Permit n CITY OF TIGARD ELECTRICAL PERMIT
` �1 : - COMMUNITY DEVELOPMENT Permit#: ELC2013 00653
[G AR D 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/30/2013
-F
Parcel: 2S103CB10400
Jurisdiction: Tigard
Site address: 12192 SW QUAIL CREEK LN
Project: Gadbery Subdivision: QUAIL HOLLOW-EAST Lot: 62
Project Description: Adding(1)branch circuit for floor heat in bathroom.
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: GADBERY,MICHAEL K&CATHY A
PO BOX 3948 12192 SW QUAIL CREEK LN
WILSONVILLE,OR 97070 TIGARD,OR 97223
PHONE: 971-563-8211 PHONE:
FAX: 503-266-1349
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 10/30/2013 $56.18
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/30/2013 $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 OAR 952-001-0090. You may obtain a copy of I or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: Permittee Signature: 0
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.
•
i Electrical Permit Applic b` 1..,EIVED FOR OFFICE USE ONLY _ •
City of Tigard Received
Date/3 : LO , o 1 ill Permit No.: C'LG- 0i3—a3 s
N >? ! 13125 SW Hall Blvd.,Tigard,0 p7?231 O 2013 Plan Review
Phone: 503.718 !439 Fax: 50 . I9 Date/Bv: Other Permit: all nod)3—..6017n
,� T I C A R D
Inspection Line: 503.639.4175 Date Ready/By: lyric
Tntemet: www.tigard-or.gov CITY OF TIGARD Notified/Medtod: Page 2 for
% p Supplemental Information
tTY i,4, ! Vi DIVISION PLAN REVIEW
0 New construction 5 Addition/alteration/replacement Please check all that (subunit m
wt apply(sunit 2 sets ofplans w/ite checked below):
❑Demolition ❑Service or feeder 400 amps or more ❑Building over three stories.
? ID where the available fault current ❑Marinas and boatyards.
Q —,-
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings.
and 2-family dwelling ❑Commercial/industrial ❑Accessory building less to grall other or exceeds ons. ❑Commercial-use agricultural arnps tk ❑Multi-family 0 Master builder For all oche inslttllatimts. buildings.
❑Other. ❑Fine pump, ❑installation of[50 K VA m
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑Addition of new motor load of ❑°A" •E"'l_r•'1.3".
Job no.: Job site address: fill Z IOOHP or more. occupancy.
Cl •t>2 A ❑Six or more residential units. ❑Reercational vehicle parks.
' City/State/ZIP: ❑Hhalthcarc facilities. ❑Supply voltage For more than
❑Hazardous locations. 600 volts nominal
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
Cross street/directions to job site FEE SCHEDULE
.4
Descriptiea 1 Qty. I Fee. I_ maxi I
New residential single-or multi-family dwelling unit.Includes attached garage.
V Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Tax map/parcel no.: Fa add'I 500 sq.R.or portion 33.92 1
Limited energy,residential 75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
1\ ADD C k� r Limited energy.multi-family' 75.00 2
ADD ( (�.r �_j � � residential(with above sq.ft.)
!`� Renewable Energy ❑ See Page 2
Services or feeders installation,alteration,and/or relocation —
o l ❑ PROPERTY OWNER ❑ TENAN3- 200 amps or less 100.70 2
201 amps to 400 am
Name: P amps [33.56 2 r
401 amps to 600 amps 200.34 2
Address: 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:( ) Fax:( ) relocation
V Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
T.
/. intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. 201 amps to 400 amps 125.98 2
401 amps to 599 amps [68.54 2
Owner signature: Date: Branch circuits—new,alteration,or extension,per pooch
❑ 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 fee,first r
branch circuit 56.180 r 1 2
Address: 742 2
Each add'I branch circuit
City/State/ZIP:
Miscellaneous(service or feeder not induded)
Each manufactured or modular _ -
Phone:( ) Fes::( ) dweller servireand/or feeder 67.84 2
E-mail: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
4
Business name: cTiL � G," n CL Signal circuit(s)or limited-energy See .
- 47 �`-G4I /�-. panel.alteration or extension. Page 2 2
L. Address: P. 'Jr a 314 p, Each additional inspection over allowable in any of the above
City/State/ZIP: (An,1�S�/!'i� o/J C1�1�D
Additional inspection(I hr min} 66.25/hr
Ci[_ �'1 ! r Investigation(t hr min)
6625/hr
Phone:(q1+) gle3 � ' U Fax:( b Z4O{D (7 ql Industrial plant(1 hr min) 78.18/hr
CCB Lic.: + Electrical Lie.: J Inspections for which no fee is
`(0 13gZ .:,1 L Suprv.Lie.: 51 —5 specifically listed(%a hr min) 90.00/hr
Ni.. Suprv.Electrician signature,regal -1: t 0 i/(e ELECTRICAL PERMIT FEES
Print name: r Subtotal:_ �p r �g -
.iA.1/„� IV,et,y • Date: 1p_z „ /3 Plan review(25%of permit fee):
J State surcharge(12%ofpermitfee): �p r 74
Authorized signature: F
TOTAL PERMIT FEE: (j z ✓j
Print name: Date: This permit application expires if a permit is not obtained wittu t80
days after it has been accepted as complete.
Z'd 617£199Z£O9 oppe3 Iinoai0 aid dl£:90 £l 6Z PO