Permit RI CITY OF TIGARD Perm E LECT #: ELC201 L 00378 PERMIT
`r'-! g • COMMUNITY DEVELOPMENT it
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/08/2013
Parcel: 2S104AA05300
Jurisdiction: Tigard
Site address: 12245 SW 127TH AVE
Project: Hale Subdivision: BELLWOOD NO.2 Lot: 74
Project Description: Panel change and (1) branch circuit for lighting.
Contractor: WEST SIDE ELECTRIC CO INC Owner: HALE, THOMAS L & TERESA L
1834 SE 8TH AVE 12245 SW 127TH AVE
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 07/08/2013 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 07/08/2013 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 07/08/2013 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
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 Not'' lion Center. Those rules are set forth in OAR
952- 001 -0010 ough • • - 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by ca .. 03.232.1987 or 1.800.332.2344. .
Issued B Ie/ t / `1 Permittee Signatullaki /4 '' /c5
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' �,�_ ", './ n C� 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.
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- riloile: aco: ) 1 0:Z•43, rim: Do:a,cr. 1,00 Vileii9; -- • — —"'
Inspection Line: 503.639.4175 Date Ready/By: Adis: Ea Se 1
TIGA Internet: RD
rnet: www,tigaid Notified/Medved: Supplements/ Information
s ECEivE
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0 New construction ' 1214ddition/aiteratilikepi dinl 3 Please chock all that apply (subunit a sets of plans w/items checked below):
Cl Service or feeder 400 amps or more CI Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
61"Er;(*itpf.:, akti A ., c b ii ,,,, r , : . .... :...‘,,,„,:;„..;,....,,,::,.,,:,:,,. exceeds 10000 amps at 150 YORS Or 0 Floating buildings.
. I b
less to ground, or exceeds 14,000 In Commereial agricultural
F : d 2-family dwelling 0 Commerei 1 PP' : 17 11i ! • I ‘•ry building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: Fire pump. 0 Installation of 75 KVA or
., a Emetsency system. larger sepamtely derived system,
40 . 0 0itir0:40 :1 4 1 0$ ', ' , .*:■: ,', 04 , 7,0* P t ,• 5;c 1 :,: , ::• . ;; • •;: ;" .;'', rj Addition of new motor load of 0
occupancy.
Job no.: —, (fl d Job site address: 1 2.2,,Lt S Li,..1 t 27 01_ p _ 1?01 or more.
0 Six or more residential units, 0 Recreational 'chick parks.
City/State/ZIP: - rt . P\tl..,V1 0 g 9 1 225 uHealth-earo facilities, OSupply voltage for more than
D Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 1—kelAIL, 11;1M. '4- i 0 Service or feeder 600 amps or more,
I .:-'::;..*:';::::.' ‘., : :' . :r 6 V:&,EF.V: SCHEDULE' : ::: . . ,
Cross street/directions to job site: Destelptian / QTY. I Fe.. I Total I *
• New residential single- or multi-family dwelling unit.
Includes attached garage. .
Subdivision: Lot no.: 1,000 sq. ft_ or less 16854 • 4
F.a. add 500 sq. ft. or portion 33.92 I
Tax map/parcel no.:
Limited energy, residential •
75,00 2
,' t,%*01.4((Al (with above sq. R.)
Limitod °norm, multi-family
75.00 2
IFt,V)e,i 0-A tk011/KtIrP) • residential (with above sq, R,)
Services or feeders Installation, alteration, and/or relocation
200 amps or less \ 100.70 iti.). - ID 2
1 : 1 ';:'.PROttl , 0* - ; .. -OWNE 1 0g;e0V4;gPg17A1:Itt** 4 4i#7, 7 500N;':f 201 amps to 400 amps 133.56 2
Name 401 amps to 600 amps 200.34 2
:
-
601 amps to 1,000 amps 301.04 2 •
Address: Over 1.000 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 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
Branch circuits- new, alteration, or extension, . eryanal
Owner signature: Date: A. Fee for branch circuits with
I: ie b.
servi fee,
7.42 1. 1 1 2 --' 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: . branch circuit 56.18 2
Each addl branch Chug 7.42 I 2
Address:
Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP:
dwelling. service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67,34 2
E-mail: _ '
„ . Sign or outline lighting 67.84 2
• ,, i.• :'..:1;• :, ••• ::: :::r.:,,,..I.:.:.:.;..P::.tONntACrt:iV■JnN'r,'::.';:'5'..1)S.5:.11'.MY,,'gi;■t*:,!I3i.c:':.'. Signal circuit(s) or limited-energy
Business name: West Side Electric Inc. ,}/ Co., ., panel, attemtion, or extension, Page 2 2
• Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 6625/ hr I I
Investigation (1 hr min) • 66.25/ hr
City/State/ZIP: Portland/OR/97214
Industrial plant (1 hr min) 78,18/ hr
Phone: (503) 231 Fax: (50.3) 736 inspections for which no fee is
90.00/ hr
specifically listed (4 hr min)_
CCB Lic.: 13306 Electrical Lic.: 26-135C Suprv. Lic.: 4654-S ,,.i:,.:!,,:?;:,:',$:4A:,;:'.'.:1',1ELECIRICALI7P:ERNIrr 'FE . _. :.' '
Subtotal: 1 .
Suprv. Electrician signature, require _t .42.6 ,
Plan review (25% of permit fee): n i-d
Print name: Randall F Roberts Date: '1f'7 13 • State surcharge (12% of permit (ee): I 2.. , 9
TOTAL PERMIT FEE: I 2-.L
Authorized signature: ,
This permit application expires if a permit is not obtained within 180
Print name days after it has been accepted as complete.
: Date: . -- Number of inspections allowed per permit.
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