Permit CITY OF TIGARD ELECTRICAL PERMIT
1111 � ,'r� Permit#: ELC2013-00536
COMMUNITY DEVELOPMENT
Date Issued: 09/11/2013
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 parcel: 1S134BD11100
Jurisdiction: Tigard
Site address: 10957 SW 118TH CT
Project: Brokke Subdivision: PENN LAWN ESTATES NO.2 Lot: 39
Project Description: (4)branch circuits for kitchen remodel
Contractor: PDX ELECTRIC LLC Owner: BROKKE, CHRISTIAAN J
7933 WHITFURROWS CT 10957 SW 118TH CT
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503-997-1989 PHONE.
FAX: 503-200-1362
FEES
Quantity Description Date Amount
4 crt Branch Circuits wo/Purchase 09/11/2013 $78.44
Specifics: Service or Feeder
1 ea 12%State Surcharge- 09/11/2013 $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- -009 . You may obtain a copy of the rules or direct questions to OUNC by calling 503`.2/32.1987 or 1.800.332.2344.
Issued By: 10 Permittee Signature: eN 41/5/.8�--/C62-770A)
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.
9/10/2013 7:07 AM From: PDX Electric LLC/503-200-1362 To: 15035981960 2 of 3
I�Electrical Permit Applicatl� � rcili orH 1c�: fsE oNl:
Received p •
City of Tigard �s 2013 I Dec6,,:: 9,� lr��� Permit Nit zCO/ -d#3
u 1 3125 SW Hall Blvd.,Ti.„ ,OR 97223JEP 10
-':,C. Phone: 503.7182439 Fax: 503.598.1960 ISSI Other Permit:
TI G A R D Inspection Line: 503.639.4175 CITY OF TIGARD Date Ready/By. IMII 19 See Page 2 for
Internet: www.tigard-or.gov ,JI�LD LONG DIVISiON NotifccliMctlrod: Supplemental Information
TYPE OF�1'ORTZ PLAN REVIEW
El
construction ®Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked below).
Demolition ❑Service or feeder 400 amps or more ❑Building over three stories.
❑ ❑Other: where the available fault current ❑Marinas and boatyards
CATEGORY OF CONSTRUCTION cscceds 10,000 amps at 150 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 an other installations. buildings.
❑ Multi-family ❑Master builder ❑Other: I 0 Fire pump. ❑Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION 1 ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑"A""L' "1-2" "I-3"
Job no.: Job site address: 10957 SW 1181h Ct 1001IP or more_ occupancy.
❑Six or more residential units. . ❑Recreational vehicle parks.
City/State/ZIP:Tigard/OR/97223 ❑Health-care facilities. ❑Supply voltage for more than
❑Hazardous locations. G00 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
Cross streeUdirections to job site:• FEE SCHEDULE
.) Description I Cam. i Foe. i Total i
New residential single-or multi-family dwelling unit.
Includes attached garage. !
Subdivision: Lot no.: 1,000 sq.ft.or less ' 108.54 1 4
Ea.add'I 501)sq.ft.or portion 33.92 I
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above so.ft.)
Limited energy,multi-family 7500 2
Kitchen remodel residential(with above sq.ft.)
Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
❑ PROPERTY OWNER ❑ TENANT 200 amps or less 100.70 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps _ 200.34 2
I 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 properly 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. 401 amps to 599 amps i i 168s4 2
Owner signature: __ Late: Branch circuits—new.alteration,or extension, Cr panel
❑ APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with I
above service or feeder fee,
7.42 2
Business name: PDX Electric each branch circuit
B.Pee for branch circuits without
Contact name:Marty Palmer service or feeder fee,first 1 50.18 %.1 Q 2
branch circuit O
Address:7933 SW Whitfurrows Ct Each edd'I branch circuit 3 7.42 22,24, 2
Cay/State/Z1P: Durham/OR 97224 Miscellaneous(service or feeder not included)
Each manufactured or modular
67.84 2
Phone:(503)639-9708 Fax: :(503)200-1362 dwehing.service and/or feeder
Reconnect only 67.84 2
E-mail:info @pdxelectric.com Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
Business name: PDX Electric Signal circuit(s)or limited-energy Sec
panel,alteration,or extension. Page 2 2
Address:933 SW Whitfurrows Ct Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66.25/hr
City/State/ZIP: Durham/OR 97224 investigation(I hr min) 6625/hr
Phone:(503)639-9708 Fax:(503)200-1362 industrial plant(1 hr min) 1 78.18/hr
Inspections for which no fee is 90.00/hr
CCE Lic.: 192731 Electrical t�•ic..: C69 Suprv.Lie.: 56125 specifically listed(y,hr min)
Suprv.Electrician signature.required' � F.LECTRTCAi. PERMIT FEES
�C Subtotal: /$3.,44
Print name: Marty Palmer I Date: 9-9-2013 Plan review(25%of permit tee):
State surcharge(12%of permit fee): e 1 ✓
Authorized signature: TOTAL PERMIT FEE: IT
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has heen accepted as complete.
• Number of inspections allowed per permit. -
I:iDuildingt'ermits1ELC,-Permit App_OLR_6P,I,doc Rev 0i,"21!]n13 440-46151ii I:ntiCOMAVER
9/10/2013 7:07 AM From: PDX Electric LLC/503-200-1362 To: 15035981960 1 of 3
PDX ELECTRIC
7933 SW Whitfurrows Ct
Portland,OR 97224
(503) 639-9708
(503)200-1362
www.pdxelectric.com
info @pdxelectric.com
To: City of Tigard Permitting From: Kelly Palmer
Fax: (503) 598-1960 Date: 9/10/2013 7:07 AM
Phone: Re: Electric Permit Application
Comments
Application and Credit Card autho attached.
facsimile