Permit CITY OF TIGARD ELECTRICAL PERMIT
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1111111 • COMMUNITY DEVELOPMENT Permit#: ELC2015-00832
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/14/2015
Parcel: 1 S 136AA02100
Jurisdiction: Tigard
Site address: 10310 SW 69TH AVE
Project: Williamson Subdivision: FUR VALLEY Lot: 1
Project Description: Change 200amp service from overhead to underground.(House-Meter#1941106)
Contractor: POWER LINE ELECTRIC INC Owner: WILLIAMSON, KRISTOPHER
8403 SE SHERRETT ST 10280 SW 69TH AVE
PORTLAND, OR 97266 TIGARD, OR 97223
PHONE: 971-645-3807 PHONE:
FAX:
FEES
Quantity Description Date Amount
1 ea Services or Feeders-200 10/14/2015 $100.70
Specifics: amps or less
1 ea 12%State Surcharge- 10/14/2015 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 accordnck 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. ATT ION: Orego law re.uires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-6! 4090. Yo may obtain a copy of the rules or direct questions to OUNC by calling 503.232. •= .8111 2.2344.
Issue By: Permittee Signature: X • oL _ •
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. 15-3C) 5 5
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.
Electrical Permit APP li FOR OFFICE USE o�l.l
City of Tigard �VEP Received /0 // �S Permit No.: el-e-�'t//S 60 a 3
13125 SW Hall Blvd.,Tigard,OR 97223 Plan R view!
s Phone: 503.718.2439 Fax: 5 1 Date/ : Other Permit'
p 2(115
1 I t i t R I Inspection Line: 503.639.4175 Date Ready By: lu is 0 See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
I it), ,GARD PLAN REVIEW
New construction A•t' • . '� ib�',t �It t nt Please check all that apply(submit 2 sets of plans w/items checked below):
❑ P
0 Service or feeder 400 amps or more 0 Building over three stories.
❑ Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑Floating buildings.
less to ground,or exceeds 14,000 ❑Commercial-use agncultural
'1-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings.
❑ Multi-family ❑ Master builder ❑Other: ❑Fire pump. ❑Installation of 150 KVA or
❑Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑"A","E","l-2", `I-3",
f1 ��. 10OHP or more. occupancy.
Job no.: Job site address:
`� \c) �� G� Pie. ❑Six or more residential units. ❑Recreational vehicle parks.
City/State/ZIP: ❑Health-care facilities. ❑Supply voltage for more than
\\�('� \ O� ❑Hazardous locations. 600 volts nominal.
Suite/bldg./apt.no.: Project name: ❑Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I Qty. I Fee. I Total I •
New residential single-or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq.ft.or less 168.54 4
Ea.add'l 500 sq.ft.or portion 33.92 1
Tax map/parcel no.: i 5 / 34''4'4 C9 0-1 3C Limited ener gy,residential
75.00 2
DESCRIPTION OF WORK (with above sq.ft.)
\ Limited energy,multi-family
C`, ? ;�1 \'> ���� C V�cY\rCLt ,� residential(with above sq.ft) 75.00 2
Q M trig- •� Renewable Energy ❑ See Page 2
\-kv\(LZc accr.)-vv),- ec.i ((+t.t t_5 ., l'`p a Services or feeders installation,alteration,and/or relocation
fir P OPERTY OWNER ❑ TENANT 200 amps or less I 100.70 Mr.-70 2
I 201 amps to 400 amps 133.56 2
Name: .c\5 � • �Ak ,,,,LS0„ 401 amps to 600 amps 200.34 2
Address: \e-2....(6G Sw Gc1 i,. 1,4e., 601 amps to 1,000 amps 301.04 3
l Over 1,000 amps or volts 552.26 2
Cit}'/State/Z[P: `� ,‘ck` Temporary services or feeders installation,alteration,and/or
Phone:( ) Fax:( ) relocation
200 amps or less 59.36 1
Owner installation:This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
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
APPLICANT ❑ CONTACT PERSON A.Fee for branch circuits with
above service or feeder fee,
7.42
Business name: 'a �\,∎C each branch circuit
pVvC c v�� , B.Fee for branch circuits without
Contact name: Vc.s,„ew� service or feeder fee,first
c. c��� �� 56.18 2
c L branch circuit
Address: ,al.tU 5 '-'c, �1_,c‘'E'kk Each add'l branch circuit 7.42 2
\ 1 Qa �r�/ Miscellaneous(service or feeder not included)
City/State/ZIP: V(i,c\ciciv'\(i C� 11! Each manufactured or modular
Phone: n �( q Fax:: dwelling,service and/or feeder 67.84 2
(v,�' ) —\ `� \ �� ` ( ) Reconnect only 67.84 2
E-mailAtN•1(c OU lec:Lci, 6 c��inio.Co*' Pump irrigation 2
Y Pum or irri anon circle 67.84
CONTRACTOR Sign or outline lighting 67.84 2
Business name:?0s, V.,„4.,C., \e Ckt,,..c.. ,- Signal circuit(s)or limited-energy See
panel,alteration,or extension. Page 2 2
Address: QLQ', e - Each additional inspection over allowable in any of the above
Additional inspection(l hr min) 66.25/hr
City/State/ZIP: •Vock-VoiNck , Q (.�" (,y- Investigation(I hr min) 66.25/hr
Phone:(cm) (c_-?,c '-T.7 T" `Fax::(( ) Industrial plant(1 hr min) 78.18/hr
� ;�' I Inspections for which no fee is
CCB Lic.:4V 1 6 Electrical Lie.: C ,® q Suprv^Lic.:5 -3O j ee specifically listed('/2 hr min)
90.00/hr
ELECTRICAL PERMIT FEES
Suprv.Electrician signature,required: Subtotal: /cc). ''7
Print name:��,,G /2 ate:C3L� A. Plan review(25%of permit fee):
rle� (` y Statesurcharge(12%of permit fee): /a g
Authorized signature: ,U,� TOTAL PERMIT FEE: //A.•7
1 This permit application expires if a permit is not obtained within 180
Print name: e__,.,(.., \(U` v yc\1 Date: CL� V A.\S' days after it has been accepted as complete.
V • Number of inspections allowed per permit.
I.\BuildingWermits\ELC PermitApp_ELR_ERE doe Rev 05/21/2013 440-46t5T(11/05/COM/WFB