Permit ".1
•
CITY OF TIGARD ELECTRICAL PERMIT
111 COMMUNITY DEVELOPMENT Permit #: ELC2013 -00026
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/14/2013
Parcel: 1 S 125DB07300
• Jurisdiction: Tigard
. Site address: 7155 SW SHADY CT
Project: Conley /Holstad Subdivision: SHADY DELL NO.2 Lot: 46
Project Description: (1) 200 amps or less for grounding and bonding
•
Contractor: WEST. SIDE ELECTRIC CO INC Owner: CONLEY, MATTHEW P
1834 SE 8TH AVE HOLSTAD, TRACY R
PORTLAND, OR 97214 7155 SW SHADY CT
TIGARD, OR 97223
PHONE: 503 - 2 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/14/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/14/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR, Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 952 -001- 90. You y obtain a cony of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.234 I
4.
Issued By: �7► l.C,i Permittee Signature: Oil A-PPL(C.4' `7" " i
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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HUM: alki. /111.2439 rug: Sti.l.RIICEIVED Diii/13i..
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. 1 . G 3 Internet: www.tigard-or.gov
Inspection Line: 503.639.4175 Date Ready/By: ,./,, , ( 7 e _____ See Page 2 for
1
Notified/Method: "1" / ••/ 1 1 b Supplemental Information
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0 New construction 1:21.Addition0l4eigaii)
[]Other: DUILDING DIVISION Please check all that apply (submit A sets of plans whtems checked below)
lidia_piiad :
El Service or feeder 400 amps or more 0 Building over three stories.
0 Demolition . where the available fault current 0 Marinas and boatyards.
.. ..:::'....' i::::;.C.:,:.':-.;":::.',::;:.:1;.:e.•;.--'::ICATEOciitt,'.00:%tONSTAvc.170$:::.,;:',.:::::%:.5.?.C4:9g..;!..6. exceeds 10,000 amps at ISO volts or 0 Floating buildings,
less to ground, or exceeds 14,000 0 Commercial-use agricultural
Land 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings,
0 Multi-family 0 Master builder 0 Other: 1:IPiro pump, Cl Installation of 75 KvA or
.;.....,...- . .. ... ,,,,,,. 0 EmenlencY sYstelm larger separately derived system.
. ... ".7.J'' ' ...:. ' ' ':' ...:: '' '.; : • ... : ' , : ; : ' .:.i .. . 4 08 : 44 .7 , 0 40#0****All*.t.04:V.,4zI.4'S;4:a., : ::'1 1 1 ., ..! . ;.!:::::•Zil -. :'1';' . . 0 Addition of new motor load of El
Job no.: 3 fel Job site address: 1 155 SW SIA.kat.,4 al, 100HP or more.
0 Six or more residential units. 0 occupancy.
Recreational vehicle parks.
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City/State/ZIP: - 1 - l_ o‘a.V7A 012— C ri '2.-.3" 13 Heralth-care &edifies. 0 Supply voltage for more than
0 Htomnious looaticms. 600 volts nominal.
Suite/bldg./apt no.: I Project name: \-10 c3 i-, --tr
) 0 Service or feeder 600 amps or more,
.':-"' ' ::1j-3 " .:.^7- i l. :WOlklUE . ; , SCHEDULE:. .• . - . .
Cross street/directions to job site: Desaipilan QM Pm. TO141 •
_ ,
New residential single or multi-thmlly dwelling unit.
Includes attached garage.
Subdivision: [ Lot no.: 1,000 sq. ft. Or 1c55 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
P: [1.4"Yr
• •;.,.:. ; 1:. a 4 1:. ,.. ; -, :q ,; ! -,f.,t-; : ,,•i.,• ;! . .: :.. ;:;' , : .. ` :: :: !• : . t ..1 ::' , „ ,. :,...4,..;..itif*:10:110()NAII*Oilies461!; .1 ` 1 !..k:!;7, , ,,4,:z.:: . W6 t ro: t t . f4 (with above sq. ft.) 75,00 2
- Limited anew, multi-family
mund.Ln.ep c4- l(?..)0111-&6111.5 residential (with above sq. ft.) - - 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or less t . 100.70 1 W ,n D 2
! 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 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59,36 I
0
Owner installation: This installation is being made on property that I own which is not 201 amps to 40 amps 125.08 2
168.54 2 599 o t amps
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
- .::;•:.„ .. APPLICANT '' :5.$40:6;i,*::::: above ServiCe or feeder fee,
7.42 2
each branch circuit
-
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
.. _
Each add'I branch circuit 7.42 _ 2
Address: Miscellaneous (service or feeder not included)
' Each manufactured or modular
67.84 2
City/State/ZIP:
dwellilip service and/or feeder
.-----.----, . . .
Phone: ( ) Fax: : ( ) Reconnect only _ 67.84 - 2
E - mail: Pump or irrigation circle 67.84 ' 2
-ma
ine lighting 67.84 2
:1:. ....• . .,.-. . . .- l'...•:... Sign or out ligh
•: '.. 10 tr:TR.A.c 17 0. ; Y ,:: : :,:.. :; .: Z!g r 'MP. ) .: 7, 44.:1;0 : 40.Afq:q 0 :''..; ' Signal circuit(s) or limited-energy '
panel, alteration, or extension. _ Page 2 _ 2
Business name: West Side Electric Co., Inc.
Each additional inspection over allowable in any of the above
Address: 1834 SE 8 Ave. Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/hr
Portland/0R197214
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 231 I Fax: (503) 736-0677 Inspections for which no fee is
90.00/ hr
specifically listed (4 hr min) _
CCB Lie.: 13306 I Electrical Lie.: 26-I35C Suprv. Lic.: 4654-S , . , "'t:21.SPAVW1.! ° , 4 AMECitiucitriVE.R1VIIT.:TEES . .,:. •• •
Subtotal: 1 0 () i n 0
Suprv. Electrician signature. requirrdl
Pian review (25% of permit fee): 12._ ■ 05
Print name: Randal! F Roberts Date: 1 --. ( /-. / 3 State surcharge (12% of permit fee):
TOTAL PERMIT FEE: k 12...lb
Authorized signature:
This permit application expires ifs permit is not obtained within 180
.
days after It has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit
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