Permit CITY OF TIGARD ELECTRICAL PERMIT
o ` COMMUNITY DEVELOPMENT Permit #: ELC2013 -00341
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/2
Parcel: 1 S1 �
3 3DA0 DA01900
Jurisdiction: Tigard
Site address: 11055 SW SUMMER LAKE DR
Project: Woodbury Subdivision: AMART SUMMER LAKE Lot: 41
Project Description: (1) branch circuit for new kitchen lighting and arc fault circuit.
Contractor: ENERGIZED ELECTRIC LLC Owner: . WOODBURY, LOUIS CHARLES
1696 SE 26TH DR WOODBURY, MARILYN KAY BARKER
GRESHAM, OR 97080 11055 SW SUMMER LAKE DR
TIGARD, OR 97223
PHONE: 503 - 781 -3647 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 06/20/2013 $56.18
S — Service or Feeder
1 ea 12% State Surcharge - 06/20/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT •
Type of Const:
Occupancy Grp:
• Total $62.92
Required Items and Reports (Coflditions)
•
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 01- . You m y obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.432.2344.
Issued Permittee Signature: C/� /'/-.
•
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 Dat@;
LICENSE NO.
Call 603.639.4176 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 ApplicatiRECEIvED . • FOR OFFICE USE ONLY
����+ Femrit
City of Tigard q DatcrB C- i 3X0.3
- ° 13125 SW Hall Blvd., Tigard, OR 9727 U N O 2 Received vi Plan Review LCD-
Phone: 503.718.2439 Fax: 503.598.196 2 Date/Bt Other Permit
Inspection Line: 503.639.4175 Date Ready /By. �� E See Paget for
TIGARD CITY OF TIGARD Notified /Method: Supplemental information
Internet: www.tigard- or.gov {��}} �//�� +r p
TYPE OF 44 W�C"G DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
0 New construction Addition /alteration/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 ISO volts or ❑ Floating buildings
loss to ground, or exceeds 14,000 ❑ Commercial -use agricultural
--'- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump. ❑ installation of ISO KVA or
❑ Emergency system. larger separately derived system.
• JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ ".4 ", `B' , "1 -2 "l -3 ",
G e 100HP or more. occupancy.
Job no.: D E5 - 2 _ Jab site address: ��OSS Sw S1. 4,u 1r L ee ❑ Six or more residential units. ❑ Recreational vehicle parks.
17,
" j
El Health-care fa ctious.
Health-care cati o ies.
❑ Hazardous ❑ Supply voltage for more than
City/State/ZIP: ' i � O� (,i �✓ 600 volts nominal.
c
Suite/bldglapt. no.: J 1 Project name: Oa0/L/el _ 0 Service or feeder 600 amps or more.
FEE SCHEDULE �---
Cross street/directions to job site: Deveri goon I Qty. Fee. 1 Tota
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1,000 sq. fl_ or less 168.54 4
Ea. add'l 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft) .
/ " ,{^ /e. 7 /C / Limited energy, multi - family 75.00 2
S A ' .1 /' PCf 53 l 4.ry �4e. A (.lµ residential (with above sq. fr.)
/ /f_ t Renewable Energy ❑ See Page 2
/ ✓l O L ! "r /eot A /- a ,4 /
W c A (1V ci.,4 Services or feeders installation, alteration, and/or relocation
200 amps or le 100.70 2
❑PROPERTY' OWNER ❑ TEN ANT 201 amps to 400 amps 133.56 2
Name: - -
401 amps to 600 amps 200.34 2
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 552.26 2 '
Cih /Statc71P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 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 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, per panel •
❑ APPLICANT ❑ CONTACT PERSON A. Fee for branch circuits with
above service or feeder fee, 7.42 2
Business name: each branch circuit
B. Fee for bautch circuits without
Contact name: service or feeder fee, first
1 56.18 r y 2
branch circuit / co ` ,
Address: Each add'l branch circuit 7.42 2
Miscellaneous (service ur feeder not included)
CitylSlate /ZIP: Each manufactured or modular ' I
67.34 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E - mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
` /Q C LL c Signal l t era tt(s)or ie x t ens - cnergvv See
Business name:
L NP / panel, al or extension. Page 2 12
Address: /(�9 fe c ,26 - g O" Each additional inspection over allowable in any of the above
Additional inspection (1 hr min) 66 25/ hr
City/Slate/21Y: 6 d / t' C f 7 c r 3 C.) Investigation (1 hr min) 6625/ hr
Phone: (51) ) 7 8/ 6 e(7 Fax: ('5b 3 ) 78 S r re ( industrial plant (I hr ruin) 78.1&I hr
J inspections for which no fees 90.00/ hr Lie.: ! f3 / 3 5 7 Electrical Lic.: `7 �� Suprv Li e.: 5 7 & Z " specifically listed (V• hr min)
K CCB ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ------,. Subtotal: 5(o- li)
Date: Plan review (25% of permit fee):
Print name:
7)01.1/// /L! t C L T7 l
� State surcharge 02% of permit fee): C ,7 S /
Authorized signature: TOTAL PERMIT FEE: G 2. 9 2--
, f
Ibis permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
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