Permit li pv w CITY OF TIG ARD ELECTRICAL PERMIT
a ' COMMUNITY DEVELOPMENT Permit #: ELC2010 -00268
IA GARD' 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 06/03/2010
Parcel: 1 S133DD12500
Jurisdiction: Tigard
Site address: 11945 SW 126TH PL
Subdivision: VILLAGE AT SUMMER LAKE NO. 4 Lot: 162
Project: Ramsden
Project Description: (3) branch circuits for bathroom remodel.
Owner: FEES
RAMSDEN, DANA C & DEBRA L Quantity Description Date Amount
11945 SW 126TH PL
TIGARD, OR 97223 3 crt Branch Circuits 06/03/2010 $71.02
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 06/03/2010 $8.52
Electrical
Contractor:
ELECTRICAL SPECIALTY CONTRACTORS LLC
PO BOX 2853
OREGON CITY, OR 97045
PHONE: 503 - 723 -0371
FAX: 503 - 656 -4537
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $79.54
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 i ccor an 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. ENTION: Oregon la eq•ires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules kre set forth in OAR
952- 1 -0010 through OAR 952 •u may obtain a copy of the rules or direct questions to 3.246.6699 or 1.800.332.2344.
Iss ed B y: d Permitte % Signatures_
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' t 1 Date:
LICENSE NO.
Call 503.639.4175 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.
_
-- C - i - ty — o - f — T - Tga - r - cl . ----s-- iPIVFO---- Iteudived ,
D atemy: C ("6-7,---"" Pennit No.:Etk
. 4 13125 SW Hall Blvd., Tigar , 21 ' . " "' '-': ' Plan Review
, : :I • . Phone: 503.639.4171 Pax: 503.T.O6b i 2 010
7
Date/By: Other Permit:
T I A R1)
' . Inspection Line: 503.639.4175 J Date Ready/13y: Anis; lid See Page 2 far
Cj
Internee www,tigard Notified/Method: Stsplernental information
ungcT1CARD , ,.
'.. TY" mmia .' 'V jg.IVISION . .. — :PLAN REVIEW
- • - • ,
0 New construction 7 Addit._ ......_._.._- r,l-acement' Please check all Mat apply (submit 2 sem of plans whtems checked below):
9 Service or feeder 400 amps or more El Building over three stories.
D Demolition • ither:
where It available fault current 0 Marinas and boatyards.
.
; CATEGORY O' T.i■FONStRUCIIIIN exceeds 10,000 amps al ISO volts or 0 floating buildings.
_ • •
less to ground, Or exceeds 14,000 0 Commercial-use agricultural
frt 1- and 2-family dwelling D COmmercial/industrial El Accessory building amps for WI other installatio»s. buildings.
• Multi-family 0 Master builder 0 Other: 0 Fire pump. D i Installation
ri y 5 d v r sysi e in
&
. • :. • '• ' •• . • . .405.6 fSITE iINFORIVIAT(01S1 AND. :LocArioN 0 Emergency y am.. • '
0 Addiii. of new motor toad of a "A", E", "1-2", "1-3",
Job no.:
City/State/ZIP: „..--7,Job site address:
I , C U.)
0 ( ■ ‘ 31 a a 3 a b 11- 100111' or more.
4 0 Si K or mor tial e reS•den units. 0 Recreational vehicle
0 Heanh.care facilities.
.
0 Hazardous locations, occupancy.
parks.
0 Supply voltage for inort than
600 volts nominal.
Suite/bldg./apt. no.: Project name: -
I 0 Service or feeder 600 amps or more.
• I. — ' . i
PEE SCHEDULE .
Cross street/directions to job site:
Dricripnon —
I Q0. r Pee. 1 Total •
New residential single- or multi-family dwelling unit.
Iiri Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less MI 168.54
II3
E. adds1500 sq, II or portion — 3192
]
Il
Tax map/parcel no.: .
- Limited energy, residential
67.84
.:„. .. . -.. ' ..... •:' :. .: ■DESCIOPTION pF MORK • ' " (with above s . It.
•
t .1. t Limited energy, multi-family
II ct:rvorCa.-- , • 0 residential (with above sq. ill 67.84 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 TENANT 201 amps to 400 amps _ 133.56 2
401 amps to 600 amps 200.34 2
Name: P 'i..& 00Ata It- be-6a
_ 601 amps to 1,000 amps 301.04 2
Address:
Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/o
relocation
Phone; ( ) Fax: ( ) 200 amps or less 59,36
201 amps amps 1 1
to 400 125.08 2
Owner installation: ThiS inSIallation is being made on property that 1 own tvhich is not
401 amps io 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS Owner s re: 447, 449, 670, and 701.
Branch circuits- new, alteration, or extensiomier panel
ignatu Date: A. ree for branch circuits with
LH 7'''•,_., •ID 'AITIACANT • .. . ' . El CON7TACT PERSON above service or feeder fee,
7.42 2
each branch circuit
BuSiness name: B. Fee for branch circuits withal,/
Service or feeder I'M, first 1 IQ
56,18 51• 5
branch circuit 2
ContaCt name:
Each addl branch circuit 1:,, 7.42 / , ' y 2
Address:
Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular
67 84 '
dwelling. service and/or feeder .
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign Of outline lighting 67.84 2
, . .,, ..,..„:: . . :. '..:.;'.. ',. .,' .„ .. • ' - or*ITTRACTOR . •
signal eircuit(s) or limited-energy
Business name: e i c , r .k / • : 4 LV--- _panel alteration. or extension. Page 2 2
ess: 114111rAMIMMIE
C additional inspection over allowable ln any of the above
Addr Additionol iftSpeCtion (1 hr min) 66.25/ hr
' City/State/Z1P: 8 e , I. 1 , 4. l-o S
t.).\) Investigation (1 hr min)
Industrial piant (1 hr min)
PlIone: (5) - - 1 5 - 5 7., 5 - 3 -1.- Inspections for which no fee is
ex ? r , specifically listed (Y2 hr inin) _ 66.25/ hr
78.18/ hr
90.00/ hr
CC13 Lic: , 8 6 1 Electrical Lic,; 6( Suprv, Lic.: / 5-565 ..ELECTRICAL .PERMIT FEES . .
Suprv. Electrician sign . ta?, l 4 ,7, d , • Subtotal; / . 0 ._
4.` I Plan review (25% of permit lee):
• Milli 0
Print name: e " _ COi".%. - k Dale: State surcharge (124 of permit fee); t 4 ,_:) ) . 5,?..,.
V MS , k I.H.
Authorized signature: TOTAL. PERMIT FEE - Si
- This permit application expires if a permit is norobtaincd within I8
Print name: Date: days after 11 has been accepted as comPleti,
* Number of inspections allowed per permit.
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