Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit#: ELC2013-00644
TIGAAD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/28/2013
Parcel: 2S 103CC 12400
Jurisdiction: Tigard
Site address: 13620 SW PIPER TER
Project: Parker Subdivision: WHISTLER'S WALK NO.2 Lot: 71
Project Description: Wiring for outside kitchen and fountain plug
Contractor: SQUARE 1 ELECTRIC INC Owner: PARKER,TREVOR L& DEBRA M
10117 SE SUNNYSIDE RD., STE. F-216 13620 SW PIPER TER
CLACKAMAS,OR 97015 TIGARD, OR 97223
PHONE: 503-867-2423 • PHONE: 503-970-7807
FAX: 503-914-0432
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/28/2013 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/28/2013 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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. ATTENTIO . n law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 t ugh OAR 2- - 09 . You may obtain a copy of the rules or direct questions to OUNC by callin• e . 2.1987 or 1.800.322.2344.
Issued By: Permittee Signature: Ara�
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' .,f, 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.
•
Oct 24 13 03:08p Square 1 ELectric 5038553516 p.1
1 ' ECEI�J@' ED
Electrical Permit Application FOR OFFICE t SE ONLY- . •
City of Tigard , T 2 4 2013 Date/B Received
lam/5 le' t�C a-Ol " 4°64
= Permit No.:
1111
13125 SW Hall Blvd.,Tigard,OR 9 Plan Review I
Phone: 503.718.2439 Fax 503.598.1960 Date/B . Other Pennit
rIGARD Inspection Line: 503.639.4175 CITY OF TIGARD DateReadyBy: Jwis: Ea See Page 2for
Internet: www.tigard-Or.gov Notified Method: Supplemental Information
TYPE Bii.J )NC DIVISION
PLAN REVIEW
❑Nmy construction ,1 Addition/alterationlreplacement Please check all that apply(submit asets of plans w/itetns checked below):
❑Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSIRIJCT[ON I exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agricultural
M 1-and 2-family dwelling El Commercial/industrial ❑Accessory building amps for all other installations. buildings.
El Multi-family ❑Master builder ❑Other: ❑Fire pump. ❑Installation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ n system_ larger separately derived system.
❑Addition o fnewmotorloadof ❑"A","E',"1-2","1-3°,
tivJob no.: Job site address: 1�3(p Zo S {fit,1 .2 I � 100HP or occupancy.
1' ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: I -c- T N3 0./7_, 2 Z
❑Health-care facilities. ❑Supply soilage for more than
❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: { v- -K ❑Service or feeder 600 amps or mare.
FEE SCHEDULE
Cross street/directions to job site: oeteription 1 Qty. I Fee- I To 011 I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1.000 sq.ft.or less 168.54 4
a.add'I 500 sq.ft or portion 33.92 1
Tax map/parcel no.: Limited energy,residential
DESCRIPTION OF WORK { (with above sq.ft.) 75.00 2
e Limited energy,multi-tinnily 75.00 2
t \ A - DR- Cn S iCLP L C, ,"' residential
vices or feeders above ve sq.ft),
Services or feeders installation,alteration,and/or relocation
t7 k/Lt., 200 amps or less 100.70 2
X PROPERTY OWNER 1 J ❑ TENANT 201 amps to 400 amps 133.56 2
_ 401 amps to 600 amps 200.34 2
Name: f-1 o e D��0'- �wNr 601 amps to],000 amps 301.04 2
Address: Sa,/■,s_i2 CL.5 Gt.-ADO-V.-C.— Over 1,000 amps or volts 552.26 2
relocation
Temporary services or feeders installation,alteration,and/or
City/State/ZIP:
Phone:(y)3) q1 D'-) 80-1 I Fax:( ) 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
Owner signature: Date: A.Fee for branch circuits with
0 APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee,each 7.42 2
rdt branch circuit
Business name: B.Fee for branch circuits without
service or feeder fee,first 56.18 2 '
Contact name: branch circuit s(o C g
Each add'1 branch circuit 1 7.42 '1.4.2.- 2
Address: Miscellaneous(service or feeder not included)
Ci lStatrlZiP: Each manufactured or modular 67 84 2
dwelling,service and/or feeder
Fax: ( ) Reconnect only 67.84 2
Phone:( ) -
Pump or irrigation circle 67.84 2
E-mail: Sign or outline lighting 67.84 2
CONTRACTOR I Signal circuit(s)or limited-energy
Business name: panel,alteration,or extension. , Page 2 _ 2
5 LI.E� c , ��I "" rnL eLl1 G j Each additional inspection over allowable in any of the above
Address: I O ( (, 3i✓ St t..vl t1 s i ti2 Rd • S 1 E F--2f(p Additional inspection(l hr min) 6615/hr
City/State/ZIP: � O 2 /'t-7 0 I � � Investigation(1 hr min) 6625/hr
ell) , "1 Industrial plaru(lhrrain) 78.18/err
Phone:(S{f3) ?,(0-1 - 2.41'Z 3 I Fax:(ap3)GI f y-CYy 32- Inspections for which no fee is 90.00/hr
Q specifically listed(%lir min)
CCB Lie.:(O 5(010 Electrical Lic.: O 2(v Suprv.Lic.: 53' i—15 ELECTRICAL PERMIT FEES
l/I • Subtotal: (0 3 •(cD
Suprv.Electrician signature,required:F� � t o� Plan review(25%of permit fee):
Print name: J4... ,-e '} c .,� Date: /0/24//3 State surcharge(12%of permit fee): 1 ,,(0 j
TOTAL PERMIT FEE: '-( I . 2`j ,,,\�/
Authorized signature. _�'/�N�� This permit applicatian expires it a permit is not obtained within 180 V"
Lfr days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
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