Permit CITY OF TIGARD ELECTRICAL PERMIT
8 • COMMUNITY DEVELOPMENT Permit#: ELC2013-00469
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/07/2013
Parcel: 1S 136CA10300
Jurisdiction: TIGARD
Site address: 11072 SW LEGACY OAK WAY
Project: Snyder Subdivision: WHITE OAK VILLAGE Lot: 24
Project Description: Electrical for NC replacement.
Contractor: ENGELMAN ELECTRIC INC Owner: SNYDER,ADAM
PO BOX 451 11072 SW LEGACY OAK WAY
HUBBARD,OR 97032 TIGARD,OR 97223
PHONE: 503-981-8041 PHONE: 406-381-3459
FAX: 503-981-4026
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/07/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/07/2013 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 th- •r direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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i
Issued By: �_ rmittee 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.
Aug/7/2013 8:45:00 AM Engelman Electric Inc 503-981-4026 1/2
Electrical Permit Application fort(.)1 t,t<'i:. i.isr.(.)NI.■
City of Tigard Received f
a Datem , I / 1 .Zi ..•
131x5 SW Hall Blvd.,Tigard,4c.,,NA
O\� Pl an Review pater Permtr.�_V Phone: 503.718,2439 Fax. A 'L D�By.I t;A 1c 1 t Inspection Line: 503.639.41 ` ® Data Ready/By: rude el See Page 2 for
Internet www.tigard-or.gov ∎\) ��, NottfedNiethod: •-r—Z Cy Supplemental Information
RTG .
❑New construction ,:,• Please oheok all that apply(submit a sets of plans w/items checked below):
®Other:ltl/alterati i 4, "Rt d Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other where the available fault current ❑Marinas and boatyards.
. !EQto !,o's c01q.�G"!F'145F exceeds 10,000 amps at 150 volts or 0 Floating buildings.
leas to ground,or exceeds 14,000 ❑Commercial-use agrioultural
® 1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps the all otter Installations. buildings.
❑Multi-family ❑Master builder ❑Other 0 Fire pump. 0 Installation of 150 KVA or
❑8mergency system. larger separately derived
Job no.:26742 I Job site address:11072 SW Legacy Oak Way 10011P or more. occupancy.
❑Six or more residential unite. ❑Recreational vehicle parks.
City/State/ZIP:Tigard OR 97223 ❑liealthoare facilities. ❑Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg,/apt,no.: I Project name:Wolfer's/Snyder ❑Service or fbeder 600 amps or more.
Cross street/directions to job site: neac,loMen 1 Qtr. I Fee. I Tetel I •
New residential single-or multi-Rustily dwelling unit,
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft,or less 168.54 4
map/parcel no.: Ea add'1500 sq.ft.or portion 33.92 1
Tax ma
P/p Limited energy,residential 75.00 2
' ,D, S 1 tits$:OP-woe (with above eq.ft-)
' Limited energy,multi-family 75.00 2
change out breaker&fuses for A/C replacement residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation alteration,and/or relocation
. li PRdE*,i.`Y OFVftiIt ; .: ;' , s ;11 10EAN'T :
200 amps or less 100.70 2
Name:Adam Snyder 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
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or
Phone:(406)381-3459 I Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that 1 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, erpanel
r A.Fee fbr branch circuits with
CI L crlc1`i .
above service or feeder fee, 7.42 2
Business name: each branch circuit
B,Pee for branch circuits without
Contact name: service or feeder fee,first 1 9618 56.18 2
branch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP; Miscellaneous(service or feeder not included)
Each nterutfhctured or modular
Phone: dwelling,service and/or feeder 67.84 2
( ) I Fax '( ) Reconnect only 67.84 2
E-mail: Pump or Irrigation circle 67.84 2
Sign or outline lighting 67.84 2
Business name:Engelman Electric Inc Signal circuit(a)or limited-energy ' See
panel,alteration,or extension. Page 2 2
Address:P O Box 451 Each additional Inspection over allowable In any of the above
CI /State/Z1P:Hubbard OR 97032 Additional inspection(1 hr min) 66.25/hr
�' Investigation(I hrmin) 66.251 hr
Phone:(503)981-8041 I Fax:(503)981-4026 'Industrial plant(1 hr min) 78.181 hr
Inspections for which no fee is 90.001 hr
CCB Lk.: 94581 Electrical 24-46C r" Suprv. •Sc.:• 47399 -specifically listed(t4 hr min)
Suprv.Electrician signature,required: ,v� �. ; $i;� ikEliSubt`ial: :'`: :ii;'.:•.
f Subtotal: 56.18
Print name: Ron Thun rbird Date: 08/07/13 Plan review(25%of permit fee):
State surcharge(12%of permit fee)` ...64r Authorized signahtre•
lb TOTAL PERMIT PEE: X62;93 , )„
This permit application expires if a permit is not obtained within 18
Print name: Kristina Nichols Date: 08/07/13
days altar It has bean accepted as complete.
' Number of inspections allowed per permit.
C\Bulldtna\PermltslBLC,ParmItApp BL5. RQ,doo Rev 05/21/2013 44046tSTpuos/COMPNSe