Permit CITY OF TIGARD ELECTRICAL PERMIT
s • COMMUNITY DEVELOPMENT Permit#: ELC2013-00046
Date Issued: 01/22/2013
IL G A R D 13125 SW Hall Blvd,Tigard OR 97223 503 718 2439 Parcel: 1 S 134CD01900
Jurisdiction: Tigard
Site address: 12050 SW 118TH AVE
Project: Douglas Subdivision: LERON HEIGHTS NO 3 Lot: 45
Project Description: Reconnect only
Contractor: ABC ELECTRIC Owner: DOUGLASS,ARLENE RAE
135 NE 9TH AVE 12050 SW 118TH AVE
PORTLAND,OR 97232 TIGARD, OR 97223
PHONE 503-233-7551 PHONE:
FAX' 503-233-7552
FEES
Quantity Description Date Amount
1 ea Reconnect Only 01/22/2013 $67 84
Specifics:
1 ea 12%State Surcharge- 01/22/2013 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75 98
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 OA",•.2-001-0'•0. You ma obtain a copy of the rules or direct questions to OUNC by calling 503 232
�[&32 1987 or 1 800 3l322223344
Issued By: ��i ' // lam'" Permittee Signature: 9A 4t� I 0 S
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 603.639.4175 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.
1/18/2013 1:31 PM FROM: ABC Electric ABC Electric TO: 503-598-1960 PAGE: 003 OF 003
1
Electrical Permit Applicati R ECEIVED FOR 0F'h'lCF'USE ONLY
City of'Tigard 2 tta�a, 1a Prrmu
" 13 i25 SW Hall Blvd-,Tigard,OR 9722 A N 2 2 2013 DA1e�ajm 13 S '�(3-e) i
Plan
Mu a Phone 503.718.2439 Fart: 503.598.1960 Other Penult: •
inspection Line SQ3.b39:41 T5 CITY CITY OF TIGARD `+
Tt GARiJ "me Ready/By: r"^S:t / i i�flee Page 2 for
1Mtxnot.:WWW diplid if:gor . NotitkdANetbrd: l ((,
• a.i. I. dl - -- Supplemental
Ifib#
❑New eonstrucliDrt ' l A(iditfonfalZEHItionittpplac Pleau check all that apply(submit 2 ads of plans whtams checked below).
r:Llcm01 itlOn UQter . Q Service or feeder 400 amps or mote- Q Building over three stories.
. .__
:1 ' ' .`• exceeds 10,000 amps al 150tvolts or 0 Floating MoW�gs.urds.
where
e
less to Brood,or exceeds 14.000 °Ctmtmercial-use agricultural
`0 1-and 2-fatally dwelling !I Commercial/industrial Q Accessory building amps for all other instailations. buildings.
Q Multi-family Q Master builder CI Other: I°yke putap. Q Installation of 73 KVA or
rtinergency system large,separately derived system,•
- . _. . ddition of new motor load of 1:1"A' "E",1-2",
� QA •{.3•
Jot no.:�'�t ai�fl�.r! Job site address: 'r: B ,.\ t00(iP or mere occupancy.0 II []six at more residential units, 0 Recreational vehicle parks.
City/$tetaliP: Q Health-rare facilities. ❑Supply voltage for more than
Q Hazardous locations 600 volts nominal.
Suite/bldg./apt.no.: I Project name: / t/ /6.0..„/ 0 Service of fide 600 amps or more.
Cross:street/directions to Job site: ,, taw
MI Ism ElliM11111 XI:
' -' New reatdentiatslegle-or multi-family dwelling uit.
• .: : Includes ettt eked+re e,
Subdivision
l lean ..
tart:map/pltroel:no.. . ga- : Stec g.ft 4r mat .: 33 92
Limited energy,residential 75.00
with above . fi.)
J Limited energy,mufti-family 75,00
s 41{. db 111i• r r '
Mill residential with above ft) ■
Services orf rdera installation,alteration,and/or relocation
260.atape er less p 100.70 --
,>,, :'.1 . 201 amps to 400 amps 133.56
V
Name: i r 40I coin to 600 antis, 200.31
__�
'___. , Gel amps to 1,000 amps ® 301.34
Address. / - \ v over I amp'.ur rolls
f ( J �0 / l y �.� p 552 26 2
Temporary services or feedersioafallation,alteration,and/or f CitylStaterLFP: t' i�a i 1.1. !■ )
relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
° M'installation This installation ie:Wig made on property that I own which is not
401 maps to 509 amps
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. _ _ 168.54 2
Branch circuits-new.alteration,or extension,r r.ane1
OWilcr
$ ri.__.......... Date: __ A.Pee riot branch circuits waft i
f e N'''-'55:1.Z6,. above service or feeder fee.err 1 ls1c e, st in; �:a' 4_;;: � 7.42 2• =+r each branch circuit
Business name:: A•t E3.Pc,for branch circuits without
II
service or feeder fee.first
Contact name: 4 y branch circuit 56.1$
. ' `)�
Each add'I brunch circuit 7.42 2
Address: j r Miscellaneous service or feeder not included
City/StateiP: f Each manufactured or modular __
�1 q._._ 3� dwelling,service and/or fecder E7.84 II
Phone: J[� Reconnect only, Fax: J } M 67.84 J3'/
—- Pump or irrigation midi': 67.84
r mail: - - _____
!� id '�� fk F h t f Sign or outline lighting 67.84
.
tit'r I" . Signal en-minis)or limited-t:nergv
Business barite: f ^ �+ _,Eane i iteration,ar extension Pa. 2 II
• [ Each additional ins reetlon over allowable in an'of the above
J
Address: ti r//47 t e 4- Additional inspection(t hr min) 66 251 hr
`.W/1 ,' ,/) , r/jnY 0. � -` Investigation(t hr mm) 6625/hr
City/State/ZIP: i� i( V ■
Industrial plant(1 hr min) 78 l8/In
' l_ Fax: ) Ins ctitx s for which no fee is .
�ryy"" ��]� /,, s citicall listed 7/lirmin) 90,001 hr
Electrical L.ic'oe((J/ d Suprv,Lie,: -� ./0S a L °i.ik, r�s=:ii' F.:^,• a;':�x?,). ��:;rF..':•v:.
Su pm.Electrician signature,required: c Subtotal: 1'7 L
" '�-� Plan review(25%of permit fee):
Print name: t Date: 7i7; State surcharge(l2%e of permit fee): iu
TOTAL PERMIT FEE: r-=' t
Authorized signature: ino-'illirs phis permit appticanna expires if a permit is not obtained-Within 18 I
Print na w ate: !�� t� t, days after It bas been accepted as complete.
1/ • Number of inspections allowed per ptamii.
I:'+$uildiny'd'ermite.ELC-YermttAppdoe 0710.t:10 440.45151t1Itu fCOM/WPB
1/18/2013 1:31 PM FROM: ABC Electric ABC Electric TO: 503-598-1960 PAGE: 001 OF 003
ABC Electric
135 NE 9th Ave
Portland, OR, 97232-2912
c o n f i d e n t i a l
To: City of Tigard
Fax Number: 503-598-1960
From: Anne Braden
Fax Number: (503)233-7552
Business Phone: (503)233-7551
Home Phone:
Pages: 3
Date/77me: 1/18/2013 1 31 17 PM
Subject: