN 1 0 2013 Da�6 I(/ 0 i 3 ST ./ & 9/3 — t:: r.
y . Pe rmit He.
13125 SW Flail lllvd., Tigard, OR 97213
7 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960
CITY ur TIG ' 1 D268Y Oilier Permit:
TIC A IL D
H Inspection n l, inc: 503.639.4175 Ire Read B See Page 2 For
lnlcmet: www.tigard-or.gov BUILDING DNISI _ Itlfed/Meth C o Supptemcntal Information
TYPE OF WORK PLAN REVIEW
Please lint apply
❑ New construction , 2Addition/alteration/replacement
❑ Service or feoder400 amps or more CI over three stories.
❑ Demolition ❑ Other: • where the avaipble fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
- and 2 - family dwelling ❑ Commercial /industrial less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder
❑ Other: ❑ Fitt pump. ❑ Inslaibjiori of 75 KVA or
JOB sl'I'E INFORMATION AND LOCATION CI Emergency system. larger separately derived system.
° Addition of near motor load of
Job no.: 1 Job site address: . l] f�� cr. !O liP
I Z r ► t I fV • ❑ Six O or mote ormore, occupancy,
resi dcutial units. ❑ Recreational vehicle parks.
City /State/ZIP: ❑ Health -pee facilities. ❑ Supply voltage for more than
❑Hazudous locations. 600 volts nominal
Suite/bldg. /apt.no.: Project name: 0 Service or Rieder 600 amps ormom.
Cross street/directions to job .: itc: FEE SCHEDULE
Dnaptien 1 0,„ I Fen I Tont I
New residential single- or multi- family dwelling unit.
Includes attached garage. •
Subdivision: 1 Lot no.: 1,000 sq. IL or less 168.54 4
Tax map /parcel no.: Ea. add'! 500 sq. R. or portion 33.92 I
Limited energy, residential
DESCRIPTION OF WORK 67.84 , 2
(with a sq. H.)
() e6(A o, �r flJny �1n�! �• Limited energy, multi- family 67.84 2
f jZ residential (with above sq. 0.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
OPERTY OWYER I ❑ TENANT 201 amps to 400 amps (33.56 2
Name: //f, Be f 401 amps to 600 amps 20034 2
Address: �W 60I amps to 4000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 l
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, rem, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Dale: Branch circuits– new, alteration, or extension. per panel
A. Fee For branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,
Business name: -
each branch circuit 7.42 2
B. Fee for branch circuits
Contact name: without service or feeder fcc, 1 11 ffj�,
first branch circuit 56.18 2
Address: . Each add'I branch circuit 7.42 , 2
City /Sta1c171P: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) I Fax:: ( ) dwelling, service and/or feeder 67 G7.84 2
E- mail: Reconnect Reconnect ono' .84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2 '
Business name. t– P‘C) /1 i c u1.1-1 ,1 t Signal circuit(s) or limited -
� energy panel, alteration, or
Address: 1
I. 0 S SR L IR extension, Describe: Page 2 2
City/State/ZIP: Wi.1 4 0 f Wile_ 0 T7 07 0 Each additional inspection over allowable in an of the above
Phone: ( I) 51,3 S� - d I I Fax: (�'��) �- Per inspection 66.25
��� ( 34 / Investigation per hour (1 hr min) 66.25
CCB Lic.: / ( e 7 ( - 7 , t 5 - 1 . . . , I Metrical Lic.: –L 0( ` Suprv. Lic.: 5i 07. 5 Industrial plant per hour 78.18
Suprv. Electrician signature, req tired: I, / "—IC.' (2 ELECTRICAL PERMIT FEES I
f ? Subtotal: 5/9. to
Print name: It',NJe_ A) 0C1,(„ I Date: Plan review (25% of permitfce):
Authorized signature: State surcharge (l2%ofpermit fcc):
TOTAL PERMIT FEE: Z-' 2 I
Print name: f D ate: This permit application expires if a permit is not obtained within 110
11 days after it has been accepted as complete.
• I , �DaddinstPemri61CLGPamirApp.dcc tr>lotros Number of inspections allowed per permit
440- 4615T(1 U05/eoM/WaD
Z 617£L99Z£09 ou }oa13 main oat e9990 £L 06 uer