Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMEN Permit #: ELC2013 00738
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2013
'TIGARD Parcel: 2S1070001305
Jurisdiction: TIGARD
Site address: 16780 SW BULL MOUNTAIN RD
Project: PARK Subdivision: CHURCHILL FOREST Lot: C
Project Description: (1) service and (2) branch circuits for fire damage.
Contractor: SQUIRES ELECTRIC Owner: PARK, BETTY
1001 SE DIVISION STREET #1 KIM, KWANG JOO
PORTLAND, OR 97202 16780 SW BULL MOUNTAIN RD
TIGARD, OR 97224
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/12/2013 $100.70
Specifics:, amps or less
2 crt Branch Circuits w /Purchase 12/12/2013 $14.84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/12/2013 $13.86
Electrical
Type of Const:
Occupancy Grp:
Total $129.40
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 the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: Permittee Signature: ✓ /4��L�..�
Ale
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.
1ECEIVEI� a
Electrical Permit Aaplicat' r f 1R t,r1 lc'[ t_s� ii�l
City of Tigard Revalued Permit No.; 2
_ g g C 1 2 13 OateiBY, l //6/ 13 Orr- GLC d7l i i 7.94?-7 .71
I - ° 13125 SW H Blvd., Tigard, OR 9 Plan Review
Phone: 503.718.2439 Fax: 503.598. 60 Date/13y: Oihtr Perini':
f1GARD Inspection Line: 503.639,4175 Date Readyigy: — 1 53 Sec rage 2 for
Internet: www.tigard- or.gov CITY OF T�IGARFD� Notihed/Method: I , SUpplrmentallnfOrtt1 n
l0
r = ' P!y t!ii IJHl ISION PLAN REVIEW
Ne w construction A ddition /alteration/replacement Meese check ail that apply (submit 2 sets of plans +�litems checked below):
El Service or fader 400 amps or more ❑ Building over three stories.
t I Demolition Q Others where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 Amps at 150 volts or ID Floating buildings.
� less to ground, or exceeds 14.000 ❑ Commercial -use agricultural
," I - and 2-family dwelling ❑ Commercial /industrial Q Accessory building amps for all other installations. buildings.
E Multi- family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation or KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency n1. A r aepar1tcly "I. 2d system
[] Addition of ,sew new motor loud or ❑ " " . "E'' "1-2",
Job no.; Job site address: r � � � ;J . t0OH ar more occupancy.
■ A it) ,� �-.� s al>R►1 ltd ` �❑ Six or more residential lints. ❑ Recreational vehicle parks.
City /State/ZIP: '� /19 �. �/? ❑He - rare f ac ili t i es. ❑ Supply voltage for snore than
a` l! ` L — ❑ Hazardous locations. 600 volts nominal.
• Suite/bldg. /apt, no.: Project name: 0 Service or fonder 6 amps or mole.
FEE SCHEDULE
Cross street/directions to job site: oes '1 Ow. Fee. I Total I -
New residential single- or multi - family dwelling unit.
■ Includes attached garage. r
' Subdivision: 1,000 sq. rt or less _ 168.54 1 4J
Tax map /parcel no.: Ea. add'I 500 sq. R. or portion 33.92 I
Limited energy. residential 7500 -,
DESCRIPTION OF WORK . (with above sq. _
^ + Limited energy, multi-family 75,00 2
- O` s residential (with above sc. ft.)
~ +� t P. ' Renewable Energy ❑ See Page 2
A Services or feeders installation. alteration, and /or relocation
`
• El PROPERTY OWNER ❑ TENANT 200 amps or less ` 100.70 Vb , 2
201 an+ps to 400 amps 1 33 1 I
fie 401 amps to 600 amps 200.34 2
•1 ' a dress: 601 amps to 1.000 amps 301.04 2
V - - Over 1,000 amps or volts 552.26 _ 2
arty /State/ZIP:
Temporary services or feeders installation, alteration, and /or
at: ( ) Fax: ( )
200 amps or less 59,36 I I
O r
Owner installation: This installation is being made on property that I own which is opt 201 amps 10400 amps 125.08 '
intended for sale, leaSe. rent, or exchange, according to ORS 447, 449, 670. and 701. 405 amps to 594 amps 168.54
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
❑ APPLICANT A. Fee for branch circuits with r
❑CONTACT PERSO above service or ieeder tee,
7.42 I {� 1 12
Business name: SQUIRES ELECTRIC, INC. each brunch circuit
--
B. Fee fur branch circuits w ldmt,r
Contact name: ANDREW COHEN service or feeder fee, first 56.18 1 2
branch circuit
Address: 1001 SE DIVISION ST., #1 Each 8dd'1 branch circuit 7,42 IT
City /State/ZIP: PORTLAND, OR 97202 Miscellaneous (service or feeder not included)
- •- C Each manufactured or modular 67.94 2
Phone: 503 252 - 1609 dwelling. service and/or feeder
Phone: ( 503) Fax:: (503 - ) 253 - 5831
Reconnect only 67.84 2
", E -mail: ANDREW@SQUIRESELECTRIC.COM P omp or irrigation circle 67.84 2 -
CONTRACTOR Sign or outline lighting 67.84 I 1
Business name; SQUIRES ELECTRIC, INC. Signal circuit(s) or limited - energy
panel, alteration, or extension. I Page 2 2
Address: 1001 SE DIVISION ST. #1 Each additional inspection over allowable in any of the above
• Additional inspection (I hr min) 1 66.25/ hr 1
City /State/ZIP: PORTLAND, OR 97202 _ • Investigation (I hr min? ] 66.251 hr
Phone: (503) 252 -1609 •ax: .03) 253 -5831 Industrial plant (I hr min) 78.18/ hr . 1
Inspections for which no fee is I
90,00/ hr I
CCB Lic.: 135085 Electrical Li .: 26 - I 'IC Suprv. Lie.: 4882S specificany listed cA hr min) I I
EL PERMIT, FEES
Suprv. Electrician signature, r • ' -d: Subtotal: otal: e
t name: JOE SQUiRESMIF l Date. ` la Plan review (25% of penr)it fee):
State surcharge (12% of permit fee): b - 8
'Thorized signature: -1" TOTAL PERMIT FEE: ,
I f This permit a pplication expires if a permit is not Obtained within 180
?Tint name: JOE SQUIRES Date:
� is ` 3 days after it has been accepted as coniplere.
• Number of inspections allowed per permit.
I.18uitding\Permits\ELC PemaiIApp o4o913.eoc 440.161ST( Il /0) /Com /En