Permit rt CITY OF TIGARD ELECTRICAL PERMIT
g COMMUNITY DEVELOPMENT Permit#: ELC2014-00593
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/16/2014
Parcel: 1 S134CB01800
Jurisdiction: Tigard
Site address: 12130 SW SUMMER ST
Project: Cluff Subdivision: SUMMER HILLS PARK Lot: 21
Project Description: Electrical reconnect only
Contractor: NOT REQUIRED Owner: CLUFF,WAYNE W&THERESA D
12130 SW SUMMER ST
TIGARD, OR 97223
PHONE
PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Reconnect Only 10/16/2014 $67.84
Specifics:
1 ea 12%State Surcharge- 10/16/2014 $8.14
Electrical
Type of Use: SF
Class of Work: OTR
Type of Const:
Occupancy Grp:
Total $75.98
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. ATTEN .': Oregon law requires you to follow the rules adopted by the Oregon Utility Notification C nter. Those rules are set forth in OAR
952-001-0r I through OAR 952-II -so" Y+r may obtain a copy of the rules or direct questions to OUNC by cal' 2.1987 or 1.800.332.2344.
Issu d By: -- / Permittee Signature: 1 lard < G
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.
4 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.
,pf ei
r /3 Approved plans are required on the job site at the time of each inspection.
ti 1'I
10/15/2014 02:58 3608851795 ALL AROUND MAINTENAC PAGE 01/O1
Electri I Permit A Iicati : �,, FOR tu,rlcr t SE(mr,v
City of Tigard 1_c Rewlaved: -005 G
13125 Sw Hall Blvd.,Tigard,pl2 97223 '` `r gate /l Pumit No.: �/, '�C(��
l g Phone: 503.7182439 Pax: 503.598.194V
��
�� 1;,j, : Othsr Permit:
•a c A RD Inspecttow Lane 503 539.4175 '` • . to Ready/By:
IMemel: wWw Tigard or gov Notified agno 2 for
��V� ����� Notified/Method: 6..See lemo tat laltxmation
❑New construction ❑Addition/alteratio Z'replacesuent rPlease chock all that apply(submit 2 sets of plank w/µems checked below):
Demolition �Otltez in Service or feeder 400 amps ar orerc ❑Building over three stories.
m •, whets the available fault current Marinas and boatyards.
i . ,,- Li. ,r r ra1.10' 1, q.,11,?,,, V tr,_ eutands 10,000 am at 150 volts oY•
.-. ti, pia - Ps Cll9oatingbu0usea.
r )•slid 2 farnjly dwelling ❑" ' - -rcia]/industrialVT less to ground,or exceeds 14,000 ❑Commerolal-use agricultural
b Accessory building, amps nor all other installations, buildings.
❑Multi-family ❑Master builder• ❑Other: El Fits pump.
❑l larger sepa of 150 derived vA or
s .t._., ,�'4 ' r , s at : J i 7tiial r r` ❑)emergency now largerstately"I-3", system.
— '� y La Addition of now motor load M U"A". 1.1", 1.3 ,
--- ._. ,..rte •.� __s-..
Job no.: lob site address. 1, ��(� S;,trnmQ,r �t,` y 100HP or more occupancy.
` ❑SfF M more rtaidenlnl units. ❑Recreational v,Mok parks,
City/State/Z1P:T\%Ot(01 a (j� 3 ❑Health-care facilities. ❑Supply voltage Sir dam than
l(t Y i ❑Hazardous locadom. 600 volts nominal.
Suite/bldg./apt.no.: Project name: Q ('j��lr'^yQ O- ❑Service or feeder 600 amps or pools,
Cross street/directions to job site: ``/� 1 ... c-= fi`_�."s,-1',:. , '� i ` '.''
... 1:h ice tlop Qty. Fee. Tato •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: f Lot no.: 1,000 sq.fl.or leas 168.54 4
)
Tax map/parcel no.: Ea.add'I 500 sq,ft or portion 33.92 3
- ,a� a -:-.7'::77.-... .,.,.� �^ —' Limited energy,residential
4- m m f ( i ,+ s ,• -� - 75.00 2
5.., a. L a . 1'- •s ,i-,e.)0 tip VSO:�: *a `i�. _ (with above tiq.ft)
(' C _o `� Li s'n( nti,j ithab above •.
r `-•-, l 1` o edattdal with above ft. 73.00 2
u Services or feeders installatiois,slteration,and/or relocation
.t a +v�o-=41.ZZ t:r s, 1`i;.'1d .', .1r - fI r ; r - z .. 200anlpsorless 100.70 2
Name: w(\�l rt/1 _..._:`� - --- ,,
201 amps to 400 amps 199.56 2
�J `{ Y 1 Irk 407 amps W fi00 amps 200,34 2
Address: V - 601 amps to 1,000 amps 301.04 Z
City/State/ZIP:
_ Over 1,000 amp or volts 552.25 2
Temporary serrices or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
Owner installation;This installation is being made on property that f own which is not 201 amps or less 59.36 1
Intended for sale,lease,rent,or exchange,according to ORS 44'7,449,670,and 701. X201 amps to 400 amps 125.08
401 amps to 599 turps 168.54 2 2
Owner signature: Date Braucb circuits-nom,alteration,or extension,1?c r panel
/, -e t' 01,4'rtr t .:as > n rye t i..-. A.Fee
..., + S-.f r._a� �r.: �.:<._ .ti ��� �jt / far branch circuits with
S ,-'3777',=-,,,"7.1,1,31.6,.:4;.*A shove 5ervicti or reedu fee,
7.42 2
Business name: �, . • , A .CA IA f i/��( each branch circuit
1 1 t 1 S.Fcc for branch ctr ti ins Withpu!
Contact name: scik__, service or feeder fee,first 5618 2
branch circuit
Address: 504),
It •`
• aim - Each add'i branch circuit 7.42 2
City/state/ZIP: ti • • ��BSI`� Miscellaneous(service or feeder not included)
Each manufactured or modular 67 2
Phone:(moo ) ,-a a1 Pax::(_ ) dwelling,service and/or feeder
Email a C%r6 • I'yt i' t 6 1 a 6 A 1 S Reconnect only X 67.84 2
�' :� r/ "i ti ,F" --,' �i13"' r rr _ Pntn00rirrigarioncircle 67.84 2
_._ Sign or outline liotigg
61.84 2
Business name: Signal circuit(s)or limited-energy Sec
panel,alteration,or extension. Page 2 2
Address: Each additional inspection over allowable in any elflike above
'• Additional inapectfoo(1 hr min) 6625/hr
City/Stale/LIP: investigation(1 hr min) 66,25/hr _
Pbona:( ) flax:( ) industrial plant(i hr min) _ 78.18/in
Inspections for which no Inc is 90.00/hr
CCB Lie.: Electrical Lie.: Suprv.Lie.; s• 'Stall listed l4 hr min
r ' rgZie a mJ- -r Sup . electrician signature,required: Subtot al:
Print name: //�J 11 Date: Plan review(25%of permit fee):
Cc h. .a_ ,_.e,,JLd(�CL State surcharge(12%of permit fee
`1_ Authorized signature: �j y TOTAL PEANUT ME: ��,d(
....
�(rJ�`` Print name: Alena Gorbunova 10/15/14 T�P it applicatiop aspires If a permit ii soon cbtaiaod within 180
Date; days attar it lard been accepted as complete.
" Number of inspections allowed per pennil.
l:tButdfnalPetint nz.,'armtiAN, n.t p,i-don Itevns/21a013 44O-'057111/05,COM/v/aa