Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 00103
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/14/2013
Parcel: 2S104DA02000
Jurisdiction: Tigard
Site address: 13400 SW 128TH PL
Project: Voegtlin Subdivision: QUAIL HOLLOW - WEST Lot: 6
Project Description: (1) branch circuit to connect fog free mirror in bathroom
Contractor: ERTELL ELECTRIC LLC Owner: VOEGTLIN, DAVID
PO BOX 279 13400 SW 128TH PL
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 -841 -4511 PHONE: 503 - 332 -1901
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/14/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/14/2013 $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 OAR 95 - 01 -0090 You may btain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: � Permittee Signature: 1 ,U ►l PPu 0641 2Uad
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 ApplicaRL
FOR OFFICE LSE ONLY
City of Tigard F 3 1.3 2013 Received
13125 SW Hal] Blvd, Tigard, OR 4 3 22
Dare/By: a- ) / y 1 3 $ r
11 1 1 4
Plan Review Pettit No. :PLC 3 oo l D3
o Phone: $03.7182439 Fax: 503
Ins coon Line: 503.639.4175 C F TIGARD Date/Bv. Other Permit: /(,(��i 3 _boo 35
7 7 G A R D Date Ready /By: S
6G See Page 2 for
Internet: www.tigard-or.gov BUILDING DIVISION Notified/Meth Supplemental Information
TYPE OF WORK PLAN RENTER'
❑ New construction ® Additionlalteratiort /replacement Please check all that apply (submit 2 sets of plans w/items cheered below):
❑ Demolition ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Other: where the available fault current 0 Marinas and boatyards. •
CATEGORY .0F. exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
®I- and 2-family dwelling less to ground, or exceeds 14,00C ❑ Commercial -use agricultural
Y wellin g ❑ Commercial/industriai ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder p p.
Other: 0 Fire um ❑ Installation of 75 KVA or
•
JOB SITE INFORMATION AND LOCATION . JOB system. hager separately derived sys cni.
❑Addition of new motor load of ❑ "A^ "E ", °1 - " I
Job no.: Job site address: 13400 SW 128 Place IODIIIs mom. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard OR 97223 ❑ Health-care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: ❑ Service or (ceder 600 amps or more.
Cross streetidirections to job site: ; PEE SCHEDULE
Description I Qty. I Fee. I Total 1 •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: :,000 sq. ft. or less 168.54 I 4
Tax map /parcel no.: Ea. add'/ 500 sq, ft or portion 33.92 • I
Limited energy, residential
DESCRIPTION OF WORK : • - (with above sq. ft.) 75.00 2
Limited energy, multi- family
75.00 2
residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
Connect fog free mirror in ball] 200 amps or less 100.70 2
❑ PROPERTY OWNER I - ❑ TENANT . 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 I 552.26 2
City / State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 am - 125.08 2
• intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 40) amps to 599 amps 168.5 2
Owner signature: Date: Branch circuits— new, alteration, or extension, per panel
A. Fee For branch circuits with 1 l
❑ APPLICANT • I • . .. O CONTACT' PERSON chebrancice o feeder fee. 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee. first 1 56 18 56.18 2
Contact name: branch circuit
Address: Each add'/ branch circuit 7.42 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
dwelling service e
or feer
Phone: ( ) j Fax: : ( ) Reconnect only 67.84 2
E I Pump or irrigation circle 67.84 2
•
f Sign or outline lighting 67.84 2
CONTRACTOR. Signal circuit(s) or limited- energy
Business name: Ertells Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: PO Box 279 Additional inspection (I hr min) r 66.25/ hr
City/State/ZIP: Cornelius Or 97113 Investigation (1 hr min) 66.25 / hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 841 8507 I Fax: (503) 359 5652 Inspections for which no fee is
specifically listed CA hr min) �/ hr
CCB Lic.: 180540 Electrical Lie.: c390 Suprv. Lic.: 5420S ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: Subtotal: 56.18
Plan review (25% of permit fee):
Print name: Dylan Wentworth ! Date: 2/13/13 State surcharge (12% of permit fee): 6.75
Authorized signature) TOTAL PERMIT FEE: 62.93
` 1 )A,L This permit application expires if a permit is not obtained within IRO
Print name: Date: days after it has been accepted as complete. 7
N:nnber of inspections allowed per permit. cpa R
r.. Buildvu ,•-mPennits'AI- C- PcrmfApp cos 07/01 /I0 440.4615T(l1105 /COM/WEB
l'd Z99969££09 011 ' 11 dZO: LO £ l £ l qe3
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13400 SW 128TH PL, TIGARD, OR, 97223
Residential - Electrical
120 Electrical rough-in
02/19/2013
ELC2013-00103
FAIL
No one home 9:00 am
Please leave detailed message for access when recalling inspection
Violation Summary:
Inspector Contractor
Location:
Record Type:
Inspection Type:
Comments:
Inspection Date:
Record ID:
Result:
City of Tigard
13125 SW Hal Blvd.
Tigard, OR 97223 Tel: 503.718.2439
13400 SW 128TH PL, TIGARD, OR, 97223
Residential - Electrical
120 Electrical rough-in
02/19/2013
ELC2013-00103
FAIL
No one home 9:00 am
Please leave detailed message for access when recalling inspection
Violation Summary:
Inspector Contractor