Permit trx n + TIGARD ELECTRICAL PERMIT
�"e CITY OF
/,' CITY I
° PERMIT #: ELC2007 -00842
COMMUNITY DEVELOPMENT
D ATE ISSUED: 12/14/2007
TIGARD_ 13125 SW Hall Blvd., Tigard, OR 97223 503.639.4171
PARCEL: 2S104AD -00900
SITE ADDRESS: 12790 SW MARIE CT ZONING: R - 4.5
SUBDIVISION: BELLWOOD LOT : 006 JURISDICTION: TIG
PROJECT: BARMETTLER
Project Description: (2) branch circuit heat pump, GFI.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: 1 PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: 1 IN PLANT:
601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
KEVIN BARMETTLER SIMPSON ELECTRICAL CONST.
12790 SW MARIE CT 2145 NE MCDONALD LN # C
TIGARD, OR 97223 MCMINNVILLE, OR 97128
Phone: 503 - 579 - 5409 Contact #: PRI 1- 503 - 472 -2530
FAX 1- 503 - 435 -0157
FEES
Description Date Amount Reg #: ELE 36 -82C
IELPRMT1 ELC Permit 12/14/200' $53.50 LIC 133886
I MAXI 8% State Surcharge 12/14/200' $4.28 SUN 30935
Total $57.78 REQUIRED ITEMS AND REPORTS
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for
more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in
OAR 952- 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at 503.246.6699 or 1.800.332.2344.
Issued By: / Permittee Signature:
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: DATE:
LICENSE NO:
Call 503.639.4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
Dec` 13 i)7 11:45a KEVIN IMPSON 503 - 435 -0157 p.2
i x OR,OFFICE`aUSE :ONLY M i r
Electrical Permit Application ed. � , , F Electrical r '' yr` ' /^ EGON; Date/By: I a 1 3) 01 f 1 Permit Nei - i" -D007— o e)8--- City of Tigard � ` Planning Apprdval Sign
TOW
ti
Date/By: Permit No.:
13125 SW Hall Blvd. t< Plan Review Outer
Tigard, Oregon 97223 t Date/By: Permit No.:
` 1 A1 Post - Review Land Use
Phone: 503 - 639 -4171 Fax: 503{Sic8�1900�i • � „ ;t t o Date/By: Case No.:
Internet: www.ci.tigard.or.us (( � � i � _ Contact
Name/Method: nt
Juris. ]$I See Page 2 for
24 -hour Inspection Request: 503 - tf4 "°
� ® Suppteentarinfortnativn.
BUOL t
- TYPE OF WORK PLAN REVIEW (Please check all that apply) .
❑ New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
commercial ❑ Hazardous location
❑ Addition /alteration/replacement ['Other: ❑ Service over 320 amps - rating of ❑ Building over 10,000 square fcet.
CATEGORY OF CONSTRUCTION 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ['Commercial/Industrial . ❑ System over 600 volts nominal one structure
0 Building over three stories ❑ Feeders, 400 amps or more
Accessory Building ❑ Multi- Family ❑ Occupant load over 99 persons 0 Manufactured structures or RV park
❑ Master Builder ❑ Other: ❑ Egress/lighting plan ❑ Other:
JOB SITE INFORMATION and LOCATION Submit i sets of plans with any of the above.
,� /�
The a are not applicable to temporary construction service.
Job site address: !2 0 � (,O I fn/ ^ to I � e ce-- FEE* SCHEDULE
Suite #: 1 Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: Description Qty Fec (ea.) Total i
New residential- single or 'multi-family per
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 9
Each additional 500 sq. ft. or portion thereof 33.40 , 1
Limited energy, residential 75.00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
DESCRIPTION OF WORK service and/or feeder 90.90 2
Services or feeders - installation,
ite4t pi r,i�AA .* 4-
alteration or relocation:
/ r 1 / 200 amps or less 80.30 2
��1 i� iT I'P 201 amps to 400 amps 106.65 2 ,
401 amps to 600 amps - 160.60 2
?ROPERTY OWNER 1 ❑ TENANT 601 amps to 1000 amps 240.60 2
Over 1000 amps or volts 454.65 ; 2
Name: 4 y/j ►') ' , i Reconnect only 66.85 i 2
Address: i Z 1C f) SW l r ' ,/y} / J t'P l �7 1t Temporary services or feeders- installation,
alteration, or relocation:
City /State /Zip: T c / tCt ��" 200 amps or less 66.85 1
p L j 201 amps to 400 amps 100.30 2
Phone: 5-7q- r' 9 Fax: 401 to 600 amps 133.75 2
[] APPLICANT [❑ CONTACT PERSON Branch circuits - ncw, alteration, or
Naive: extension per panel:
A. Fec for branch circuits with purchase of
Address: service or feeder fee, each branch circuit 6.65 2
City/State/Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit I 46.85 W, .2"..6' 2
Phone: Fax: Each additional branch circuit ' ( 6.65 to. (5 2
E -mail: Misc.(Service ar feeder not included):
CONTRACTOR Each pump or irrigation circle 53.40 2
Each sign or outline lighting 53.40 , 2
Job No: Signal circuit(s) or a limited energy panel,
j tn a n j J _ _ Dcscri plion:
on or extension Page 2 2
Business Name: i r J J ! J (�(Tl scri
Address: .210,5 ML, �0 Y iiii C e
Each additional inspection over the allowable in any of the above:
l
City /State/Zip: ht in, MUh ir{ (7Q ?1128 Per inspection per hour (min. 1 hour) 62.50
Phone: -c.s1d -t 30 Fax: 5t, 3- /5- 6/57 Investigation fee:
Other:
CCB Lic. #: /3.3, Lic. #1,/ $2 C_ 71 (. Ci?, Electrical Permit Fees*
Supervising electrician to Subtotal $ 5 3..Ci
signature required: • . j % O. 1 • Plan Review (25% of Permit Fec) $
L t/ S tate Surcharge (8% of Permit Fee) 5 r ,2 E
Print Name: K Lic. #: 509 3s TOTAL PERMIT FEE $ 5 , 78'
Authorized Notice: This permit application expires if a permit is not obtained within
Signature: Date: 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
(Please print name)
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