Permit q
CITY OF TIGARD ELECTRICAL PERMIT
- COMMUNITY DEVELOPMENT Permit#: ELC2013-00560
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 09/24/2013
Parcel: 2S 111 AD 13700
Jurisdiction: Tigard
Site address: 15073 SW 91ST AVE
Project: Lidington Subdivision: MALLARD LAKES Lot: 3
Project Description: Replace panel
Contractor: ROSE CITY ELECTRIC CO Owner: LIDINGTON, STEPHEN
PO BOX 10004 15073 SW 91ST AVE
PORTLAND, OR 97296 TIGARD, OR 97224
PHONE: 503-287-6164 PHONE:
FAX: 503-282-1060 _
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 09/24/2013 $100.70
Specifics:, amps or less
1 ea 12%State Surcharge- 09/24/2013 $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 acc. :• 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. ATTE ION: Oreg.'n I.. requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-00 I through OAR : -001 0'•0. You may obtain a copy of the rules or direct questions to OUNC by callin .23 .1987 or 1.800. 32.2344.
Issued B'• L _ . 24 rL// kt /„,„Lid Permittee Signatu •
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' ` l/0' # i _ 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.
09/19/2013 12:04 FAX RECE�em el 001
Electrical Permit Application ED
City of Tigard - 19 2013 Rey /ay /3 Permit No.: & /3-0o56to
13125 SW Hall Blvd.,Tigard OR 97223 pt.yr ; Permit:
Pb ones 503.7182439 Fax: 503.598aNy OF TIGARD Dare/By.
T,,; F n Inspection Line 503.639.4175 BUILDING DIVISION N1otrG Ready/By: ': Other
®see rage x fur
Internet www.tigrird-ur.gov Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction Addition/alteration/replacement Please check all that apply(submit Z sets of pleas wfitems chocked below):
0 Service or feeder 400 rumps or more ❑Building over three stories
❑Demolition ❑Other where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION narcoeds 10,000 amps at 150 vole or []Floating buildings.
less to ground.or exceeds 14,000 ❑Commercial-teat agriculturnt
.1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑Multi-family D Master builder ❑Other: ❑Fire pump, []Installation of 150 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergetrry system. larger 1y�i sy t•
Cl Addition of now motor load of 0 A"."E"."1-2","1-3",
Job no.: l Job site address:6-07 3 S1.11 47`t- Six or uecuearrcy.
a Six or more residential units. 0 Recreational vehicle patio:.
Ci ty/Statc/Z1P: T i-,7 4 c a_ 15 z L c ❑Health-care facilities.❑Hazardous locations. ❑Supply voltage for more than
600 volts uominal.
Suite/bldg./apt.no.; Project name: Li 4l ,''` _ , ❑Service or feeder 60o or more.
FEE SCHEDULE
Cross street/directions to job site: eneRprloo 1 Qty. I- Fee. 1 rend 1 •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq.ft or less 168.54 4
Ea add'l 500 sq.R or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.R)
Limited energy,multi-family
0 6 L'e a qo//1 -'1 residential(with above sq.R) 75.00 2
I Renewable IF.nergy , n See Page 2
Services or feeders installation,alteration.and/or relocation 'M
- IQ PROPERTY OWNER I ❑ TENANT 200 amps or ass j_._ 100,70 z
201 amps to 400 amps 13356 2
Name. S 4 e I v„l L,'ol t fin-. - 401 amps
200.34 2
Address: /5-0•_-A. Jr c. 4. / J-N 601 amps to 1.000 amps 301.04 2
City/State/ZIP: Over 1,000 amps or volts 552.26 2
Temporary services or feeders Installation,alteration,and/or
Phone:( ) I Fax:( ) relocation -
200 amps or less 5936 1
Owner installation:This installation is being made on property that I own which is not 201 amps to400 gimps 125.08 2
intended for sale,lease,rent.or exchange,according to ORS 447,449,670,and 701. 401 amps to 599 amps 168.54 2
Owner signature. Date: Branch eireuit —new,alteration,or extension,zer emu;
❑ APPLICANT ❑ CONTACT PERSON A Fee for branch circuits with
above service or feeder fee,
7.42 2
Business name: each branch circuit
- B.Fee for branch circuits without
Contact name: service or feeder fed`,first 56.18 2
brunch circuit
Address: Each add'I branch circuit 7.42 2
City/State/ZIP: Miscellaneous(service or feeder not indnded)
•
Each manufactured or modular 67.84 2
Phone:( ) 1 Fax::( ) dwelti,service and/or feeder
Reconnect only 67.84 2
E-mail Pump or irrigation come 67.84 2
CONTRACTOR - Sipn or outline lighting 67.84 2
G
Business name: (7 L� 1<e 1 c Signal circuits)or limited eoerm, See
panel,alteration,or extension. Page 2 2
Address: Po :a.* 1 QO L( - Each additional Inspection over allowable in any of the above
City/St<tteJTIP: �P 1 !(� ^Additional inspection(I hr min) 6625/hr , -
G. 41 a u: 0e, 7 L Investigation(I lir min) 6625/hr
Phone:( -?) 2,e7-4((o Y - 1 Fax:(.col 2L_(O C,G, V Industrial plant(1 br min) _ 78.18/hr
Inspections for which no fee is
y r 7/I<CCB Lie.: (�'I(,3 ' 1 Electrical Lie.: (7 cz, D.,' Suprv.Lie.:S ,_S y�specifically listed(h hr min)
90.00/t`r
ELECTRICAL PERMIT FEES
Suprv_Electrician signature,required: A C, -subtotal:_ /o).70
/ 3 Plan review(25%of permit fee): —_----
Stale��,.n (,��l 1c.0 j Hate:5 7/i
Stale surcharge(12%of permit felt): /a.O fr-
Authorized signature; .9 --<_ TOTAL PERMIT FEE: //A.7 V
Print name: "' r L Date: / Tia permit application e�tpires if a permit is not obtained within 180
.�T., '77(e s-L'� ei (7/0 days after it has been accepted as complete,
• Number of imxpnctiocc allowed per permit
l:\&tadi,epermiblsc P m App_/ .R_EtE.dec Rev 05121/2013 410.46151(1lJO3JCOM Wun