Permit v CITY OF TIGARD ELECTRICAL PERMIT
2 • COMMUNITY DEVELOPMENT Permit#: ELC2013 00485
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 08/19/2013
Parcel: 2S104CC07700
Jurisdiction: Tigard
Site address: 13604 SW ASCENSION DR
Project: Sandford Subdivision: HILLSHIRE WOODS Lot: 96
Project Description: (4)branch circuits for remodel.
Contractor: WEST SIDE ELECTRIC CO INC Owner: SANDFORD,JUSTIN S&TRACY A
1834 SE 8TH AVE 13604 SW ASCENSION DR
PORTLAND, OR 97214 TIGARD,OR 97223
PHONE: 503-231-1548 PHONE: 503 341-1858
FAX: 503-736-0677
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 08/19/2013 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 08/19/2013 $9.41
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $87.85
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 ma obtain a copy of lea 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.
2013-08-12 05:13 WEST SIDE 15037360677 >> 5035981960 P 2/2
Electrical Permit Applicati lPl. 1/EIVED roc O1:1:1 1 1..5.1'.O\I.1
City of Tigard Received _
I I3I25 SW Hall Blvd.,Tigard,OR 9n23AU G 1 3X013 Date/13 ' �� ' I
:: . Plan Review
Phone: 503.718.2439 Fax: 503.598.1960 I p Other Permit: X41 . t "O 6
.1.l r.; „,., Inspection Line: 503.639.4175 CITY OF TIOARD Date Ready/By; ®see rage'for
Internet: www. gaud-or.gov Notified/Method: Supplemental Information
. ...,........'::'74.7.:F7-....... - - � pip._
... '°�f?1�C�'!)r!f--`^•r.. k��?� :� :�u7.w.... .�! .,., 77.,`5: �:'."=:'- '�1'':"`:�.i•'•' 4:M��+���•�VI.-.�..:,.
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❑New construction p Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below).
I D service of feeder 400 amps or more ❑Building over three stones.
❑Demolition ❑Other: I where the available fault current ❑Marinas and boatyards,
: -i exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,m exceeds 14,000 ❑Commercial-use agricultural
1-and 2-family dwelling ❑Commercial/industrial ❑�ecessory building
amps for all other installations. buildings.0 Master builder ❑ thee. less
pump. ❑Installation of 75 KVA or
t Emargenc system. larger rely derived system.
'a ' 44.0 0.4.L p ":L, ' ' ❑Addition of new motor load of ❑"A","sE�,"l-2 l-3
Job no.: ,4 Job site ad teas: f �j(_.' �`J Y [�r7S/Oi7 100o more residential occupancy,
`+ /
0 or more residrnual units. ❑Recreational vehicle parks.
City/Sous/ZIP: /G �lrz( 97z43 ❑Health-care facilities. ❑Supply voltage for mote than
/ J t , ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt-no.: Project name: SO4��r.,.-, JL/� .4/%gyp o ❑Service or feeds 600 amps or more.
/ "' :_,1;''• '• .0-iltt'SCHEDULE;
Cross street/directions to job site: (TC.'/71'd/ Dmeriptio. I Qty.1 Fa. I Taut I
New residential single-or multi-family dwelling unit.
- Includes attached garage.
Subdivision: I Lot no.: 000 sq.ft or less 168.54 4
Ea,add'I 500 sq.R or portion 33.92 1
•Tax map/parcel no.: I Limited energy,residential -
F�, Swithabovesq.ft.) 7500 2
+;: Limited energy,molt family
L// � 1 75.00 2
A/y/ +e��{/!C %FC /C(4(//4)40'/14,C>a- residential(with above sq ft;Z,__
/ Services or feeders installation,alteration,and/or relocation
1Y/•C 9/-t/,/lcr 200 amps or less 100,70 2
' �,�y�; ,,,•,r,v' ..:V.Til l/. _„ ,,:tc; `',,rF' 201 amps to 400 amps 1 33.56 2
`' QIA !!A ° 4�a� : : h�S,,, K� I h. is t 200.34 2
Nerve: 401 amps to 600 amps
-601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 552,26 2
Temporary services or feeders installation,alteration,and/or
Litt'/Slate/ZIP: I relocation
Phone:( ) I Fax:( ) i 200 amps or less 59.36 1
_ 201 amps to 400 amps 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
I Owner signature: I Date; A.Fee for branch circuits with
_ x� above service or feeder fee, 742 2
•0P44CA1r;;<<r f;`;,;a'. .. � dq..,. *'1,.:? 1 .i t=;; tech branch circuit
I Business name: 4 B.Fee for branch circuits without
7 service or feeder fee,first / 56.1 ■ 2
branch circuit 8
Contact name: -
-1 Each add'I branch circuit 3 7.42 ,Z 2.IA- 2
Address: Miacellaneousfservice or(ceder not Included)
Each manufactured or modular 67.84 2
City/State/ZIP: dwelling,service and/or feeder
•
Phone:( ) _ ( Fax::( ) — Reconnect only 67.84 2
_ f Pump or irrigation circle 67.84 2
E-mail: yr� sign or outline lighting 67.84 2
- "Y'.^ ',,pi a: asK}ai' :;rn°'.IZti�7 ,r' :E} t., ,a(I. rr" ;,, F Signal circuit(,)or limited-energy
panel,alteration,or extension. Page 2 2
Business name:_West Side Electric Co.,Inc. Each additional Inspection over allowable in any of the above
Address:1834 SE 8j°Ave. i Additional inspection(1 hr min) 66.25/hr
Investigation(1 hr min) 66.25/hr
City/State/ZIP:Portland/OR/97214 industrial pram(1 hr min) 78.18/hr
Phone'(503)231-1548 Fax:(503)736-167 Inspections for which no fee is 90.00/hr
s,pecifically listed %:hr min)
CCB Lic,: 13306 .7-electrical Lic.: 26-135C Suprv,I.ic.: 4654-S ✓=r.. �.'4l w.'-'i�;' RE> T`+ES •.:
- I Subtotal: .7 g
Suprv.Electrician signature,require d‘,:rd/(9° 2-e > • I _Plan review(25%of permit fee):
Print name: Randall F Roberts
Date: State surcharge(12%ofpermit fee): 7T
TOTAL PI.ItM1T FEE: g7 �
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it ass been accepted as complete.
Print name: tc- - - Number of inspections allowed per permit.
l'.1u iildingPerminrRl,GPormi1A9p.d0c 07/01/10 440�615T(11/05/COM/wF.11
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