Permit CITY OF TIGARD ELECTRICAL PERMIT
a : COMMUNITY DEVELOPMENT Permit #: ELC2013 -00362
T j GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/01!2013
Parcel: 1S134BD05700
Jurisdiction: Tigard
Site address: 11530 SW GLENWOOD CT
Project: Coward Subdivision: ENGLEWOOD NO.2 Lot: 145
Project Description: 200 amp service
Contractor: PDX ELECTRIC LLC Owner: COWARD, GEORGIA AYERS & MICHAEL
7933 WHITFURROWS CT 11530 SW GLENWOOD CT
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/01/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 07/01/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: R -3
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 copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: M ,AV1 Permittee Signature: OA/ /} pr 1 YGATa C/A)
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.
6/26/2013 8:48 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 2 of 3
Electrical Permit Aaulicatiorl� F(�Irc)Frkt f I sI: O;NI.Y
City of Tigard ���, Per
it
13125 " No . LC ur3 - Uo 3G
13125 SW •
Hall Blvd., OR 97223 I y Platt Review
6 . Phone: 503.7182439 Fax: 503.598.1960 UN 2 7 2013 natem . Odter Permit.
T IG •v R u Inspection Line: 503.639.4175 Date Ready /By: tuns. 63 See Page 2 for
Internet: www.tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental Information
- -.__ —. TYPE 01 I PLAN REVIEW
Please check all than apply (submit ?sets at' plans vv.'items checked below)
❑ New construction ❑ .Addition/alteration/replacement
❑ Service or feeder 400 amps or more ❑ Budding over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings_
less to ground, or exceeds 14.000 ❑ Commercial-use agricultural
❑ 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 150 KVA or
❑ Emergency system. larger separately derived system,
JOB SITE INFORMATION AND LOCATION
0 of new motor load of
l ❑ "1° "E" "I 2 "I m"
Job no.: _ 1 Job site address: 11'5 3 51,-,.) 0 t,� ) 'j Lvi c( �jt- 100 re s. R c
❑ Six or more residential units. ❑ Recreational ' parks.
CityiStalc /ZI P: — 7) a e1,, _ /c*-./ g'7',2-3 ❑ Health -care facilities
0 Supply voltage for more Man
tl - -- I ....__ ❑ I la'iardous locations. 600 volts nominal.
Suite /bldg./apt. no.: : Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to job site:
Description - I Qty. I Fee. 1 Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sy. It or less 168 54 4
- -- Fa.-add'I - 500 sq. ft or portion - 33 -92 - I
Tax map /parcel no.: l.imited residential
DESCRIPTION OF WORK (with above sq ft) 75.01 2
Limited energy, multi- family
75.00 2
residential (with above sq. N.)
Renewable Energy ❑ See Page 2
Services or feeders installation, alteration, and /or relocation
❑ PROPERTY OWNER I ❑ TENANT 200 amps or less / 100.70 / O(J, ' j 2
M �2 f co { 201 amps to 400 amps 133 56 2
Name:
t't-' 4l (L (0{ 401 amps to 600 amps 200.34 2
Addi ess: tJ 601 ampstu I,000amps 301,04 2
Over 1,000 amps or volts 552.26 2
City /State /ZIP: Temporary services or feeders installation, alteration, and /or
Phone: ( ) Fax: ( ) relocation
200 amps or less 59.36 I
Owner installati 'Phis installation is being made on property that 1 own which is not 201 amps to 400 amps 1 25.08 2
intended for sale. lease, rent. or exchange. according to ORS 447, 449, 670, and 701.
401 amps to 599 amps 168 54
-
Owner Signature. ... Date: Branch circuits- new, alteration, or extension, per panel
® APPLICANT ❑ CONTACT PERSON A. Fee tot branch circuits with y
above service or feeder fcc.
7.42
Business name: PDX Electric each branch circuit
B. Fcc for branch circuits wwuhout
Contact name: Marty Palmer service or feeder fee first 56.18 2
branch circuit
Address: 7933 SW Whitfurrows Ct Each add'l branch circuit 7.42 2
City/State/ZIP Durham /OR/97224 - Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
Phone: (503) 639 -9708 Fax:: (503) 200 -1362 dwelling, service and/or feeder -
-- Reconnect only 67.84 2
E - mail: info@pdxelectric.com
Pump or irrigation circle 67 84 2
CONTRACTOR Sign or outline lighting 67.84 I 2
Business name: PDX Electric Signal circuit(s) or limited- energy See
panel, alteration, ur extension I Page 2 2_
Address: 7933 SW Whitfurrows Ct Each additional inspection over allowable in any of the above
_...- ..._....___._.___- Additional inspection hr min) 66.25/ Iir
City/State /ZIP: Durham /OR/97224
Investigation (I hr min (i6 251 hr
Phone: (503) 639 - 9708 Fax: (503) 200 -1362 Industrial plant (1 hr min) 78.18 / hr
Inspections for which no Fee is
CCB Lie.: 192731 Electrical L, c.: C696 Suprv. Lie..: 5612S specifically listed C.4. 90,001 In
hr min) _ i —
ELECTRICAL PERMIT FEES
Suprv. Electrician signature requir
���� J)ft, Subtotal: /Oi9. 70
Print name: Marty Palmer Date: 6 4,-13 Plan review (25% of permit fee):
State surcharge (12% of permit fee): /; - !9
Authorized signature: TOTAL PERMIT FEE: / / a 7 K
This permit application expires if a permit is not ',Wined within 180
Print name: Date:
days after it has been accepted as complete.
. ' Number of inspections allowed per permit.
I:\Duilding PermitApp EI.R ERE doe Rev l5/7I /71)I3 440- 4615T(I I /05 /COM/WFR
6/26/2013 8:48 PM From: PDX Electric LLC / 503 - 200 -1362 To: 15035981960 1 of 3
PDX ELECTRIC
7933 SW Whitfurrows Ct
Portland, OR 97224
(503) 639 -9708
(503) 200 -1362
www.pdxelectric.com
info@pdxelectric.com
To: City of Tigard From: Marty Palmer
Fax: (503) 598 -1960 Date: 6/26/2013 8:36 PM
Phone: Re: Electrical permit application
Comments
I have attached an electrical permit application and credit authorization form
Thank you
facsimile