Permit CI OF TIGARD ELECTRICAL PERMIT
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3 COMMUNITY DEVELOPMENT Permit #: ELC2010 -00393
',ICI GARD 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171
Date Issued: 07/30/2010
Parcel: 2S104CD08501
Jurisdiction: Tigard
Site address: 13520 SW ESSEX DR
Subdivision: HILLSHIRE ESTATES NO. 2 Lot: 84
Project: McKay
Project Description: (2) branch circuits for A/C and meter.
Owner: FEES
MCKAY, BRACKEN & MARCY Quantity Description Date Amount
13520 SW ESSEX DR
TIGARD, OR 97223 2 crt Branch Circuits 07/30/2010 $63.60
wo /Purchase Service or
PHONE: Feeder
1 ea 12% State Surcharge - 07/30/2010 $7.63
Electrical
Contractor:
SIMPSON ELECTRICAL CONSTRUCTION
2145 NE MCDONALD LN # C
MCMINNVILLE, OR 97128
PHONE: 503 - 472 -2530
FAX: 503 - 435 -0157
Type of Use: COM
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 o o •w the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 - 001 -0010 through OAR 952 - 001 -0100. ou may obtain a co• • the_rules or direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
i _ �
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 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 ' ' f `
,��orz or lase c�n�i� 1.
City of Tigard Ra rid ,/�
1111 l
13125 SW Hall Blvd., Tigard, OR 97223 �� Plan Review
'; Phone: 503.639.4171 Fax: 503.598.1960 \)\-- - a • e/By;
Other Permit:
r y
1 C, A 0 D Inspection Line, 593.639.4175 N i 1, ead lads: 81 See Page 2 for
,a.- Internet: w'ww.tigard- or.gov �� OI1� I�
TN /Method: .61 Supplemental Information
TYPE OF WORK �`1� l PLAN REVIEW
11 New construction Addition/alteration:repL ment Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition 0 Other: whore the avaitablc fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or El Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling ❑ Commerciallindustrial ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORM4TION AND LOCATION ❑ Emergency system. Larger separately derived system.
❑ Addition of new motor Ioad of ❑ "A ", "E , "1.2 ", "] -
100HP or more occupant}'.
Job n0.: Job site address:
1-35 a O s,,..) t SS r • ❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State /ZIP: ' Q ❑ Hcalth -care facilities ❑ Supply voltage for more than
I t F�Ct t' cX ❑ Hazardous locations. 000 volts nominal.
Suite/bldg. /apt. no.: f Project name: l/c4 y
ID Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description 1 Qty. I Fee. 1 Total 1 •
New residential single- or multi-family dwelling unit.
includes aHached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4 s.
Ea. add'1500 sq. R, or portion 33.92 1
Tax map /parcel no.: Limited energy, residential
2
DESCRIPTION OF WORK (with above sq. ft.) 75.00
_ J� c Limited energy, multi- family 75.00
!}�'f qr�..( V el D �
Ibin4 I?c` -I lZ /t C DISC�,✓t✓e, - + - residential (with above sq. R.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 : 2
401 amps to 600 amps 200.34 j 2
Name:
60I amps to 1,000 amps 301.04 1 2
Address: Over 1,000 amps or volts 552.26 ' 2
Temporary services or feeders installation, alteration, and/or
City /State /Z[P: relocation
Phone: ( ) � Fax: ( )
200 amps or less 59.36 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property 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 branch circuits with
1:1 APPLICA,�17• ❑ CONTACT PERSON above service or feeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 ,..5,. ( 2
nine: ine: _ branch circuit , l
- Each add'I branch circuit ( 7,42 7 -'Z 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: ;State /ZIP: Each manufactured or modular 67 g4 2
ty dwelling, service and/or feeder
I Reconnect only 67.84 2
Phone: ( ) I Fax: : ( ) -
Pump or irrigation circle 67.84 2
E - mail: 2
Sign or outline lighting 67,84
CONTRACTOR Signal circuit(s) or limited -energy
L panel, alteration, or extension. Page 2 2
Business name
9 m i 5 Ed ,.-1--,, c i CD., 54 G l7 0 .'� Each additional inspection over allowable in any of the above
Address: a 1 S i✓ filL - )Oa'lo, fi /.._ Sfe _Additional inspection(1 hr min) 66.251 hr
Investigation (1 hr min) 66.251 hr
City/Slaw/ZIP: l/ L Y / `7 n t (j,f D/2-. ' i (Z Industrial plant (I hr min) 7$.181 hr
Phone: (52 3) L 72- 2 3 Fax. (5b3)(� � Inspections for which no fcc is 90.001 hr
�L3 d [ J� f specifically listed (% hr min)
CCB Lic.: 133 g - g ( � 1 Electrical Lic ' b _ " C I Suprv. Lic.: 5b53S ELECTRICAL PERMIT FEES
f < < Subtotal: ( j - (cO
Suprv. Electrician signature, required: ` r �.. Plan review (25%ofpermil fee): —
Print name: J t Date: 2 j St s (12% of permit fee): --/, 403
ttl i■ S m �So. -∎ ` (v n
TOTAL PERMIT FEE: , J ( . 2..'
Authorized signature: This permit application expires if a permit is not obtained within 180
days after it bas been accepted as complete.
Print name: 1 Date: s Number of inspections allowed per permit.
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