Permit n CITY OF TIGARD ELECTRICAL PERMIT
3 , COMMUNITY DEVELOPMENT Permit #: ELC2013 -00032
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/16/2013
Parcel: 2S103BB02500
Jurisdiction: Tigard
Site address: 12115 SW 124TH AVE
Project: Howson Subdivision: BROOKWAY Lot: 25
Project Description: (3) branch circuits to remodel (3) bathrooms - exhaust fans and lighting
Contractor: COHO ELECTRIC INC Owner: HOWSON, BRIAN C & GRACE A
PO BOX 40 PO BOX 4017
WILSONVILLE, OR 97070 BEAVERTON, OR 97076
PHONE: 503 - 582 -9774 PHONE:
FAX: 503 - 582 -9840
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 01/16/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/16/2013 $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. 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 O ,952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
DI
Issued By: Permittee Signature: /1 IrP� / C-�( 'C/ ILL
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.
Jan 1513 10:07a Coho Electric Inc 503 -582 -9840 p.1
Electrical Permit Application RECEIVE FOR OFFICE 1 SF ONLY
City of Tigard Received Permit 140.:
13123 SW Hall Blvd., Tigard, OR 97223 JAN 1 5 2013 Date/By: I lc° (3 c\-- PLC v13 •ULjj�-
Phone: 503.639.4171 Fax: 503.598.1960 Datee/By: a,By: w
D Other Permit:
TIC Al'. D Inspection Line: 503.639.4175 CITY OFTIGARD Date Ready/By: Jura: ® See Page 2 for
Internee www.6gard- or,gov RI III. DING DIVISIO °° nh""°a I I UO Supplemental Information
❑ New construction ii2 Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps tar more ❑ Building over three stories.
❑ Demolition ❑ Other:
where the available faalt current ❑ Marinas and boatyards.
:... . . -- . CATEGORY OF' :CON exceeds 10,000 amps at I50 volts or ❑ Floating buildings.
] 1 - and 2- family dwelling ❑ Commercial/industrial less to gourd, or exceeds 14,000 ❑ Commercial -use agricultural
❑ Accessory building , amps for all other installations. Moldings.
❑ Multi- family ❑ Master builder ❑ Other. O Fite pump. ❑ installation of 75 KVA or
Em y system. larger separately dewed system
< ..: • . YOB = SITE;' INFORMATIO\ A1ND LOCATION •. :;.-r-• ., . ` ; ' : : : : :: • , i•.: - .. CI Addition ition itfan of new motor load of ❑ -A ", "E"• '1 -2 °, °1 -f
Job no.: t -- 19 �4 Job site address 1 e�111 — ti} ` `'11'� v tOOHP or more. occupancy.
� 1 `�� 4 ❑ Sis or more residential units ❑ Recreational vehicle parks.
�
City'State/ZIP: 1 1 s^arf r Q Q Q, facilities. ❑ Health -cue cilities. ❑ Supply voltage for more than
.5 ❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: ( Pro name: C e , r , - 4..,_, _ 13 Service or feeder 600 amps or more.
Cross street/directions to jab site: t' > FEE SC9EDUi.1 ' !. :.' •._' .
Description I Om 1 Fee. I Toad I • '
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.: Ea. add'l SOO sq. fr. or portion 33.92 1
residential
Limited e re
pp
... •.. ............ D ESC . IO1Q :'QF WORI '.` :, - (with above sq. ft.) 67.84 2
�.srloGLc,1 3 ((�7 Limited energy, multi- family
N perLS -- ea(11ei,4 — e 0119 `1r residential (with above sq. ft) 67.84 2
t
20 Services installation, alteration, � d %r relocation 2
amps or less
- :.. : PROPERTY OWNER TEX4NT..: . `' •'. . • -,
.. ....... .. ... 201 amps to 400 amps 133.56 2
Name: \ 4 S p � 401 amps to 600 amps J 20034 2
, �� - R 601 amps to 1,000 amps I 301.04 2
Address: ,a >r�� ° J\,,,.,, 1 ay Nv Over 1,000 amps or voles 1 552.26 2
City/Stale/ZIP: --\--�� pp C� 1 Temporary services or feeders Installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 5936 ' 1
Owner installation: This installation is being made on property that I own which is riot 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension. per panel ,
A. for branch circuits
El :4 PPLIC T .--.1. , .
re rrcu with
::_ ._ ❑: CONT PERSON a serv or feeder f ee,
7.42 i
each branch circuit
Business name: B. Fee for branch circuits
Contact name: without service or f eeder f ee, 56.18
first branch circuit 5�.1g 2
Address: Each add') branch circuit , & 7.42 (t{,Q34 1 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular I 67.54 2
Phone: ( ) Fax : ( ) dwelling, service and/or feeder
Reconnect only I 67.84 2
E -mail: Pump or irrigation circle t 67.84 2
CON TRAC fOR .: ' : Sign or outline lighting I 67.84 2
Business name: . �. � i‹ � 1 e Signal circuit(s) or limited- I
�._.� 1. ,+ ( t 1 .. energy panel, alteration, or
Address: ? ^ L extension. Describe: Page 2 2
City /State/ZIP: y1-i11 • i t G , !r-„ S — 1 CZ - t Each additional inspection over allowable in an of the above
V 1 tee r, Per inspection 6625
Phone: (' ) "%;° "1-1 ''4 Fax: ( ) F_ S ? s '
i L 4 Cti Investigation per hour (1 hr min) 66.25
CCB Lic.: 'I `; "'i , ,,z i I Electrical Lic.: ; -. 1 c S rv Lie.: :59,e )-t V Industrial plant per hour 78.18
Supra. Electrician si�tatu[e, required: � �� . .: : ELECTRICAL IPER� IT FEES • . • -: • - -
f�/ • ,.., , j e� /-�'� Subtotal: --% ‘. pa
Print name: i /' i� C ��
+ Plan review (25% of permit fee)
l��t � \ { x 1 k f r� E� Darts „ `��� State surcharge (12% of permit fee): %.SD
Authorized signature: -� ' 1/4‘, , j ' r --- : 1Q1 TOTAL PERMIT FEE 1 O, , Ski
Print name: J, + i 1,-,•,41.6., k D ate: \ , ptsmpermit ap days al i t has b if a pe een oceo ed no o obtained within ISO
t 1 't� �� `�� cloys ofbr t Jsa b
• Number of inspections allowed per permit.
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