Permit CITY OF TIGARD ELECTRICAL PERMIT
`` '1 8 ' COMMUNITY DEVELOPMENT Permit#: ELC2015-00862
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 10/22/2015
Parcel: 2S 110AA90941
Jurisdiction: Tigard
Site address: 10813 SW CANTERBURY LN 104
Project: McMicken Subdivision: CANTERBURY HEIGHTS CONDO Lot: 9-4
Project Description: (2)branch circuits for reconnect of furnace and a/c
Contractor: WEST SIDE ELECTRIC CO INC Owner: MCMICKEN, ELIZABETH A REVOCBLE T
1834 SE 8TH AVE 10813 SW CANTERBURY LN#104
PORTLAND, OR 97214 TIGARD, OR 97224
PHONE: 503-231-1548 PHONE:
FAX: 503-736-0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 10/22/2015 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 10/22/2015 $7.63
Type of Use: SF Electrical
Class of Work: ALT 1 ea Investigation Fee 10/22/2015 $90.00
Type of Const: 1 ea Investigation 12%State 10/22/2015 $10.80
Occupancy Grp: Surcharge
Total $172.03
' I
Required Items and Reports(Conditions)
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in ac ith approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATT TION: Orego law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001- 10 through OAR 952-•: 00•0. You may obtain a copy of the rules or direct questions to OUNC by . • ••232.1987 or 1.800.332.2344.
•
Issu d By: _ / ' ! Permittee Signatur- 04/Sri r-// _
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale,lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR.ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
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Inspectio Line: 503.639.4175 bate Ready/By: brit: ® See Page 2 for
Internet: www.tigard-or.gov Notified/Method: 1 Supplemental Information
`'i' I "1,M1Ih `.r _' wl• s . ,�y1. �,yy. i',�•S.^ u,a' "tGut�„i+c. J i IseiA1.U,�I�'•Gln �p�p Mi1j4IPWi '
'r ,.I•:�.. ',��'�rrhit+kJrrflLatF:�!:�i!�,,�,���G��,`I;Y�di� +�f`,ln i�i�°$ r '�"� )„'��� !M.iMn..:.,,5•"'ru.,rtl^."TwiR1!J�,�: w.r�
❑New construction Addition/alteration/replacement Please check all that apply(submit 2 sets of plans wlitcros checked below).
0 Service or feeder 400 amps or more ❑Building over three stories.
❑Demolition ❑Other: where the available fault current ❑Marinas and boatyards.
,I
r,vda II TE pRY QF,GQl!! AG � a h I , „ exceeds 10,000 amps at 150 volts or ❑Floating buildings, 17.•
. O losq to ground,or exceeds 14,000 ❑Commercial-use agricultural c1 Q -and 2-family dwelling ❑Commercial/industrial ❑Accessory building on for all other installations buildings M
❑Multi family ❑ Mastcr builder ❑Other Fire pump. []Installation of 150KVA or
w r Emergency system. argerlseparately derived system.
1•,.; ..:.,..':',,..r., 4401 ... i� h'51t1fi 41X,°. 'yR~ ❑Addition of new motor land of ❑"A.. „E...,t 2•• ,•t.;' Q
Job no.:D----7 I Job site address: ��j �y Q l^/ '
?QOHP or more, occupancy.
/�� �r)/� �(f �'fr{��✓V , ��- or more more residential units, ❑Recreational vehicle parks.
City/StatcJZlP: '� ' Vl, E)� / /�-,d / ✓ ❑Health-cam facilities. ❑Sudety voltage for more than C
❑Hazardous locations, 600 volts nominal. 0
Suite/bldg./apt.na / 7 Project name: E/012(j (t I / , ❑Service or feeder 600 amps or more. (J.t
bWnI .tj,.hk;:, fii:,ryrEEISCI'EDuLE 03
Cross strcct/dircctions to job site: 1 I L \.,Ail neaerl lion rot, i nee_ 1" -,,,„, I • -.1
- - 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'!500 sq.ft.or portion 33.92 I '
' Tax map/parcel no
#"
Limited enery,residential
ntial
75.00 2
II -le J. , i..11l"e `w / Jr7M J►V1 I k 0 �P l VP r rrt (with abovesq,ft.)
, ";NI „,I 61 „ 1 .i4 : . . r..'..,!� iY tw Limited energy,multi-family e` r F-/ a n� n)/7J f residential(with above s gR) 75,00 2■ Renewable Enery ❑ See Pare 2
Services or feeders installation,alteration,and/or relocation
a'F '. ❑ Ii �, '”'{;+.°c. d�r6tI: i��n�',��yyrs;.'1s1d7r�a' Il�'FF•iilti J1 `'. ;11r y,4 I- 200 amps or less 100,70 2
.t .. islY I ��1 ,7iiAr�l;�'.�':1�1'ri�"-?J�+nl'j' ...,. .. -.. ' `N'� ry.
201 amps to 400 amps 133,56 2
Name: 401 amps to 600 amps 200.34 2
Address: 601 amps to 1.000 amps 301,04 2
Over 1,000 amps or volts 552,26 2
City/State/ZIP: Temporary services or feeders Installation,alteration,and/or
Phone:( ) I 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,Iease,rent,or exchange,according to ORS 447,449,670,and 701.
401 amps to 599 amps 168,54 2
Owner signature: Date: Branch circuits-new,al
ter ation,or cxte�nsip c r
panel
�
I III„;1'e Ft�Lb x��� 'Y"'-+11k{ ,IG i.I r�4A � 1� .�ev C A.FCC for branch circuits with
•I I' . .� Mr' Me,5r":Ir.4 imlr9^I ! !MI ,k�• . above service or feeder fee,• 7,42 2
Business name: each branch circuit
B.Fee for branch circuits without /� ^
�
Contact name: service or feeder fee,first / 56.18 7 51 2
branch circuit
Address: Each add'l branch circuit / 7.42 ,7 et7 2
City/State/LIP: Miscellaneous(service or feeder not included)
Each manufactured or modular 67.84 2
Phone:( ) Fax: :( ) dwelling,service and/or feeder
Reconnect only 67.84 2 I
E-mail: C..rt_ s c.—(-f' a • 2 t-Q c Yr: e✓. CaNI Pump or irrigation circle 67.84 2
'!::'fII •„;' It■;,;.' .. 0,1; 4'1il`),n.,;'''ICON :h C Z ''i • '41'•'7° r;, '. I k! tw�"q tJI.^,” Y '. Sign or outline lighting 67,84 2
i Business name:Nest Side Electric Signal circuit(s)or limited-energy Sec
panel,alteration,or extension. Pape 2 2
Address: 1834 SE 8th Ave. Each additional inspection over allowable in any of the above
Additional inspection(I hr min) 66,25/hr
City/Statc/ZIP: Portland/Oft/97214
Investigation(1 hr min) 66.25/hr
Phone:(503)231-1548 Fax:(503)736-0656 industrial plant(I hr min) 78.18/hr
inspections for which no fee is 90,00/hr
CCB Lic.: 13306 Electrical Lie.: 26-135C 'Suprv. Lie.: 46545 speci ficallylistedy(i.5h/rminn)) t-E
Suprv. Electrician signature,rege /n
Subtotal: l�� -} (/c
Plan review
(25%of permit fee)::
Print name: Randall F Roberts Date:
- State surcharge(12 of permit fee):
J u Authorized signature: TOTAL PERMIT FEE: `//• 3
Print name: Dart: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete.
• Number of in pections allowed per rimy /pp.5.6)
_as a rau rt.,..se.,.,nsYN2by7 ,..()-,'.,y,•,!.5I«,...t•'..,s /N1i�gTi a.4-77(LE fT�
`_ /Z #�., .�.�,.._ L8666£Z£OS ! 096686S£O9 :01 a! -11-0913 9P!S ;S9M:uloa3' i /7A.,03
10-20-15; 11 : 32 ;From:West Side Electric To: 5035981960 ; 5032319987 # 1/ 2
4(1 a)2 S
Ea)
42.01
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0,26,.
Location:
Record Type:
Inspection Type:
Result:
Comments:
Inspection Date:
Record ID:
Inspector:
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
10813 SW CANTERBURY LN 104, TIGARD, OR,
97224
Residential - Electrical
199 Electrical final
PASS - No C of O
ELC2015-00862
David Young
Violation Summary:
Inspector Contractor