Permit CITY OF TIGARD ELECTRICAL PERMIT
'1 a COMMUNITY DEVELOPMENT Permit #: ELC2010 00546
T 1 G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.639.4171 Date Issued: 10/06/2010
Parcel: 1S134CB12400
Jurisdiction: Tigard
Site address: 12212 SW MILLVIEW CT
Subdivision: MILL VIEW Lot: 24
Project: Simer
Project Description: Panel replacement.
Owner: FEES
SIMER, MARTIN & JENNIFER Quantity Description Date Amount
12212 SW MILLVIEW CT
TIGARD, OR 97223 1 ea Services or Feeders - 200 10/06/2010 $100.70
amps or less
PHONE: 1 ea 12% State Surcharge - 10/06/2010 $12.08
Electrical
Contractor:
WEST SIDE ELECTRIC CO INC
1834 SE 8TH AVE
PORTLAND, OR 97214
PHONE: 503 - 231 -1548
FAX: 503- 736 -0677
Type of Use: SF
Class of Work: ALT Type of Const:
Occupancy Grp:
Total $112.78
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 -0100. You may obtain a co • of th : • : o r direct questions to OUNC by calling 503.246.6699 or 1.800.332.2344.
,-
Issued By: L /��'_= / Permittee Signature: =� 4 ra=r
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.
Oct 01 2010 4:05PM West Side Electric 503 - 736 -0656 p.2
RECEIVED
Electrical Permit Apalicatio 1 ;'1C 4 )1; I 1 I I< 1'.1.1 :•: :
City of Tigard ` ` J Received Permit No. 5-t ,
'
13125 SW Hall Blvd, Tigard, OR ' " OF TIGARD Phut Review - r` Phone: 503.639.4171 Fat: 503. • . • i• ome,8 , Other Permit: _ _ •
Inspection Line: 503.639.4175 I3U f ,1 u'4G DIVI Date Ready /By: See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Supplemental information
+: � .. c, .' .,� T' 'der -,,. a>!P!• -te �z,. �; _ ... - r . r �- s _
p •�" }}yy 1 3;.�J -� -tic ?.. , ,... i'- 1's ^,-.1; �31:�,:1'" � � 1: � ` } �.�. q .,�
r.,, .. ..•..:R .� iP.� -. - ,t'lc,,;a:e l+" G f d 7!'i'^:}+::,Cxs i m. ;..... .waif i'.i�,. ''iiiS Irhi* ?> ,i;;i_. - }i- ..w,:k'" ,.•�',
❑ New construction Mi Addition/alteration/replacement Please cheek all that appb (submit 1, sots of plans w/items slaked bolos):
❑ Servi or feeder 400 amps or more ❑ Building over titre stories.
❑ Demolition ❑Other:
where the available fault current ❑ Marinas and boatyards -
..y,;lyt,� .,....._:' i:�r:.'•ag ri.:'.:• : �- r _.,.. _ oew r:J,: s �3`,k:':C�.i.• '
;.3: a- - .:" rl''S�,:.�i 1 a ,...,,�. �;,;_:- 5. x . exceeds 10.000 amps at 150 volts nr ❑ Floating buildings
1*rorslr'tir`1,� .r. -° ;';i :�''= :' %:' "- :. less to ground, or exceeds 14.000 ❑ Conunercial - use agricultural
firr 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building
amps far all otha installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump ❑ tnstaItatioo of 75 KVA or
1 t `a,.
ill ;' ig ,z�•v Atiw "�-- r 1• _ `ir .5 :.= = ❑ Faoer eocy aysm. larger saparuoly derived system.
y ; ";- :: .. _ era .. . .1�n
F a
�rara. ?x.�..:: ...._ . ... _. , .^ •_.,,�:.�:3 =>a , ❑ Addition ofrrowmotor load of ••p•, »E.,.1_Z..•..l_3..
Job no,: J bZ7 / I Job site ddress /2 , 2 /L St!)4 /tt e 100HP or more. ❑ occupancy.
❑ Six or more residential emits. ❑ Recreational vehicle parks.
City /State/ZIP: l �94 t�jQ JZ 23 y-.1 ❑ Health-care facilities
❑ Hazardous locations ❑ Supply voltage for more than
I e 600 vole seminal.
Suite/bldg. /apt no.: 1 Project name: X./ � y ,7 '" ' ) ❑ Sen •ice feeder 600 or more.
Cross street/directions to job site: nese h } T et a , i � t
t+e [ 4h. � vin. � l Total i ���
New residential tingle- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no,: 1,000 sq, ft or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. P. or portion 33.92 1
15
Tax r�a�b f'Arr^ :[' _ :,. •:r a Limited energy, residential 75.00 2
e.� -`'`' i.�s, =='`�. ;,.;;.�: � '';;�' •ir_iz'�;��1.�� =k: .�: °� (with above
sq
Limited energy, multi - family
hS,.Z/ / • , residential (with above sq. ft.)
75.00 2
J Services or feeders installation, alteration, and/or relocation
� .y am 200 amps or less / - 100.70 /pp 1 ,e 2
..p `'..... - w*4 -. - 'i• 'ill '
y :i. •;"l :rV,- ; , N. ., ;3 .YT.Y...vil •_ .•l. ^ _' ^ ' / • .. . .. . tti:t l - . i;$ t ' ° 1, V;14;:�= r..O ' a: r, >;:r� _ ;�:rrr . RS ,. r t ■ wc; .; ., { 4 • 201 amps to 400 amps 133.56 2
J i
:. aF£ =; ...• 401 am to 60
Name: Ps 200.34 2
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/or
relocation
2 00 amps or less 59.36 1
Phone: ( ) I Fax: ( )
made on ro 201 amps to 400 amps l 125.08 2
Owner installation- This installation is being p per' that 1 own which is not
401 amps to 599 amps I 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alreratioa, or extension, per panel
Owner signature: Date: • A. Fee for branch circuits wrth
AMU ,' -"° c: :ey�...,»F�, ? . e: p l: o _ _-.°....p above service or feeder fee,
Sr o.rM.;c7r "a. t :..!i _ `. '.n?y3_i_ ue' r � ::,.fcrifin ., each branch circua 7.42 2
Business name. B. Fee for branch circuits wirhota
service or feeder fee. Pmt 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Misetllaneom (service or feeder not included)
Ci lState,21P: Each manufactured or modular
tY dwelling v
. service d/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
l Pump or irrigation circle 67.84 2
E - mail:
t. '" .. = ::w;.0 -s ,., u . _t• , •l.',l''. ul. i _ „ r' :t , : , j : ; .F oi , ;p; -> r'?1;.= ' "': , . Signor outline lighting 67.84 2
• .- _,.».x '�=a-tl:gg,,, ?- ...- v ,,,: _. •:...... - :r -.4 - : '' :• 5. : :,k tkr,! :, Signal circuit(s) or limittd•.energy
Bu nam west Side Electric CO . , I riC . ' r panel, alteration. or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 ter min) 66.25/ hr
City /State/ZIP: Portland /OR/97214 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (5 0 3) 2 31 8 Fax: (5 0 3) 736-0677 inspections for which no fee a 90.00 / hr
specifically listed S Y, hr mini
CCB Lic.: 13 306 Electrical Lic.� 6 - 13 5 C Supr L 4 6 5 4 - S � lc.: 1 -r' . == � ': � ! � . • «lEt�s' . �;- 4�.r= `s;:,`r1?•lI� ' „y.�
Suprv. Electrician signature, required: f7 -ts•G l z l Ill I ) / o Subtotal: fee): /00 c�J
i dl. Plan review (25 /o of permit fee
Print name: Randall F Ro berts Date: d /// State surcharge (12% of permit fee): 1 Z ‘?=
TOTAL PERMIT FEE: //2_, 7k
Authorized signature: This permit application expires if • permit is sot obtained within 100
days after it has been accepted as complete.
Print name: Date: • Numb= of inspections allowed per permit.
1ABuildtng ■PsrmtitII.C- PermnitApp.dec 07/01/10 440.4615T(11/]5.COMIWEB
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