Permit CITY OF TIGARD ELECTRICAL PERMIT
I a
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00328
T [ GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2013
Parcel: 2S102CD01101
Jurisdiction: Tigard
Site address: 9580 SW OMARA ST
Project: DURFEE Subdivision: EDGEWOOD Lot: 17
Project Description: Panel installation.
Contractor: L & K ELECTRIC Owner: DURFEE, STANLEY & CYNTHIA
10122 SE SHADY LN 9580 SW O'MARA ST
DAMASCUS, OR 97089. TIGARD, OR 97223
PHONE: 971 - 506 -8351 PHONE:
FAX: 503 - 663 -0343
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/12/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 06/12/2013 $12.08
Type of Use: SF Electrical •
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 co.y of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: Permittee Signature:
i
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.
JUN -12 -2013 10: 30 AM Y1°12' 5036630343 P.
Electrical Permit A 1 2 2313 ,1. t,h11, Hsi-
City of Tigard CITY OFTIGARD Da e/Bed l IFSA
13125 SW Hall Blvd., TigarB V 't DIVISION Plan Review
Phone: 503.718.2439 Fax: 51 . • :. B 966 Date : Other Permit
i i , , k 1 Inspection Line: 503,639.4175 Date Ready/By! El See Page 2 for
i. Internet: www.tigard - or.gov Notifled/Met)ad Supplemental Information
. TYPE OF WORK . ..:;,,: . PLAN REVIEW
❑ New construction (ii Addition/alteration /replacement Please cheek all t apply (Submit' sets of plans w /items checked below);
❑ Service or feeder 400 amps or more ❑ Building over three stories.
1:1 Demolition ❑ Other:
where the available fhult currant La Marinas and boatyards.
CATEGORY OF CONSTRUCTION ' exceeds 10.000 amps at l50 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I- and 2- family dwelling ❑ Commercial/industrlai 0 Accessory building amps for all other installations, buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of ISO KVA or
Am SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition anew motor load of ❑ "A" .. E" "I.2" "I -t"
Job no.: 13 -4495 Job site address: 9580 SW Omara IOOHPormore. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: Tigard 97223 ❑ Health -oars facilities. ❑ Supply voltage foe more than
• / � CI Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: O r 't-f� D Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: ' o>:rerlents 1 oa. 1 re.. 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 1
Tax map /parcel no.: Limited energy, residential 75.00 2
• DESCRIPTION OF WORK =r . <with above sq. R.)
Limited energy, multi- fitmily
75.00 2
Install 200A panel on existing feeder. Upgrade grounding electrode system. residential (with above sq. R.)
Renewable Energy CI See Pape 2
Services or feeders Inatallatlon, alteration, and/or relocation
❑ PROPERTY -OWNER 1 13 TENANT 200 amps or less 1 100.70 1 00.70 2
Name: Stan Durfee 201 amps to 400 amps 133 2
401 amps to 600 amps r 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) 1 Fax: ( ) relocation
200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps r 125.08 2
intended for sale. lease, rent, or exchange, according to ORS 447. 449. 670, and 701. 401 amps to 599 amps 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension,perpanel
. 0 APPLICANT I • 0 CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B. Fee for branch circuits wirhoar
Contact name: • service or feeder foe, first 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
Miscellaneous service or feeder not included)
City/State/ZIP: Each manufactured or modular
67.84 2
Phone: ( ) [F : ( ) dwelling, service and/or feeder
L Reconnect only 67.84 2
E -mail:
Pump or irrigation circle 67.84 2
CONT OR RACT Sign or outline lighting 67.84 2
Business name: L & K Electric, Inc Signal circuits) or limited -energy See
Address: 1 OlZ1 SE Shady Lane panel, alteration, or extension. Page 2 2
Y Each additional inspection over allowable In any of the abov
City/State/ZIP: Damascus, OR 97089 Additional inspection (I hr mm) 66,23/ hr
Investigation (I hr min) 66.25/ hr
Phone: (971) 506 - 8351 l Fax: (503) 663-0343 Industrial plant (I hr min) 78.18/ hr
inspections for which no fee is 90.00 / hr
CCB Lie.: 157326 Electrical Lic.: 26 -1180C 44prv, Lic.: 4975 S specifically listed (' /5 hr min)
Suprv. Electrician signature, required:: :1 ' ELECTRICAL PERMIT FEES ..
Subtotal; I00.70
Print name: Larry Peterson 1 Date: 6/12/2013 Plan review (25 % of permit fee):
State surcharge (12% of permit fee); 12.09 t 0
1
Authorized signature: �, TOTAL PERMIT FEE: �/ b
Print name: Larry Pe arson I Date: 6/12/2013 This permit application expires it a permit is not obtalaedd within 1
days after it has been accepted as complete. .
' Number of inspections allowed per permit.
1 ASuild iityptreil its∎Et.C_PermilApp_ EL.rt_ERE.dos Rev 05/21/1013 440.41115T(IIm5/COM/WEB