Permit q CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013-00476
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/12/2013
Parcel: 1 S134CA00608
Jurisdiction: Tigard
Site address: 11990 SW MANZANITA CT •
Project: Taylor Subdivision: PANORAMA Lot: 7
Project Description: Installation of ground rods and gas bond
Contractor: LM ELECTRIC LLC Owner: TAYLOR, LORRAINE J
PO BOX 493 11990 SW MANZANITA CT
NEWBERG, OR 97132 TIGARD,OR 97223
PHONE: 503-858-4428 PHONE: 503-590-2852
FAX:
FEES
_ Quantity Description Date Amount
1 ea Services or Feeders-200 08/12/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 08/12/2013 $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 • accordance 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. ENTION: Oregon law .c 7e you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in-OAR
952- 1-0010 through OAR 952-s%1-0090. o may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800. 2.23
Is ued By: 1��7i- Permittee Signature: N
/ 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' /, 17u1]/ Date: S /43
LICENSE NO. CaOg4
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 09 13 07:42a Integrity Auto Body 503-554-5418 p.1
Electrical Permit ApplicatiEI V ED
11111 • City of Tigard Received ce
13125 SW Hall Blvd.,Tigard,OR 97 1 G 12 2013 °alc/R'` �3 per.;,"'°° ��°i3'°� ?� I Plan C . Phone: 503.718.2439 Fax: 503.598.1960 Date/By:Review PL.N 9l s-��67
Dale/By: Other Permit:
T I G A R D Inspection Line: 503.639.4175 Dale Ready/By: kris'
Internet www.tigard-or.gov CITY OFTIGARD Notified/Method. la See Page l for l
_ TYPE BKp IVISION ppbmenEsl rnfonnnarioa
PLAN REVIEW
❑New construction pAddition/alterationtreplacement Please check all that apply submit
sets or
plans a/g e checked❑Service or fader 400 amps or more 0 Building over three tiori es.ID Demolition ❑Other:
where the awilahlefault current ❑Mal fUlL and boatyards.
CATEGORY OF CONSTRUCTION =weeds 10,000 amps at 150 volts or ❑Floating buildings.
-and 2-family dwelling ❑Commercialiindustrial Accessory building less Sc ground,or exceeds 14,000 ❑Commercial-use agricultural
❑Ar g amps for tdl other installations. buildings
❑Multi-family ❑Master builder
❑Other: ❑Fire PAD ❑Installation of?5 KVA or
; ❑Fmer¢t ncy system. larger scphrntely derived system.
JOB SITE INFORMATION AND LOCATION
❑Addition of new motor load of ❑"A", 1-2"'I-3",
Job no.: Job site address: I lc D �J (Y1c.nzc ,} I00HP or more. occupancy.
q
❑Six or more residential nuts. ❑Recreational vehicle parks.
CityiStateiZiP: 1-1 4: a.d cr-12Z 2 ❑Health-care facilities. ❑Supply voltage for more titan
J ❑Hazardous locations. 600 volts nomimd.
Suitefhldg./apt.no.: Project name: ❑Senioe or feeder 600 amps or more
Cross street/directions to job site: FEE SCHEDULE
Dmergnme I Qm. I Too I Teal I
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1,000 5
Lot no.: q•ft or less 1 68.54 4
Tax map/parcel no.: Ea add'I 500 sq.R or portion 33.92 t
Limited energy,residential
DESCRIPTION OF WORK (with above sq.ft.) 75.00 2•
• Limited energy,multi-family
75.00 z G l��t, ] acs .,. CGa.S . ., residential
Services or feeders installation,alteration,and/or relocation
200 amps or less / 100.70 /eV g— 2
❑ PROPERTY OWNER 1 ❑ TENANT 201 amps 1o400 amps 133.56 2
Name: L occ c,,_‘•
u,�� .-7-0,. 6c..
1 401 amps to 600 amps 20034 2
601 amps to 1,000 amps 301.04 2
Address: , ,q9 O St.:t CY\o,n-Zc4nt-i-& Ova 1,000 amps or volts 552.26 2
i City($tatc/ZIP:`tp1� Q2 p.-1� Temporary servieea or feeders installation,alteration,and/or
relocation
Phone:(0)3)s';o-aSs2 I 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. 461 amps to 599 amps 168.54 2
Branch circuits—new,alteration,or extension,per panel _
Owner signature: Date: A.Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON abov branch cior eed=fee, 7.42 2
Business name: B.Fee for branch circuits without •
service or feeder fee,first
Contact name: branch circuit 56,18 2
Addrf cC: Each edd'I brunch circuit i 7.42 j 2
Miscellaneous(service or feeder not included)
City/Statc/ZIP: Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Phone:( ) I Fax::( ) Reconnect only 67.84 2
E mtu l: Pump ar irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Signal eircuit(s)or limited.energy
Business name: 1_,(Y\ E IQC�( .� L1L- pcncl.alteration,orexiension. Paget
^� Each additional inspection over allowable in any of the above
Address: r d '�L+� LC Additional inspection(I hr min) - 66.25/hr '
City/State/ZIP: CvJb -..1_ 09, �-i 132 investigation(1 hr min) 66.25/hr
Industrial plant(1 hr min) 78.18/hr
Phone:( i. 55
) °a' -L(L12-�j I Fax:( ) inspection for which no fee is
���// 3 specifically listed(V,hr min) 90.00/hr
CC1 Lic• i 9 1 le.;19 Electrical Lie.: GLaLOI Suprv.Lie.: 24p 15a S ELECTRICAL PERMIT FEES
yy ///ly Subtotal: /04 L°
Suprv. Ctrician signature,required:
Print name: Plan review(25%of permit fee):
DA') w tavStr{ I Date: g-3 — 1Z State surcharge(12%of perm'it fee): /2.
Authorized signature: I In'I'AL PERMIT FEE: 1 71
This it application n
perm ppt:utioa expiro if permit Is not obtained Within Ian
Print name: I Date: days attee it Ens been accepted as complete.