Permit CITY OF TIGARD ELECTRICAL PERMIT
s COMMUNITY DEVELOPMENT Permit#: ELC2013-00049
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013
Parcel: 1 S135CA04300
Jurisdiction: Tigard
Site address: 9715 SW NORTH DAKOTA ST
Project: Hoffman Subdivision: 1991-012 PARTITION PLAT Lot: 1
Project Description: Remodel,(1)service and(4)branch circuits
Contractor: NORTHWEST CUSTOM ELECTRIC Owner: HOFFMAN,TOM
13504 NE 84TH STREET 3825 SW 90TH AVE
VANCOUVER,WA 98682 PORTLAND, OR 97225
PHONE: 360-882-0290
PHONE: 503-292-3357
FAX: 360-883-0694
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 01/22/2013 $100.70
Specifics: amps or less
4 crt Branch Circuits w/Purchase 01/22/2013 $29.68
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 01/22/2013 $15.65
Electrical
Type of Const:
Occupancy Grp:
Total $146.03
Required Items and Reports(Conditions)
This pe - • • •ect to the regulations contained in the Tigard Municipal Code, State of OR Specialty Cod s and al other applicable law. All work will
be •• e in accordance with —proved plans. This permit will expire if work is not started within 180 days of i.=u= t, or if ,ork i suspended for more the 180
da ATTENTION Oregon la r=• - you to follow the rules adopted by the Oregon Utility Notifica • L er. ho - rules : . set forth in OAR•9,2-001-0010 th • gh OAR 952-00 r90. Y. obtain a copy of the rules or direct questions to OUNC by calling 50. it 9.7. •r / .2 •
sued By: , _�/� 4 //•
y: J - .� _/ - Permittee Signature: Ale
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 INS •LLATION 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.
1
Electrical Permit Applie• •t t FOR OFFICE USE ONLY
City of Tigard Received Permit No.: `L� /C
City g DateB A �I ��;3 ��`�/
Fri
13125 SW Hall Blvd.,Tigard,•• ' 3 Plan Review
Phone: 503.718.2439 Fax: 503.598) n 2 2 2013 Date/By: Other Permit: H ee (9,„13-400/3
TIGARD Inspection Line: 503.639.4175 Date Ready/By: 'uric VI See Page 2 for
Internet: www.tigard-or.gov CITY;1 O ARD Notified/Method: Supplemental Information
OF
TYPE tt r.ntVlS O PLAN REVIEW
toot`t Please check all that apply(submit 2 sets of plans w/items checked below):
❑New construction ®Additio a teration/replacement
❑Service or feeder 400 amps or more ❑Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF 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
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A","E","l-2","I-3",
Job no.: )Job site address: c1-715.
/ 7/ W /i prsrrl.. D 9 100HP or more. occupancy.
S• ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: 4' / 4¢4 O� ❑Health-care facilities. ❑Supply voltage for more than
J ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: I Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I *
. New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'I 500 sq.ft.or portion 33.92 v 1
Tax map/parcel no.: Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
Limited energy,multi-family
residential(with above sq.ft.) 75.00 2
-" Services or feeders installation,alteration,and/or relocation
200 amps or less 1 100.70 1C0,70 2 1
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
�-. Poicpyrfil 401 amps to 600 amps 200.34 2
Name: J 0� 601 a mps to 1,000 amps 301.04 2
Address: J Over 1,000 amps or volts 552.26 I 2
Temporary services or feeders installation,alteration,and/or
City/State/ZIP: relocation
Phone:( ) Fax:( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168 54 2
intended for sale. lease.rent.or exchange.according to ORS 447.449.670.and 701.
Branch circuits—new,alteration,or extension,per panel
Owner signature: _ __ Date:_ A Fee for branch circuits with
❑ APPLICANT El CONTACT PERSON above service or feeder fee. 4 7 42. 2/ /
1 each branch circuit V
Business name i 13 Fee for branch circuits vrrhour
smice or feeder fee.first
56 18 I ,r I
Contact name: branch circuit
• Each add-I branch circuit .7 42• 2
Address: Miscellaneous(service or feeder not included)
--. . _
each manufactured or modular • 1
City/State/ZIP: 67'84
dwelling,service and'or feeder
Phone:( ) Fax: :( )
Reconnect only 67 84 2
Pump or irrigation circle 67.84 2
E-mail: .
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s)or limited-energy
Business name:Notrthwest Customs electric panel,alteration,or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 13504 NE 84TH STREET Additional inspection(1 hr min) 66.25/hr
City/State/ZIP:Vancouver Wa 98682 Investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:(360)882-0290 Fax:(360)883-0694 Inspections for which no fee is 90.00/hr ■
�'Ispecifically listed(%]hr min)
41146
Electrical Lic.: 174425 l Electrical Lic.: C336 Suprv.Lic.: 5322s /�� ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ?/ r` Subtotal: (1 4
Plan review(25%of permit fee). ./
PrintnameIDA4e. C.6N Date: 0//3 13 Statesurcharge(12%of permit fee): 1s.(f`�
I (0..."...c.....,
TOTAL PERMIT FEE: /L/4,0
Authorized signature: \ Lw.. .1, This permit application expires if a permit is not obtained within 180
Print name: ����"�VVV Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
I Building'Permits\ELC-PermitApp doc 07/01/10 440-46151(I I O5'COM/WEB
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