Permit n CITY OF TIGARD ELECTRICAL PERMIT
N. �. COMMUNITY DEVELOPMENT Permit #: ELC2013 -00337
Date Issued: 06/18/2013
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2S110DD04600
Jurisdiction: Tigard
Site address: 15635 SW OLD ORCHARD PL
Project: Cook Subdivision: SUMMERFIELD NO.3 Lot: 148
Project Description: (5) branch circuits for lighting upgrade and A/C outlet.
Contractor: GARNER ELECTRIC Owner: COOK, MIKE
2920 SE BROOKWOOD AVE A 15635 SW OLD ORCHARD PL
HILLSBORO, OR 97123 TIGARD, OR 97224
PHONE:
PHONE: 503 - 648 -4552
FAX: 503 - 642 -7925
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 06/18/2013 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/18/2013 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $96.16
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 9 -• % -009 You ay obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. /J
Issued By: ' 7 9' / • Permittee Signature: � /L /e€7770 "
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 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 Application RECEIVED ED i'roR OFFICE USI (ONLY ... ,,
City of Tigard Received 41;, A
JUN 18 Z 013 rant',: c` /'�7 ' 'ruts a. 033 7
13125 SW 1 Blvd,, Tigard, OR 97223 Plan Review
C' . Phone: 503,718.2439 Fax: 503.598,1 %0 other nth:
CITYOFTIGARD Dat Re
LGr \Rf� Inspection 1
Internet: Date ttendylF3y; into: P EA c
�' Ik e: S .4175
;i ',:' "c'p` ylttlpl (A,.:iiinpp,y',IA "J:t 'i:llg or. ''' outicd/Methnd, r mcntall
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: , , � IL �g 9u Ic tine
,', , 1°i��1r.�1 � 111i41 ii� )l_ r1!'r,, a { r 7 4 a1 't o_ ,' 1,. :�, -
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I New construction Addition /alteration /replacement Please cheek all that apply (submit 6 seta of plans w/,lerns checked hclow):
❑ Demolition ❑ Service or feeder 400 amps Or • rc ❑ Building over three smrtcs.
[] Other:
(lijt1i , : )tN �l i 1 (JI r t 1 (({ t'ji Il' it`` { "y` �'+ fs '���r j; ' �' C•} }",, +' „ ".a , °i r where the available fault semen ' ID Marinas and boatyards
d1•, s 1\, i f 1, ']I n w ',i,. ..Y„ '�l 'r `� :i' , i'• " =r „ i ;, , '' exceeds 10.000 amps et 150 vn or ❑ Floating huildintm,
i . +,,e.r,", +,• I i „ • c.k.,n I'„ 1 "'rin , •I' t , 1- ;;i:ii �,14:4.,rtai!ir;:,�,,1 Ices to rouud.or 14,0
El 1- and 2- family dwelling [] Commercial /industrial ❑ Accessory building amps g ❑ COmmcrcinl -tsc nyricuhur.,1
mps for all other inetnllatiore, C buildings.
El ❑ Master builder ❑ Other: El Fire pump C Installation or 75 I(VA or
r wt i� .,o . n � tt
i " F �ilti;ll '!I 1 , 'Sy'i 1 -, 41 ti `�'( ! 1 �: tt y h uW ;If ?`' 1Iss1 °1V 4 �6 rn,.I• L ❑ EmerryencYS tcm lnr rsc aratel derived <
1 s1r , t 4 Ali :tr., i .11 . ai 't til 4sti,tallM .,,,11 :3V, 0, V , ' 3" l a i!I ., 47' • �IL(C+. , .. , rot, x1'6 1' system. Kc P Y sv. ICm.
, - � � � i 'I • li'flA i' 1' , ❑Addition ofncw motor load of ❑ "A "."E ", "I -2” "I.3 ",
Job no.: Job site address: /5(. 5w U id Or ha r"'( 100HP or more, oecnpnney,
❑ Six or more residential units. ❑ Recreational vehicle perk,.
City / State/ZIP: Tigard, OR ❑ Health -care fhcillties. ❑ Supply voltage fbr more than
Co � 1;:i Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: 0 k . � ❑ Service or feeder 600 amps or
r,.: 'r:: • -.. , PtC, :Ik Fi 'DL'itlE
Cross street /directions to, job site: or>cdnttnn a I .l Fee. Toni! •
New residential single-or mu -family dwelling unit.
lncludca attached garage.
Subdivision: Lot no.: 1,000 sq, ft, or loss il 168.54 4
Ea. add'I 500 sq, ft. or portion II 33.92 1
Tax map /parcel no.:
_._
energy, multi• family 75.00 2
i
; :, : , r; ,. ,;: , , L mited energy, rcaidcnti¢I 2
: !1r;jrr:ll,I� , : `.',r1i∎ ' LW;, : F;r , i ., i , . q , , ,� , ;1r:.z: r� r ,
ac %P ! ,limp'• 1 I. l t t;i 1 , ` + Ih- i `l l! L . '.y•- ,
' I I' ! ,5 i
1!!,d' „ I 1.••. t
;, i' I , , ;
V ; ' 'I�i; � t (with above sq. tl.) I 75.D0 ... .......
� D ,o / Limited
11 c-c rrI C'CLE— I 416-61-7--/A/6". a- - tri7 /Q resi (we sq,
Services n feeders ith abov installntl o alteration, and /or relocation
d li T '- u w7 yy a.y • 200 amps or less 100,70 2
t�
'r t 'Irl,
l i��lE'u+tt� R', GIL�IY�' 11,L'I W P r` r , i ;,', r � ' 0 ' i' r � ` ! 1 L1J1 ' ": til4l4,.2f1ir : r ' r " r; ii,' 201 amps to 400 amps
(.I'1.,, r. „i ,' f, .,.l.a,n ,( { ''';, i'•i b , '„ .,” 15: 133.56 2 t 401 amps to 600 amps I 200.34
Names L 1< M f/ .r
601 amps to 1,000 amps I 301.04 2
Address: . 5,49—/t/6" 9 —,'96" Over 1,000 amps or volts 5 2
Temporary, .services or feede • nstallation, alteration, and /or
City /State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or can 59.36 I
201 amps to 400 turps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, (case, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits— new_alterat ,n nr extension, per panel
Owner signature: Date: A. Fee for branch circuits with
iAl ul rt� , r r'�;' + , nr,, ('� a� r ;, �;ur ' +' "' r ' , 1 Iry 1 ., above IICrVi00 or feeder fcc,
jiiM } t U i) I 1 !}� {yji rj it "1 ! "��j ltr i I,.,,, r r j it I �P VI l +fly i 1 R " IIA t 7.42 2
i14 TiR al�il ;t„'ll'AC`yB"') NVi) l'• l:.I{� a1�'ri?I f t1 ` t'filli$ al•„i� lith ER 'i -� „ - lea:: each branch circuit
Business name: Garner Electric
B. Fee for branch circuits wtrhad Y_ .
service or feeder foe, first SG 18 � ? ., V•115
2
Contact name: branch circuit
Each add' i branch circuit l_4 7,42 Z ?, (p $ 2
Address: Miscellaneous (service or fee ;' not included)
Each manufhcturcd or modular 67.84 1 '
City /State /ZIP: dwelling, service and/or feeder II -_
V
Phone: ( ) Fax:: ( ) Reconnect only I 67,84 2
Pump or irrigation circle 67.84 2
s �, i,, i ii. r r,, C , ,r..h ,', ' trgr., `,: .',t ;,' ,.. u .., r, Signal circuit(s) cluit(s)torl -cncr r' G7,R4
E-mail:
1 11 I I. • .,, - f.' t •
U, - , n6 Itl 1 „,,tl 1 1, 1 � {,. 1 1I, ,.I+ , I r 4!r ,., +.••r, .
Business name: Garner Electric panel, alteration, or extension. i Page 2 FT
Each additional inspection ov allowable in any of the above
Address: 2920 SE Brookwood Ave. #A Additional inspection (I hr min) l 66.25/ hr
City /State /ZIP: Hillsboro, OR 97123 Investigation (I hr min) 66.25/ hr
,
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 648 - 4552 Fax' - t 42 -7925 inspections for which no fcc is f 90.00 / hr
specifically listed c hr min t� __
CCI3 Lic.: 121159 Electrical Lie,: 3 05 , e p r; , '3707S ; ' x ' ?= 'i:; l tw I'p1R F _ LGS
Suprv. Electrician signature, required: I rprV ,r �,, Subtotal: 5 (c ,
4, d _•f Plan review (25” 1)f permit fee):
Print name: Chuck Gamer Date: W / D i 3 State surcharge (12 • f permit fee); ,_a, 30
TOTA N ERMITFEE: 9 (j�
Authorized Signature: This permit application expires I i I permit it not nbh,lncr1 within (H0
• days niter it has hee . • ceepteti us cnmplelC•
Print name: Date: • Number of inspections allowed • I permit.
I: Inuitding \Pcrmiu \ELC•PermitApp,doe 07/01 /t 440.46151(1I/05/COM /WEB
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