Permit CITY OF TIGARD ELECTRICAL PERMIT
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COMMUNITY DEVELOPMENT Permit ft: ELC2014-00124
Date Issued: 03/17/2014
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503 718 2439 Parcel: 1 S134CD05500
Jurisdiction: Tigard
Site address: 11745 SW SUMMER CREST DR
Project: MILLER Subdivision: BURLWOOD NO 3 Lot: 15
Project Description: Service change with(2)branch circuits.
Contractor: STEEL MOUNTAIN ELECTRIC LLC Owner: MILLER, DAVID L
PO BOX 20786 MILLER. GABRIELLA S
KEIZER, OR 97307 11745 SW SUMMER CREST DR
TIGARD, OR 97223
PHONE 503-991-5778 PHONE
FAX
FEES
Quantity Description Date Amount
1 ea Services or Feeders- 200 03/17/2014 $100.70
Specifics: amps or less
2 crt Branch Circuits w/Purchase 03/17/2014 $14 84
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12%State Surcharge- 03/17/2014 $13 8E
Electrical
Type of Const:
Occupancy Grp:
Total 5129 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 o e r or direct questions to OUNC by calling 503 232.1987 or 1 800 33
Issued By: y �c�—ry Fermittee Signature:
�� -- 111
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.
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Electrical Permit Application FOR OFFICE USE ONLY
Received
City of Tigard �= Permit No G_ L,
Plan R
a • 13125 SW Hall Blvd.,Tigard,OR 9722 \\ Plan Review
Phone: 503.718.2439 Fax: 503. Date/By: Other Permit
Inspection Line: 503.639.4175A ♦ _.- n11�e, Date Read B Y )nms
® See Page 2 for
TIGARD Internet: www.tigard-or.gov
Notified Method - Supplemental Information
�t 'INIT. OF WORK Print name:
I--1 New construction \ddlllun/altCralinn'replacement
❑ Demolition Other: PLAN REVIEW
Please check all that apply(submit 2 sets of plans w/items checked below):
CATEGORY OF CONSTRUCTION
ElService or feeder 400 amps or more ❑ Building over three
14 1-and 2-family dwelling U Commercial/industrial U Accessory building where the available fault current stories.
❑Other: exceeds 10,000 amps at 150 volts or III Marinas and boatyards.
❑Multi-family ❑ Master builder a less to ground,or exceeds 14,000
❑ Floating buildings.
JOB SITE INFORMATION AND LOCATION amps for all other installations
Job no.: Job site address://'7 ►.t/ ❑agriculturalonmerdal•»sc
Q ecvl�A/mL s1tt" ❑Firepump
d ❑Emergency system. buildings
City/State/ZIP: T Q fz 97 27. CI Addition of new motor load of ❑
Installation of 150
100HP or more. K VA or
Suite/bldg./apt.no.: Project name:
❑Six or more residential units. larger separately derived system.
Cross street/directions to job site: ❑ Health-care facilities
❑ A., ..E.. ..l 2.. ..1 3..
occupancy.
❑ Hazardous locations Recreational vehicle
❑ Service or feeder 600 parks.
Subdivision: Lot no.: amps or more ❑ Supply voltage for
more than
Tax map/parcel no.: 600 volts nominal.
(� DESCRIPTION OF WORK
j{A✓/L E C�/92`t✓�G—— add A-
Description SCHEDULE
[lescription I Qry. I Fee. I Total I'
New residential single-or multi-family dwelling unit.
Includes attached garage.
X PROPERTY OWNER ❑ TENANT 1,000 sq.ft.or less 168.54 4
Name: via-v,n /4 i// Ea.add'I 500 sq ft or portion 33.92 I
Limited energy,residential
Address: //74/9" r" S ci,i4 sigL Gz r Q✓: (with above sq.ft.) 75.00
Limited energy,multi-family
City/State/ZIP: Q 9 residential(with above sq.ft.) 75.00
i/� �•rrz-v 2 7ZZ�
Renewable Energy U See Page 2
Phone:(' ' ) ?ell, 40-..9' Fax.( ) Services or feeders installation,alteration,and/or relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less I 100.70 )(0,/0 2
intended for sale, lease,rent,or exchange,according to ORS 447.449,670,and 701. 201 amps to 400 amps 133.56 2
Owner signature: _ Date: 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
APPLIICANT I ❑ CONTACT PERSON Over 1,000 amps or volts 552.26 2
Business name: $''JLLC-t- 46),,jr.i7H Vex/16c_ Luc, Temporary services or feeders installation,alteration,and/or
�1w relocation
Contact name
l�V`_c_C 51-4.41 L, 2-4( 200 amps or less 59 36 I
r
Address: Zj 1 78p 201 amps to 400 amps 125 OS _2
2" 401 amps to 599 amps 168.54 2
City/State/ZIP: S. ZED G(E- 5"-7367 Branch circuits—new,alteration.or extension.per panel
Phone: ) Fax: I A Fee for branch circuits tvnh
( ??/' X77& ( - 97a above service or feeder fee. 1i •L ,l
Ck @ . C TN /G,�7� each branch circuit 7 42 '�($-1 2
E-mail: u B.Fee for branch circuits without
CONTRACTOR service or feeder fee,first
branch circuit 56.18 2
Business name:$', fir _ q.JNrt1... &—/eciv2c., L(.,,G
Each add'I branch circuit 7.42 2
Address: j.0.�x 20-76j Miscellaneous(service or feeder not included) _
�c Each manufactured or modular 67 84 2
:
City/State/ZIP: / Q t2 9 7 /ry dwelling,service and/or feeder
Reconnect only 67.84 2
Phone:q;" 7 775 Fat:ebe )cj —9 7Qpp Pump or irrigation circle .
67 84 2
CCB Lic.: Electrical Lie.: C/,A t Suprv.Lic.: c.f)0 Sign or outline lighting 67.84 , 2
p 1 9 r "__ r Signal circuit(s)or limited-energ% See
Suprv. Electrician s ature,required: (566r:Tibi4A/P� � b�t �y panel,alteration.or extension Page 2 2
V 410 n Each additional inspection over allowable in any of the above
Print name: `7 ? Date: ./G,./c./ Additional inspection(I hr min) 66 25/hr
aAC-,('� v. Investigation(1 hr min) 66 25/hr
Authorized slim att re: ,
/ •(,1� �. �� Industrial plant(I hr min) 78.18/hr
J w -
1\Buil ding\Permits\ELC_PennitApp_ELR_ERE doe Rev OS/21/2013 440-46I ST(i I/OS/COM/WEB
Inspections for which no fee is
90.00/hr
specifically listed('A hr min)
ELECTRICAL PERMIT FEES
Subtotal
Plan review(25%of permit fee):
State surcharge(12%of permit fee): 'r L -1
TOTAL PERMIT FEE: f 943 1.1
This permit application expires if a permit is not obtai d wish thin 1811 days after it has been accepted as
complete.
• Number of inspections allowed per permit
1\Building\Permirs\ELC_PermitApp ELR_ERE doe Rev 05/21/2013