Permit CITY OF TIGARD ELECTRICAL PERMIT
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13 - COMMUNITY DEVELOPMENT Permit #: ELC2010 -00133
,11•1G ARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 03/24/2010
Parcel: 2S103DD00420
Jurisdiction: Tigard
Site address: 10825 SW FAIRHAVEN WAY
Subdivision: FAIRHAVEN COURT Lot: 13
Project: SampleNarnes
Project Description: (2) branch circuits for bathroom remodel.
Owner: FEES
SAMPLE, SUE ELLEN & VARNES, ALFRED Quantity Description Date Amount
10825 SW FAIRHAVEN WAY
TIGARD, OR 97223 2 crt Branch Circuits 03/24/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 03/24/2010 $7.63
Electrical
Contractor:
MULTIPHASE ELECTRIC
20701 S. MONPANO OVERLOOK DR.
OREGON CITY, OR 97045
PHONE: 503 -631 -4649
FAX: 503 - 631 -4659
Type of Use: SF
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 ac rdanc.e 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. AT ' TION: Oreg• la • ires you to follow the rules adopted by the Oregon Utility Notif - Center. Those rules are set forth in OAR
952 -001 41 010 through OAR 95 •01 -010+ ou may obtain a copy of the rules or direct questions to OUN • • - - • 46.6699 or 1.800.33 .23441
Issue. c • I Ll..al- , Permittee Si. - %,
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' i /� Date:
�- — .ru it'l�
LICENSE NO.
Call 503.839.4175 by 7:00 a.m. for an inspection that business day.
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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Electrical Permit Application .�� .- -3 .,_ � i . - o li or iv k= u� I.) , a .i,
e
�: , � r Received
r•, City of Tigard MAR: 2 2 2013 � � eta 10 PennitNo.: �lo-t��33
DaterB y
• 13125 SW Hall Blvd., Tigard, OR 97223 Plait Review a her Permit:
'�� e � Phone: 503.639.4171 Fax: 503.598.1960 p �} DaterB _
, ,�„ r i I RAND y s: B See Pagc 2 fur
(T[G: \'RI]� Inspection Line: 503.6393175 �3 ( � � DIVISION { � R cady,ey: furs
E�ac ° Internet: www.tigard or.gov BUILDING DIVISION Notitied•'Metltod: Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration /replacement please check all that apply (submit 2 sets of plans sir/items checked below):
❑ Service or feeder 400 amps or more ['Building over three stories.
❑ Demolition ❑ Other: wl.cre the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION excucds 10,000 amps at 150 volts or I] Floating buildings.
less to ground or exceeds 14,000 ❑ Commercial -use agicnln.ral
El 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ fire plump. ❑ Installation of 75 KVAor
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION A_ND LOCATION Cl Addition of new motor load of ❑ "A", "E ", I .2' , "I -3 '.
1 DOHP or more. occupancy.
Job no.: 1279 Job site address: 10825 Fairhaven Way
❑ Six or more residential urns. ❑ Recreational vehicle parks.
City /State /ZIP: ligard,OR 97223 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Haatrdous l ocations. 600 volts nominal.
Suite/bldg. /apt. no.: 1 Project name: ❑ Service or feeder600 amps or more.
FEE SCHEDULE
Cross streetldirections to job site: Description I Qtr. 1 Fe.,. 1 Total 1
New residential single- or multi - family dwelling unit.
includes attached garage.
Subdivision: Lot no.: 1.000sq. ft. or less 168.54 ( 4
Ea. add'1500 sq. R or portion 33.92 1
Ta.x snap /parcel no.: Limited energy, residential
DESCRIPTION OF WORK
(with above sq. ft ) 67.84 2
I Limited energy, multi- las y 67.84 2
Bathroom remodel I residential (with above se. tt.)
Services or feeders installation. alteration. and/or relocation
200 amps or less f 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 I 2
Name: Sue Samples/ Al Vannes 601 amps to 1,000 amps 301.04 I 2
Address: 10825 Fairhaven Way Over 1,000 amps or volts 552.26 I 2
Temporary services or feeders installation. alteration, and/or
CityiState/ZTP: relocation
Phone: ( ) 200 amps or less 59.36 1
Fax: ( )
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on propltrty that 1 own which is not 401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. — Branch circuits -new, alteration, or extension, per panel
Owner signature: Date: A. Fee for hranch circuits with
above service or feeder fee, 1 ., 42 7.42
® A I ❑ CONTACT PERSON
each branch circuit
Business name: Multiphase Electric, LLC B. Fee for branch circuits without '
service or feeder fee, first 1 56.I8 56.18 2
Contact name: Dave Gackle hranch circuit
— Each add'l branch circuit 1 7.42 -. 1 2
Address: 20701 S. Monpano Overlook Dr. M1liscellaneous (service or feeder not included)
Each manufactured or nodular
67.84 2
City /SlateiZlP: Oregon City dwelling, service an _d_/or feoder _
Phone: (503) 631 - 4649 I Fax: : (503) 631 Reconnect only 67.64 2
Pump or irrigation circle I 67.84
E -mail: - Sign or outline lighting 1 67.84 2
CONTRACTOR Signal circuit(s) or limited energy
Business name: Multiphase Electric, LLC panel, alteration, or extension. ! Page 2 2
Each additional inspection over allowable in any of the above
Address: 20701 S. Monpano OVerlook Dr Additional inspection (1 hr min) 66.25i hr
Investigation (1 hr min) 66.25/ hr
Cit} /State/ZIP: Oregon City, Or 97045 Industrial plain (1 hr min) 78.181 hr
Phone: (503) 631 -4649 Fax: (503) 631 -4659 Inspections For which no fee is
90.00 hr
specifically listed (t4 hr min)
CCB Lic.: 162827 f tit �tI Electrical Lic.:.i4 2's c6. Suprv. Lic.: 5122s ELECTRICAL PERMIT FEES
7 �tt Wit- lO�r �r0
Subtotal: 63.60
—
Suprv. F,letdrician signature, required:l�� Plan review ( % o f permit fee):
Print name: Dave Gackle I Date: 03/22/10 State surcharge (12% of permit fee): 7. --
63 �!/) /
, �
/ �� TOTAL PERMIT FEE: 71.23 ✓�/
Atlthoriz tuff - TMs This permit application expires if a permit is not obtained nithin 180
days after it has been accepted as complete.
Print name: Dave Gackle Date: 03/22/10 • Number of inspections allowed per permit.
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