Permit CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit#: ELC2013-00488
Date Issued: 08/19/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 2S104AB03500
Jurisdiction: Tigard
Site address: 13367 SW SCOTTS BRIDGE DR
Project: Richardson Subdivision: MORNING HILL NO.3 Lot: 68
Project Description: (1)branch circuit for NC.
Contractor: BOB'S ELECTRIC Owner: RICHARDSON, RONALD R
2700 NE BURTON ROAD STE A 13367 SW SCOTTS BRIDGE DR
VANCOUVER,WA 98662 TIGARD, OR 97223
PHONE: 360-254-7200 PHONE: 503-805-0934
FAX: 360-254-8219
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 08/19/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/19/2013 $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 OA 2-0 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 s or 1.800.332.2344. ^ /
Issued By: Permittee Signature: t" ,/ , PL/e /O
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 603.639.4176 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.
FROM (TUE)AUG 13 2013 4:17/ST. 4:16/No.930292E722 P 1
Electrical Permit Applic lit ICEI V 1.()1(1.()1(Oil l( h: 1;I:t)\1.1 _
City of Tigard R /9 �Fa PermitNo.:• 13123 SW Hall Blvd.,Tigard,OR 9 c �,.� F�cao�3 0o y��
'' I Phone: 503.639.4171 Fax: 503.59 ®1 3 2013 Plan Review Other rerrniere,?p/3 eo%23
TI(;.\I r) Inspection Line: 503.639.4175 Dare Ready/By: ® See Page 2 for
Internet: www•tigard-or.gov CITY OFTIGARD Notified/Method:
s�plemeotalIaformadan
".c•0/- k`v t, ••s '( `'ii i r?.},;t_ - 0/C •r-P _ i_:. 1 1 i i r . Y._ s `�,t ' 5�-i r d'�5+'r. i .P: '
...Li-YL:.C_.._.�,.....:litir A__..i.,i:i., ,.r....3._..._.. ... .::::,_Ht._.. .l.___,.. .s,.._.•,__-K,..-„:or..,il..,r.,.v. .ia.. ,,,.. ..,-„,t.. -d.. ., _ _..c ._e- _ ,?_
❑New construction ®Addition/alteration/replacement Pkase check ell that apply(submit a sets of plans whtems checked below):
❑Service or va �amps Building storks
❑Demolition ❑Other where th available ❑Marinas and boatyards.
}{ y r s ,-ki ,:.' , rS o r;,: , t -u i.
1 ._. � exceeds amps ISO or ❑Floating buildings.
i 1arw• tr ' e ._ k:- _.!♦_ ` .�:,r . _ .,..:,,:~I.-,-..•.-::;. .,
. _ :.: } , Ieo groum,oexc,,ds 14w
❑Commercial-use agricultural
® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of 75 KVA or
s W ,_... ❑Emergency system larger separately derive
d system.?�3 A � ,x r y a w r 13. a z.. ._uL .acw.s, L -t 1 '-,, . ❑Addition of new motor toad of 0 "E""1-2""1-3",
Jobno.: 13-922 Job site address: 13367 SW Scotts Bridge Dr. or re. Rcreation•
❑s Si.ix or more residential units. ❑Recreational vehick parks.
❑Health-care facilities. ❑Supply voltage for more than
City/State/ZIP: Tigard• OR 97223 ❑Hazardous/orations 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more
r. ' G' t?:?L`i_.vrr»,n: "; 3.,..' �.. 4t..r,r Mi:."
Cross street/directions to job site: naaipdoa Q . Fee. Total •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Ea add'1500 sq.ft.or portion 33.92 _ 1
Limited energy,residential 2
r . �*r 3 { a
�r ?+ r 1:11 t .. := } t r'. .` r : 1 with above&q.ft.) 84
.- ::..+f.b..c>'{.9r..✓. 21 .1-.a:.� -- '�..�. .. `,.._.-i _.. -...,lif k_... .. ._._�. Limited eder '
gy,multi-family ` 67.84 2
1 ckt for outdoor unit as •er correction on minor:-.labe residential(with above - -
Services or feeders installation,alteration,and/or relocation
#ELS376779 200 amps or less 100.70 2
•
Y j0/ ;N 7 ,, '.r a' • t ` fi• � `r-V' I�Y� r '� 201 amps to 400 amps 133.56 2
40]amps to 600 amps
'
200.34 2
Name: Ron & Jan Richardson 601 amps to 1,000 amps 301.04 2
Address: 13367 SW Scotts Bridle Dr. Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation,alteration,and/or
Ti_and OR ' 2_ relocation
Phone:( Fax:( ) 200 amps or less 59.36 1
503) 805-0534 201 ampsto400amps 125.08 2
Owner installation:This installation is being made on property that I own which is not 401 amps to 599 amps 168.54 2
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
Branch circuits-new,alteration,or extension,per panel _
Owner signature: Date: A.Fee for branch circuits with
� • S Y� „ above service or feeder fee,jr , ` .. + 1
7.42 2:V ail G H r I: . I t 4 : e i .��.L• u` , . each branch circuit
-
Business name: • B.Fee for branch circuits without
• service or feeder fee,first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous(service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
dwelling,service and/or feeder
Phone:( ) Fax: :( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail
Sign or outline lighting 67.14 2
Ef.P at - ]] e 5 z „ ",t'a 1,'111,f . `:• -F ., _ .11- :`11:: _._S. _ _"24' r
Signal circuit(s)or limited-energy
Business name: Bob' panel,alteration,or extension. Page 2 2
B s Electric Each additional Inspection over allowable in any of the above
Address: 2 700 NE Burton Rd. Ste. A Additional inspection(1 hr min) I L 66.25/hr
City/State/Z1P: • Investigation(1 hr min) 66.25/hr
V, • • .. :• • Industrial plant(1 hr min) 78.18/hr
Phone:(360 )254-7200 F":(360 )254-8219 Inspections for which no fee is 90,00/hr
fleet] listed('h hr mm
Electrical Lic.: 37, 43 Suprv.Lic.: 4322S 1 ? ,�`r s ",.._:'.�'r.�_' :i.r S ' ..� _::mss -,2
Subtotal: 56.18
,uprv. Electrician signature,required: �' L Plan review(25%of permit fee):
Print name: Kevin Broselle Dec 8 13 13 Statesurcharge(12%ofpenmitfee): 6.74
1 TOTAL PERMIT FEE: 62.92
Authorized signature: -
This permit appliwtioa expires If a permit u riot obtained within 180
Print name: Date: • days after It has been accepted as complete.
Number of inspections allowed per permit.
I:\Building\Parma'\ELC-PcmitApp.doc 10/01/09 440-4615T(1 1/05/COM/WEB