Permit CITY OF TIGARD ELECTRICAL PERMIT
III4
• COMMUNITY DEVELOPMENT Permit #: ELC2013 00211
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/09/2013
Parcel: 1 S 135 DB 12400
Jurisdiction: Tigard
Site address: 9293 SW NORTH DAKOTA ST
Project: Freeman Subdivision: 1995 -084 PARTITION PLAT Lot: 1
Project Description: (3) branch circuits for receptacles over work bench and to correct hot tub wiring.
Contractor: ERTELL ELECTRIC LLC Owner: FREEMAN, JEFFREY M & KATHLEEN E
PO BOX 279 9293 SW NORTH DAKOTA ST
FOREST GROVE, OR 97116 TIGARD, OR 97223
PHONE: 503 - 841 -4511 PHONE:
FAX: 503 - 359 -5652
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 04/09/2013 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/09/2013 $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 -0 through OlR 2 -0 -00 0. You may obtain a copy of the rules or direct questions to OUNC by calling 0.. .1987 or 1.800.332.2344.
lssu By: Permittee Signa
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 INSTA CATION ONLY
SIGNATURE OF SUPR. ELEC' ��� � AO
SIGNATURE . 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.
Apr 0513 10:35a Ertell Electric, LLC EDIED 5033595652 p.1
Electrical Permit Applic i8il" FOR OFFICE tl'E ONLY
City of Tigard P p S 2013 D� �a �/ Permit No
. :
M � -i t /
13125 SW Hall Blvd., Tigard, OR 722
' TIG ^ Plan Review
_ ' Phone: 503.718.2439 Fax: 503 pU(1J DataBy: Odra Permit:
1 i t „ P 1t Inspection Line: 503.639.4175 (IVIS`1W Date Ready/By: kris la See Page 2 Par
Internet: www.tigard- or.gov BUILDINGD Notified/Method: Seppiementallnforntadon
TYPE OF wow ) N xr
❑ New construction El Addition /alteration /replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories,
❑ Dernolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 1 SO volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Comtnercial -use agricultural
g 1- and 2- family dwelling ❑ Commercialtindustrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 7s KVA or
- - - ❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ ".A ", "E" "1.2 ", "1 - ",
Job no.: Job site address: 1 ` 100HP or st oewpancy.
�111�. 1\YD�ri 5�E : ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: l /yy ❑ Health - care facilities. El Supply voha for more than
T ► I ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: AA� , - 5 ,. � �, �1 l: Service or feeder 600 amps or more.
l • • FEES HED[TLE .
� 2 Cross street/directions to job site: e_t /-s/4. o,, ion I Qty. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 16854 4
Ea. add't 500 sq. ft. or portion 33.92 l
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
•
Limited energy, multi- family 75.00 2
A I I ` eC . I es ev L - b _ t _ residential (with above sq. fl.) -
ftC 1 Y 1CJf l Services or feeders installation, alteration, and/or relocation
(lt*tecA l0-4- - ) b WI 0 rig 200 amps or less _ 100.70 ' 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 1 133.56 2
401 amps to 600 amps 200.34 2
Name' 601 amps to 1,000 amps 301.04 2
Address: Over 1900 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( )
200 amps or less 59.36 1
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 I ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each brands circuit
Business name: 13. Fee for branch circuits without
service or feeder fee, first t , 56.18 S(0.16 2
Contact name: branch circuit —
Each add'I branch circuit 2- I 7.42 tar ear 2
Address: Miscellaneous (service or feeder rot included)
Each manufactured or modular 67.84 2
City /State/Z1P: dwelling, service and/or feeder
Phone: ( ) I 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
panel. alteration, or extension. Page 2
Business naam �� 1 c� C. P �L , Each additional inspection over allowable in any of the above
y�
Address: p �� f X 272 q Adcitional inspect on(1hrmin) 66.25/
y Investigation (1 hr min) 66.25/ hr
City/State /ZIP: &Y-e c f (S rtkie O( q'? ( I b Industrial plant (I hr minj I 78.18/hr
Phone: ) Fax: ( ) Inspections for which no fee is 90 00/ hr
[ �3 4 '� 051_ `1� specificallylisted(hhrmin)
CCB Lie.: 1S 0 Electrical Lie.: i i S S. Lie.: 542. 5 . EI',1EC'I'iltl( AIG IIt P E T:) ;>6S :::;
Subtotal: 7 l , 02
Suprv. Electrician signature, required: ( b Plan review (25% of permit fee):
Print name: �/ / �`' . / / Date: E( /S /gd�3 State surcharge (12 %ofpermitfee): �j,
/ fit/ TOTAL PERMIT FEE: -
Authorized signature: — This permit application expires if a permit is not obtained within 180
I � days after it has been accepted as complete.
Print name: �CIiS -4-yri - Date: 4 /512013 • Number of inspections allowed per permit
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