Permit CITY OF TIGARD ELECTRICAL PERMIT
' COMMUNITY DEVELOPMENT Permit#: ELC2020-00330
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 06/30/2020
Parcel: 2S112BB00200
Jurisdiction: Tigard
Site address: 14010 SW HALL BLVD
Project: Gurin Subdivision: WILSON ACRES Lot: 1
Project Description: Adding(2)branch circuits.
Contractor: OWNER Owner: GURIN, CHRISTINA J&TED A
TED GURIN 14010 SW HALL BLVD
14010 SW HALL BLVD TIGARD,OR 97224
TIGARD, OR 97224
PHONE: 971-409-2838 PHONE:
FAX:
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo/Purchase 06/24/2020 $63.60
Specifics: Service or Feeder
1 ea 12%State Surcharge- 06/24/2020 $7.63
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $71.23
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 a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. _
Issued By: Permittee Signature:
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.
Eleet'rical Permit Application rtri�t)rrl(T 1 sr ONLY
City t7fTigard I�ECEIV' '. -
,, i 13125 SW Hall Blvd.,Tigard,OR 97223
Phone: 503.718.2439 Fax 503598.1960 J U N 11 20') ' '
I.l c n u, Inspection Line: 503.639.4175 Ready Date/By: Mrie
Internet: www.tigard-or.govr CITY OF TIG: Noised/method:
PLAN REVIEW
.f TYPE OF lYORKuui�'vnv+u U „,„,,., .
❑New construction 2y Addition/altelation/replacement Please check all that apply(submit leafs of plans wtitems checked):
['Service or feeder 400 amps or more 0 Building over three stories.
❑Demolition 0 Other:
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTiON exceeds 10,000 amps at 150 volts or ❑floating buildings.
1-and 2-famil d less to around,or exceeds 14,000 ❑Co�ernial-use agricultural
® ywellin g ❑Commercial/industrial ❑Accessory building
amps for all other installations. buildings.
❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 Installation of 150 KVA or
JOB SITE INFORMATION
j AND LOCATION ❑Emergmny system. larger separately derived
(L UW i-Ft�� bi VOA. ❑100HP or f nesemore.motor Mad of system"A",'•
Job#: Job site address:
/� v 0 l ootte or more. ❑"A^."E^."t-z^.'•1-3^.
City/State/ZIP: "Ti,a,krj 1 o 417?9Af� ❑Scrormmc nsidties. omits. oneW+non
✓f ❑health-tact facilities. ❑Recreational vehicle peeks.
Suite/bldg apt.#: Project name: /i 1 a e v 0 hazardous locations. 0 Supply voltage for mom than
s 0 Service or feeder 600 amps or more. 600 volts nominal
Cross street/directions to job site: qG Dthia I, FEE SCFiEDT7LE
�lenunotl St. .!_ etenots IenJD o6A... id } � resi I ovi I slur I raw
al (�•�� New residential single-or multi-family dwelling nit.
Subdivision: Lot#: I■dedes attached garage.
G 1,000 sq.ft.airless less 168.54 4
Tax map/parcel#: R O 51 fj to J Ea.add'1500 sq.ft.or portion 33.92 1
DESCRIPTION OF WORK Limited energy,residential 75.00 2
(AM2 Z.
- - I 1 lak'S a ttr� CC -e .d^" ' (with above sq.It.)
5 t(1�vr ^ ! p Limited energy,multi-family 75.00 2
t"tC tl CS( S V t 4.1, fa L t°L'K 6 residential(with above an,.R)
�. PROPERTY O Renewable Energy ❑ See Page 2
. p �7�Lt cf. „ 200amps
,_ Services or feeders 00 Installation altuatioa, oorreloeatloa
Name: /Lo 2
Address: 1 10/0 t(Al a(ll IA vd, 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
City/State/ZIP: 77.- d,,,f t 01e— /7111 601 amps to 1,000 amps 301.04 2
Phone:(47 4 ) / an,_ agg g Fax:( ) Over 1,000 amps or volts 552.26 2
Temporary services or feeders iastaltatioa,alteration,and/or
Emat1: e...h Y&V•1. 9 L.tv't et Q 5 t c l . C OM relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59.36 1
intended for sale,l�rent,or exchange,according to ORS 447,449,670,an d 7 1, 201 amps to 400 tunas 125.08 2
Owner signature:, '4 (2,-.---2.-- Date: c,I It /2020 401 amps m 599 amps 168.54 2
El APPLICANT 0 CONTACT PERSON Breach details-sew,alteration,or extension,per panel
A.Fee far branch circuits with
Business name: above service or feeder fee, 7,42 2
---.__. each branch circuit
Contact name: B.Fee for branch Circuits without
Address: service a feeder fee,first ,z 56.18 2
branch circuit
City/State/ZIP: Bach add'l branch circuit 7.42 2
Mixdlascoas(service or feeder net Winded)
Phone:( ) Fax::( ) Each manufactured or modular 67.84 2
Email: dwelling,service and/or feeder
Recotmect Daly 67.84 2
CONTRACTOR pump or irrigation circle 67.84 2
Bu eine-e name: /et r-r Sign or outline lighting 67.84 --12
Address: Signal cimuit(s)or limited energy ❑ See e 2 2
panel,alteration,or extension.
City/State/ZIP: Each additional inspection over allowable In any of the above
Additional inspection(1 hr thin) 66.25/hr
Phone:( ) 1 Fax:( ) Investigation(1 hr min) 90.0/hr
Email: Industrial plant(i hr min) 78.18)hr
Inspections for which no fee is 90.00'hr
CCB Lic.: Electrical Lic.: Suprv.Lie.: specifically listed(Vs hr min) •
ELECTRICAL PERMIT FEES.
Suprv.Electrician signature,required: Subtotal: 5 ?, ti%
Print name: I Date: ❑Plan Review Required(25%of permit fee):
- / State surcharge(12%of permit fee):
!
Authorized signature: F rx�_• TOTAL PERMIT FEE:
J This permit application expires if a permit a cot ebtahsed within 180
Print name: `Pei l C-t U t/1y) Date: (j(i 1 )yd days after it has been accepted as complete.
" Number of inspections allowed per permit.
LO3oildinaOaminELC PermnApp fits ERFdoc Rev O6,17/201S 440.461511(11/05/COM1WEa