Permit ;' CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00117
,TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S103DB06400
Jurisdiction: Tigard
Site address: 11340 SW AMBIANCE PL
Project: Leslie Subdivision: GENESIS NO.2 Lot:. 22
Project Description: Install grounding due to replacement of water service.
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: LESLIE, THOMAS A & MARY L REV LI
PO BOX 3948 11340 SW AMBIANCE PL
WILSONVILLE, OR 97070 TIGARD, OR 97223
•
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
. FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/20/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/20/2013 $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 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 50 . 987 or 1.800.332.2344.
Issued By: Permittee Signature:
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: , 4S
LICENSE NO. 570 7
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 Application RECEIVED -
rolt orrice USE ONLY
111 q City of Tigard Receive Q
13125 SW Hall Blvd., Tigard, OR 97223 FEB 19 2013 Das ceive of i9 4d Permit No.: 1 d /3 /�
503.639.4171 lax 503.598 19 Plan Review
Phone: 503.63 r r
TI G A R D'
Inspection Line: 503.639.4175 � ?Ty OF �GA� Date Date/By: Other Permit:
Internet www_tigard- or.gov ificd( y/gy: Jude
B UILDIN lYatiGcd/Methad: I Sec Page 2 fr a
Sapplcrncnral Information
- motor TYPE OF WORK
❑ New construction ' Addit ionJalteration/1eplacement PLAN REVIEW
Please check all that apply (submit a sets of plans tvlitenns checked below):
❑ Demolition 0 Other Service or feeder 400 amps or more ❑ I;uildiltg over three stories. OF CONSTRUCTION `"b the available fault current ❑ Marinas and boatyards.
exceeds 10.000 amps at 150 volts or ❑ Floating buildings.
I- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building ass to ground, or exceeds 14,000 ❑ Comrilercial-cat agricultural •
i
❑ Multi - family 0 Master builder a for all other insWOations buildings.
Other: ❑ Fire pump. El Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION o Emergency system. larger Selgmtelyderived system.
"A "E "I -2 ", "1 -3 ",
Job no.: [ 13 ❑Addition ofnc�motor load of ❑
J Job site address: 1 A + 001IP more
occupancy.
u�
QS or more ar residcatial units. ❑ Recreational vehicle packs
City/State/ZIP
['Health facilities. ❑ Supply voltage for mare than
SuitelbldgJapt no.: Project name: ❑ Hazado u locations. 600 volts nominal.
�1 ❑ Service Or feeder 600 amps or more.
Cross street/directions to job ..:ite: FEE SCHEDULE
oc iptien I Qty- I Fm I Taal 1 •
New residential single -or multi- fniniy dwelling unit.
Subdivision: Includes attached garage.
Lot no.: (,000 sq. ft. or less 168.54 t 4
Tax map/parcel no.: Ea. add'I 500 sq. ft. or portion
33.92 1
DESCRIPTION OF WORK Limited tangy, msidrnlial
ss / / (with above sq. R) 67.84 2
A.... It ! l A • , j, JP w'+ ' Limited energy, multi- family 67.84 2
f� f residential (with about sq. IL)
Services or feeders installation, alteration, and/or relocation
iii PROPERTY O W YER 200 amps or less 100.70 2
TENANT 201 am ps to 400 amps 133.56
Name: ikj, y r - 2
� 401 amps to 600 amps 200.34 Address: 601 amps to 1,000 amps 30!.04
1 2
City/State/ZIP: Over 1,000 amps or volts 55226 2
Temporary services or feeders installation, alteration, and/or
Phone: ( ) relocation
Fax: ( ) 200 amps or less
ro
Owner installation: This installation is being made on 59.36 I
intended for stile, le property that I own which is not 201 amps to 400 amp 125 2 i
lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
Owner signature: 116825..s%8
�• 08 2
Date: Branch circuits new, alteration, or extension, . Cr panel
-
❑ APPLICANT A_ Fee for branch circuits with
Q CONTACT PERSON above service or feeder fee,
Business name: each branch circuit
7A2 2
Contact name: B. Fee for branch circuits
without service or feeder fee, l )
Address: first branch circuit 56.18 51:71. ` h 2
Each add'l branch circuit 7.42 EN
City/Slate/ZIP: Miscellaneous (service or feeder not included)
Each manufactured or modular
•
Phone: ( ) dwelling, service and/or feeder 67.84 2
E Reconnect only 67.84 2
CONTRACTOR p or irrigation circle 67.84 M•111111
Business nom: j�} (J, - Sign mainline lighting 67.84
--- - I- 1 l0 �_ L L (}� ( - I Signal circtrit(s) or limited
Address '. , energy panel, alteration, or I. • extension. Describe: I ! 2
city/State/ZIP: t,,,,Yr it 0folrCfi2r
4 - 7 o7 0 Each additional ins cton over allowable in an of the above
Phone: ( () 5,3 0�- Z(pC0 r3�q Per inspection
J D , 1 I Fax: (5� ,) 66.25 _a
investigation per hoar (I Inc min) 11.111 6625
• j Ott Weal Lic.: —(00(L Suprv. Lie.: 51 a S Industrial plant per hour =MED
Suprv. Electrician signature, rehired: ��
Print name: (t �v ` ( _ `ive
Date: 1•0110 �i Plan review (25% of permit fee):
Authorized signature: State surcharge (12% of permit fce): �j�,
Print name:
-16_( 5 TOTAL PERMIT FEE: t� ra
Date: This permit application expire if a perm itis not obtained within I811 (t
t:.a.uldb days after it has been accepted as cumpiMe
-
Rmi�s1GJ.C•permilApp,doc 111/01/09 ' Number of inspections allowed per permit.
44O4615T(1 frosicommice
Z'd 61£1993£09 ou}oa12 }pain ad 4 8060 El. LL 9ed
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
11340 SW AMBIANCE PL, TIGARD, OR, 97223
Residential - Electrical
199 Electrical final
02/26/2013 00:00
ELC2013-00117
PASS - No C of O
Violation Summary:
Inspector Contractor