Permit q CITY OF TIGARD ELECTRICAL PERMIT
•1111 COMMUNITY DEVELOPMENT Permit#: ELC2014-00386
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 07/16/2014
Parcel: 2S 111 C D06200
Jurisdiction: Tigard
Site address: 9837 SW KIMBERLY DR
Project: Reigle Subdivision: KERWOOD ESTATES Lot: 25
Project Description: (3)branch circuits for bathroom remodel
Contractor: CANBY ELECTRIC INC Owner: KEN REIGLE
790 S IVY ST 9837 SW KIMBERLY DR
CANBY, OR 97013 TIGARD,OR 97224
PHONE: 503-266-7878 PHONE: 503-569-9432
FAX: 503-266-5543
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo/Purchase 07/16/2014 $71.02
Specifics: Service or Feeder
1 ea 12%State Surcharge- 07/16/2014 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other ap.li - law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180•a s of issuance, or if work is s • for more the 180
days. ATTENT_1: Oregon 'w re. •a you to follow the rules adopted by the Oregon Utility Notificatio enter Thos. -et forth in OAR
952-001-0010 l roue h OAR 952-r 11-'r90 ou/ay obtain a a-copy.f the rules or direct questions to OUNC by calling 503. 2.19: •r 1.800:32.2;
■
/11.1
Issued B / Permittee Signature: x
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' \ u 1 -e ('1 Date: i9/45/ v
7
LICENSE NO. / a'3$
Call 503.839.4175 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.
1
Electrical Permit Application pil� [ . FOR OFFICE USE ONLY
Received Permit No.:
City of Tigard i Date,Ily 7 i Lr ,ql CAL e3cv -al 38&
II q 13125 SW Hall Blvd.,Tigard,OR 9723 J 200/. Plan Review Other Permit:
503.718.2439 Fax: 503.598.1960 Date/By:
Inspection Line: 503.639.4175 Date Rcadytl3y: — lorir
TtCARU t 1� 0 1 ® See Page 2 fur
Internet: www tigard-or.gov Notified/Method. Supplemental Information
ormation
TYPE OF WORK _ PLAN REVIEW
❑New construction Addition/alteration,/replacement Please check all that apply(submit 2 sets of plans sv/items 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 CONSTRUCTION exceeds 10,000 amps at 150 volts er 0 Floating buildings.
_ less to ground,or exceeds 14,000 ❑Commercial-use agricultural
1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations buildings.
❑Multi-family El Master builder ❑Other: ❑Ftre pump. ❑Installation of 150 KVA or
❑Fmergency system. larger separately derived sys,
.IOR SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A""F""I 2"
)���� � f /// I OONP or more. occupancy.
Job 4: Job site address: 3-2 - ,-6ef-Ig ,btrC� , ❑Six or more residential units. ❑Recreational vehicle parks.
❑Health-care facilities. 0 Supply voltage for more Iha,
Citv!Stata/ZIP: /1`j j G�(G ��. 600 volts nominal
C�� % %� ❑Hazardous locations.
Suiteibldg./apt.#: Project name: ice`•-' ❑Service or feeder 600 amps or more.
TEE SCHEDULE
Cross street/directions to job site: Description I Qty. I End, f total f
- New residential single-or multi-family dwelling unit,
Includes attached garage.
Subdivision: Lot#: 1,000 sq.n.or less 168.54
Ea.add'I 500 sq.R.or portion 33.92
Tax mapiparcel no.: Limited energy,residential 75.00
DESCRIPTION OF WORK (with above q.ft.)
Limited energy,multi-family 75.00
it7,, 4)(,— , k�,�y f residential(with above sq.ft.) _
/_ f-ZJt'v/1�-`-- /-4.41./L. ' J Renewable Energy ❑ See Page 2
,t!�G i 7 ep1.li,*rtt .3 Services or feeders installation,alteration,and/or relocation
------ --- -- —
—:l — - 200 amps or less 100.70
PROPERTY OWNER --- ❑ TENANT'
-- -
201 amps to 400 amps 133.56
Namc: �� `t / L ) 401 amps to 600 amps -__ _` 200.34
Address: �� - f [ . , - GUl amps to 1,000 amps 301.04
� y��� // Over 1,000 amps or volts 552.26
City/State/ZiP: !7' ii.f/ [its. ' 201-- Temporary services or feeders installation,alteration,and/o
relocation
Phone: „3-)6-- ,,,s,-- of 3.7 Fax:( ) 200 amps or lass _ 59.36
Owner installation:This installation is being made on property that I own which is not 261 amps to 400 amps 125.08
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps 168.54
Owner signature:____ _ _.__ Date: __ ___ Branch circuits-new,alteration,or extension,per panel
A.Pic for brunch circuits with
,APPLICANT ❑ CONTACT PERSON —
t above service or feeder fee,
1 7.42
Business name: CG) f`- tC rkJ A � G , each branch circuit —
B.Fee for branch circuits without
Contact name: / „a service or feeder fee,first
56.18 5/a` S
G - �� -- branch circuit i(, C
'Address: 1.✓E ` T J/ ) Each add' branch circuit L 7.42 i,p
—
Miscellaneous(service or feeder not included)
City/State/L1P: / C 2-E C ) �1 ?? .34_
Each manufactured or modular 67.84
- ) dwcllit ,service and/or feeder
Phone: )I�' / Fax:: � '__�45• V Reconnect only 67.84
E-mail: _ Pump or irrigation circle 67.84
--_ COT tTRACfOR Sign or outline lighting 67.84.
f i_ Et , Ty( Signal circuit(s)or limited-energy Sec
Business name: l Y,.J.� e +G.•� 1 1 ` panel,alteration,or extension. Page 2 _
Address: -1(j7,0_, 5 Each additional inspection over allowable in any of the abe-
�' - Additional inspection(I hr min) 66.25/hr
41 City/State/ZIP: f,a,�^b, __ C'��01� , — Investigation(lhrmin) 66.25/hr
) . Industrial plant(1 hr min) 78.18/hr
Phone:O ' - V�'�- Fax:{ ) _-
G Inspections for which no fee is 90.00!hr
CCB Lie.:zO1 Electrical Lie.: _.) _ Suprv.Lie.: Z3�
specifically listed('/hr min)
— - f ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: ) r Subtotal: 7 ,02.
Print name: '11 IW Date: _) q Plan review(25%of permit fee):
State surcharge(12%of permit fee):
Authorized signature: — TOTAL PERMIT FEE -M t r5
This permit application rapirca if a permit is not obtained within.
Print name: I Date: days after it has been accepted as complete.
• Number of inspections allowed per permit.
I`BuildingiPermitrEl.0 Permit,4pp_ELR FAG doe Rev 04/21,12.014 440}46157(1 UD5ICOM,'WEB