Permit t � CITY OF TIGARD ELECTRICAL PERMIT
'F1 a COMMUNITY DEVELOPMENT Permit #: ELC2013 -00397
T IGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/16/2013
Parcel: 1 S133DC00505
Jurisdiction: Tigard
Site address: 11655 SW WINTERLAKE DR
Project: Myers Subdivision: ASH VALLEY TRACT Lot: 5
Project Description: (2) branch circuits for a/c install and service outlet.
Contractor: NICE ELECTRIC CO Owner: MYERS, STEPHANIE & KELLY
PO BOX 636 11655 SW WINTER LAKE DR
MCMINNVILLE, OR 97128 TIGARD, OR 97223
PHONE: 503 - 434 -5802 PHONE: 760- 694 -7485
FAX: 503 -472 -1628
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 07/16/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 07/16/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 ac - • , ith 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. ATT ION: Oregon law re•uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0 10 through OAR 952 -'0 109 ' You may obtain a copy of the rules or direct questions to OUNC by calling 503.x.1987 or 1.800.332.2344.
Issued = : _ r1`•! d -! • Permittee Signature: C r«--
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' , i:. y Date: r
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.
2013 /JUL /11 /THU 14:57 Nice Ele r1l D FAX No, 503 472 1628 P. 002
E lectrical Permit Application . . : FOR OFFICE IiS[ ONLY
IN City of Tigard 1 1 2013 D� ®� Permit No.; &C 5 - ' 35).r n 13125 SW Hall Blvd., Tigard, OR 97223 ' 5 • • : 7
. ' . CITYU&TIG 1 Other
Phone: 503.718.2439 Fax 503.598.19 0 /ile j X31
.
I I (• n:cU Inspection Line: 503.639.4175 BUILDING DNISI ii : nlrle: see rage a for
Internet: www.tigetd- or.gov Supplementallaforniattee
4 f , ; r , , r .11,1' .k1e I t "1"Wr�7 �"r'tP'F�.S77 'aFt r ' !it ' ;,,, ! '-°y ''',::: r 1 -
'fry i :?°e h 0 0 b n 7+ i f I i V 1 = 1° rF {:
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? �.al,1,N,..� .EfV L� a
❑ New construction j Addition/alteration /replacement Please check all that apply (submit Z sets of plans whtems checked below):
0 Service or feeder 400 snipe or more ❑ Building over time stories.
❑ Demolition ❑ Other: u whore the available fault current ❑ Marinas and boatyards.
.0,5 tt' i!,:il:r r ' 1 4 . is 1 ,;. r °„* ° -, °` r n i 1 ill} .` if l c � : 1 I J H: I 1 : F I .i i exceeds 1 0,000 amps at 150 volts or ❑ Floating buildings.
leas to ground, or exceeds 14,000 ❑ Commercial -use agricultural
El 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for s11 oilier installations.
6) )
❑ Multi-fatlWy ❑ Nester builder [:I Other: ❑ F,R pump. 0 Installation of 150 KVA or
fir 14 1 r r y { ' I T 0.0-'1'-'.-.. u ac 4 l ' fit .1,1';71„°'..', i t it ° �yi= Sid r +n rr ya fa ; , . I .i -u s '� , , i r:1 C] Emergency system larger separately derived system.
• P i ❑ Addition of new motor load of ❑ "A", "E", "1-2", "1.3",
Job no.: I Job site address; 11655 SW WINTER LAKE DR 100BP or more, occupancy.
0 Six or more residential units. 0 lteereational vehicle parks.
City/State/ZIP: TIGARD OR 97223 ❑ Health -tare facilities. 0 Supply voltage for more than
• 0Ha>ardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: OHAC - MYERS 0 Service or feeder 600 amps or more.
l'r t f+ { .':: Ei7 { ,. '1 • - .: _ '_t a u P, ° - C _i t i 1 J 1'i..i l 11 r .% . '
Cross street/directions to job site: Deseriiitleo I otr, I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. R or less 168.54 4
Ea. add'I 500 sq. ft or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
► ... ti ." a; ; r *,. tr "C. -1P 1' - 'ct 7 ' i2:n'n r� • ; l r t ' ,, i -4 , 3 :. 4 rj . (with above sq. R) 75.00 2
Limited energy, multi - family 75.00 2
HOOK UP OUTDOOR UNIT FOR HEAT PUMP, ADD GFI CONVENIENCE residential (with above sq. ft.)
:gBin E5i#bie.g e , :ua %" %: 'O. R .i .......mr, a :
OUTLE •
Services or feeders inatallation and /or relocation
V i!t !e Wi t' , 4. �i -1 : , 4 q& , r . lei r & il'I i( ` c,+u :i dtti d i. t " t . r , r � 1 at 200 amps or less
100.70 2
Name: KELLY MYERS 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
•
Address: 601 amps to 1,000 amps 301.04 2
Over 1,000 romps or volts 552.26 I 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or •
Phone: (760)694 - 7485 I Fax: ( ) relocation
200 amps or Iess 59.36 1
Owner installation: 'Ibis 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
r i ; c.„ ; ci C ,r. a. A't zi r,? t t ° 7 n +'1 vi t 1 - i -,-.„;‘,1,,,,,,.,„r:„ ti i, A. Fee fbr branch circuits with
�.w_ .... 4 ri.,7e:d::rau� ' ;. 41. td l t l .. , Q t Y ; k;
" _,�„�.�� .,� � 4'<• M y 1�t� i i,1 { ., si: , i :. tnn . � s�.t a � above Se Or feeder tae,
7.42 2
Business name:' each branch circuit _
B. Fee for branch circuits without
Contact name: service or feeder fie, first 1 18 56.18 2
branch circuit _
Address: Each add'l branch circuit 1 7.42 7.42 2
City/State/DP: Miscellaneous (service or feeder not included)
Each manufactured or modular
Phone: ( ) I Fax :: ( ) dwelling, service and/or feeder _ 67.84 2
Re.cormect only 67.84 2
E v _ Pump or irrigation circle 67.84 2
rar�rf� rss ,ti+ .w- r7 , , •�^4^� arm z. r •..,�r
11 s �i��r iti��a'. �I.i3fW ra li e s r1?',•,..,i� .> 7941 1 Sit'N-8,ti +l,1daL:,F:, fP }i ,
-?.....
.. a. .,,.., ,��1�'r�."...,�.',��L>sr,� '� „tr , ,1 si outline fighting 67.84 2
Business name: NICE ELECTRIC CO • Signal circuit(s) or limited- energy See
panel, alteration, or extension. Page 2 -2
Address: PO BOX 636 Each additional inspection over allowable in any of the above
4
City /State/ZIP: MCMINNVILLE OR 97128 Additional inspection (1 in min) 6625/ lu
Investigation (1 hr min) 6625/ hr
Phone: (503) 434 - 5802 Fax: (503) 472 - 1628 Industrial plant (I In min) 78.18/ hr
-- Inspections for which no fbe is 90.001 hr
CCB Lic.: 2061 Electrical Lic.: 36 -9C Suprv. Lic.: 4829S specifically listed (h hr min)
Suprv. Electrician signature, required. # - gaiS
Subtotal: 63.60
Print name: MERVIN L ZOOK Date; 7/11/2013 Plan review (25% of permit fee):
State surcharge (12% ofpertnit fee): 7.63
Authorized signature: TOTAL PERMIT FEE: 71.23
This permit application expires if a permit is not obtained within 180 �
Print name: aft.) . 2, 260 /C Date: days after It has been accepted as complete.
• Number of inspections allowed per permit.
1:4suites Ponaita1Et.C_Pesm tApp_EL11 Eas.doe Rev 05/21/2013 440-4615Tp uOSICOM/WBB