Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit#: ELC2013-00573
T[GARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/25/2013
Parcel: 25111 DB11200
Jurisdiction: TIGARD
Site address: 15290 SW 94TH AVE
Project: Luscher Subdivision: SUMMERFIELD NO.12 Lot: 639
Project Description: Panel change
Contractor: RED'S ELECTRIC CO INC Owner: LUSCHER, BENJAMIN W AND
6336 SE 107TH AVE MARJORIE R
PORTLAND, OR 97266 9385 SW LAKESIDE DR
TIGARD, OR 97223
PHONE: 503-233-6467 PHONE:
FAX: 503-233-1281
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/25/2013 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 09/25/2013 $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 in .th 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. NTION: Oregon law r,• i es you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-0 -0010 through OAR 952-00 -0090 Y. ay obtain a copy of the rules or direct questions to OUNC by 0. - .1987 or 1.800.332.2344.
Iss d 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:
•• / ✓i�1� r I/_)
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.
Sep. 25. 2013 2: 13PM No. 3927 P. 1
Electrical Permit Applicat°'•a FOR OFFICE USE ONLY City f Tigard s' ,�,!1,,!!, 1 F—, � ReceECW9AYAfl t . Y Permit No.:
n 13125 STigard,OR 9722 pl
Phone: 503.718.2439 Fax: 5o3.598396P 2 5 2013 Date/B : OtherPermn:
I'LtiAHll Inspection Line: 503.639.4175 Dateaeady/By: tuns: M SeePage2for
Internet: www,ligard-or.gov CITY OF
/ IIGAHD Nolifed/Method:
Supplemental plemental Information
. • • �PE RPP i �WIMP. . PLAN REVIEW
❑New construction � Addition/alteration/replacemenr
Please check all that apply(submit 2 sets of plans w/items checked below):
El Demolition ❑Other:
CI Service or feeder 400 amps or more ❑Building over iluee stories.
where the available fault current ❑Marinas and boatyards.
OF
CATEGORY OF CONSTRUCTION RUCfIOi`i -- exceeds 10,000 amps as 150 volts or ❑Floating buildings.•
1-and 2-family dwelling ❑CommerclaVi
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
ial ❑Accessory building amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump, ❑Installation of 1501:VA or
Emergency system. larger separately demur system.
. JOB SITE .INFORMATIOhi.AND'LOCATION..' :.. .: .....
- S)'it
❑Addition of new motor load of ❑"A","E","1-2","1-3",
Job no.:7O'3CaS— Job site address: 1 5g 95 Su) Q/, Ale Six occupancy.
I`1 ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more rban
I ❑Hazardous locations. 600 voles nominal.
Suitc/bldg./apt.no.: Project name: l�V$e V,e v ❑Service or feeder 600 amps or more,
: ::' ,,PEE SCHEDULE .,•• .,•
Cross street/directions to job site: ii . rtpuon I QM 1 Fee. I Total
— New residential single-or ntultl-family dwelling unit.
Includes attached garage.
Subdivision: ( Lot no.: 1,000 sq,II,or less 168.54 4
A 5 // I 2 f/ Pa,edd'I 500 sq.fl.or portion 33.92 1
Tax map/parcel no.: U
Limited energy,residential
',DESCRIPTION or WORK (with above sq.ft.)
7s.00 2
limited energy,multifamily 75.00 2
n residential(with above sq.ft)
Q�e , 1 Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation
. -7.d PROPERTY OWNER:.. : • ' :fl TENANT.::' .:.. 20D amps or less 1 100.70 1 00.70, 2
201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
•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:( ) Fast:( ) relocation
200 amps or less = 59.36 1
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. 401 amps to 599 amps Mill 168.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,Leer panel
Q_CONTACT PERSON ::: : :: fee for branch circuits with
above service or feeder fee,
Business name: each branch circuit 7.42 2
— B.Fcc for branch circuits without
Contact name: service or feeder fee,first
branch circuit i 56.18 2
Address: Each add I branch circuit 7,42 2
City/Stale/ZIP: Miscellaneous(service or feeder not included)
Each manufactured or modular '
L 67.84 2
Phone:( ) Fax: :( )
dwelling,service and/or feeder
Reconnect only 67.84 2
E-mail: - Pump or irrigation circle 67.84 2
CONTRACTOR Signal lighting 67.84
Business name: ee 1 S Elf._ G.�,, ` C-- n orrlmiteergy panel,ehemt o s(on Page 2 2
Address: L p " L .E. I bi 4-- c-v- Each additional inspection over allowable in any of the above
CI /State/ZIP: 7 Additional inspection(I hr min) 66,25/hr
City/State/ZIP; 1 O - r ` c C r 0� \i a~� Investigation(1 hr min) 66.25/hr _
Phone:(S1)3) T 3 s— 6 Li tp R Fax:( ) D33-- ) ? f Industrial plant(1 hr min) 78,18/hr
Inspections for which nn let:is 90.00/hr
CCB Lie.: Li'-It-13 Electrical Lic.:)(p,153.Q- Suprv,Lie.:.jf p specifically listed(45 hr min)
.. ELECTRICAL PERMIT FEES• • • .
Suprv.Electrician signature,required: Subtotal; /op .70
Q l ry Plan review(25%of permit fee):
Print namc:� 1 t>`,` � 4`S pate: 1 f /
+ / Stale surcharge(12°/a of permit fee): f. 67,tit
Authorized signature: TOTAL PERMIT FEE: j/?., 75
This permit application espircs if a permit is not obtained within 180 p ,
Print name: Date: days after it has been accepted as complete. rL./
• Number of inspections allowed per permit,
1.1Building'Permns\ELC PermitApp HLR ERE.doc Rev 05/i t/Ora a40-1615T(IU05/COM/WEB