Permit CITY OF TIGARD ELECTRICAL PERMIT
III s , COMMUNITY DEVELOPMENT Permit#: ELC2013-00456
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/05/2013
Parcel: 2S104AA08000
Jurisdiction: Tigard
Site address: 12665 SW KATHERINE ST
Project: HAAS Subdivision: BELLWOOD NO.2 Lot: 105
Project Description: Panel replacement.
Contractor: WIRE NUTZ ELECTRICAL SERVICES Owner: HMS,THOMAS&LINDA
13023 NE HWY 99 STE. 7 PO BOX 1787
VANCOUVER,WA 98686 WILSONVILLE,OR 97070
PHONE: 360-609-2714 PHONE:
FAX: 360-727-3955
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 08/05/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/05/2013 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
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: Permittee Signature: °
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.
Electrical Permit A. alicatio 1�,.- rOR OITICf 1:SE 0.`ra
City of Tigard Received
"a1' g • I py ' Permit No.;
■ L3125 SW Hall Blvd.,Tigard,OR 97i 'i� ! W D / �� • �U
. ._ Plan Review Other Permit,
' - Phone: 503"718.2439 Fax: 503.598.1960Q 1 ste/By:
T•1( A a D Inspection Line: 503.639.4175 AUG 1 2013 Date Ready/By" �Jun• ; S See Page 2 for
-- Internet: www.tigard-or.gpv Notified/Method: / - Supplemental Information
I •
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• 0 New construction ►: 'ddition/alter. to�'i.‘I r lr ••t Please cheek all that apply(submit 2 sets of plans w/items checked below):
❑Service or Rieder 400 amps or more ❑Building over three stories.
❑Demolition ■ Other where the available fault current
tl
El Marinas and boatyards.
�i,ri' 'W,?.: , ..L �?, U e wi Y r , w an• t.y + <.. ,� 7 y-h a W?, 47•1:r
weds 10,000ampsat I50 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. ❑IttstaUatioo of 150 KVA or
�`v GS H r ,7, tl ; ry r'.°I :77 : .w 43" rl,,k - "7n'Om ❑Eme[ n system- larger
� . :°s±r i Lli(2", �:'" t x'a : . r ,, I i Ii f a•- 1 , t M� U'e cY Y f-. r.-1.2-.,tdY derived system.
_ .�.:, �., �., .,,,.� . _-+r.�±��;��� ,.<.y.� ❑Additionofnewmotortoadof ❑..q..,"B^, "i g°
.. Job"" _address: 100HP or more, oeeopanty,
�� a+ ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: / r i ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations, 600 volts nominal.
Suite/bldg./apt. , • tiaict, ❑Service or feeder 600 amps or more.
r-
Pi •-', 5 4i 1 m " ' ''X1f ' , k rt P1t r .;`i 4'APF41,).
• • • .jOb
Dmcription Qty. Fee Tani +
New residential single-or multi-family dwelling unit.
includes attached garage.
., .n: Lot no.: 1,000 sq,It.or less 168.54 4
Tax map/parcel no.;
Ea.add'l 500 sq.ft.or portion 33.92 1
Limited energy.residential
• , 11 F N.t t1,'x T' :ii,R :7r7,1 1 ws, +4... �i+n u 11'.k k :_ -1 7� (with above " 75.00 2
1 ;' kr, i�igtS tiit. l3 i;t �. 1k1::: Simlc .,.4.t.'��a.: .71F _'''' 5klt:M.Pri ?� '_
Limited energy,multi-family
75"00 2
),/}1 a residential(with above sq.ft.)
Iil�- +'.i:"y, ..C'v'5:7"`1 '��it'�rP.:l!':".ry1::::r:y.
Services or feeders installation,alteration,and/or relocation
licam 1 i r N MAT *i -r ". ,F, a, a R ,a✓-^n r , n
� .. ..t 71-.. .11. ��>s_w, �a Ii A t t 2 c+FFZ•r,,,-'St a�at17p5 Or iC55 / 100.70 Aft).-70 2
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
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 snips 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.alteratiorAor extension,per panel
r', 1 r > s1 �,r, rx a�a mt,ir ti, ', tr; Ta .• , , r 7�i j a w, A.Fee for branch circuits with
.�.r..rl L.a...;�.r.'.irlif:-2.,.�.,„44a ;c�y:rt .,.^.ia.: :t s;:.):4% ` „t_-::LI,.`y'r c` 1; rl above service or feeder fee.
7,42 2
Business name: each branch circuit _ _
B.Fee ibr branch circuits without LL
Contact name: service or feeder fee,first
56.1 s 2
branch circuit _
Address: • Each add'l branch circuit 7.42 2
City/State/ZIP: Miscellaneous service or feeder not included
Each manufactured or modular 67.84 2
Phone:( ) Fax::( ) dwelling,service and/or feeder - _
Reconnect only 67.84 2
E-mail: Pump or irrigation circle 67.84 2
1,4111 S�•- 4--1,1.., y. w "Rt ro 07- 5 :Tito:
'1,i ;.;4,1.0a.l1.F.:j of .�:":4 6:1.4 .lx., n.l;1!• SISnoroutlinelighting 67"84 2
Business name: YU f y-k , 4-I Z e-ie,,.h t'c signal circuits)or limited-energy See
panel,alteration,or extension. Page 2 1 2
Address: 1302," f\E 14t,„ Gi t 1 • 26 Each additional inspection over allowable In any of the above
City/State/ZIP: 'A /1 '&21" Additional inspection(1 hr min) 66.25/hr
V�h�/u V V�/14 Investigation(1 hr min) 6625/hr
Phone;( ) CO b Q-2/j 1 Fax:Niel )1z-7 -%q5 5 Industrial plant(1 hr miry) 78.18/hr-
Jy Inspections for which no foe Is 90 00/h
CCB Lic.: I Mg i 3 Electrical Lic.: C(`17 Suprv.Lic.: L.� l s Mean listed(h hr min) r
at z._, \� �l } ^+'„i ii_.'�r3 vr.4 m an,:: ..'* 2,a,t ti;4^tt tt^riti:,':
Suprv.Electrician signature,required: aigia `� Subtotal: /C .7o�A
Print name: go b1 r� —rid r-pr' Date: f r/1 Plan review(25^,of permit fee,,
e State surcharge(12%of permit fee); /)..c1J
Authorized signature: �1� f{�, S TOTAL PERMIT FEE: l 1 .7)'
Print name: 4 ' 'b-' Date: rift This permit application expires if a permit is nut obtained within 180
days after it has been accepted as complete.
s Number of inspections allowed per permit.
Tliguilcls Fermitsv,C PecmICApp,,,Et,tt✓l:rt>;.doc ncv 011211i013 440-4613Tt I l/01/COM/WF.1;
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