Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
'.; - COMMUNITY DEVELOPMENT Permit #: ELC2011 -00059
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/26/2011
Parcel: 2S102CB02600
Jurisdiction: Tigard
Site address: 13080 SW PACIFIC HWY
Project: Walters Subdivision: Lot: 0
Project Description: Replace service.
Contractor: WILLAMETTE ELECTRIC INC Owner: WALTER, ANGELA D
PO BOX 230547 2863 RIVERWALK LP
TIGARD, OR 97281 EUGENE, OR 97401
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 01/26/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 01/26/2011 $12.08
Type of Use: COM Electrical
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. ATTENT : Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -001 hrough OAR 9' e.t1 -0' ]r. You may obtain a copy of the rules or direct questions to OUNC by calli 9 .1987 or 1.800.332.2344.
Issued B , . Permittee Signature:
OWNER INSTALLATION ONLY l �
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' V 1 Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available inspection date.
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.
01/25/2011 TUE 11:21 FAX 5036242938 Willamette Electric lJ002 /002
Electrical Permit Application Eta =;IFOR OFFICE USE ONLY
City of Tigard g v rDeeeived A
n 'J g y ,i5 Date/13y: � PenmtNo.. - coo
13125 SW Hall Blvd., Tigard,OR 97223 - Plan Review
' P 503.639.4171 Pax: 503.598.1960 ` `1 Date/By; Other Permit:
TIGARD inspection Line: 503.639.4175 per\ e! Date Ready/13y: iutis: C>? See Page 2 for
Internet: www, tigard- or.gov J� ,Notified /Method: —'Cy Supplementallnf
_ .-r N Y
i ,. t --
• TYPE OF WORK rt'C\I (3 \" I .,tji 0 PLAN REVIEW
❑ New construction 1/ Addition /alteration /replacements °`' '� Please check all that apply (submit 2 sets of plans w /items checked below):
Q ill'A' " ❑ Service or feeder 400 amps or more ❑ Building over three stories
❑ Demolition ❑ Other: _ry _ where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling . Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of g P y
site address: Job 110.Job •�/C �i / k (/• / f 1001 or more. occupancy.
��t// Job /uV fJ V \ w C. 1 f Vi //ivy ❑ Six or more residential units. ❑ Recreational vehicle parks.
[� \ { ` City/State/ZIP; �`; , ❑ health -care facilities. ❑ Supply voltage for more than
L /Gi +_ ❑ Hazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ,4 e ✓ ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: 7 l / ���,, ,1.. Cj ncacriptien _ 1 Q I ree. I Totn1 I
! New residential single- or multi - fancily dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map/parcel no.: Ea. add'I 500 sq. R or portion 33.92 1
__ Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft )
Limited energy, multi - family 75.00 2
2 ( 75e-r1/ residential (with above sq. ft.)
.1 i[� - Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 MO. 70 2
❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 y 2
601 amps to 1.000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /State /ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
Owner installation: This installation is being made on property that I own which is not tot amps to 400 amps t 25.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: -- Date: A. Fec for branch circuits with
❑ APPLICANT ❑ 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 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City /State /ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
' CONTRACTOR Signal circuit(s) or limited- energy
Business name: Willamette Electric Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: P.O. Box 230547 Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Tigard, OR 97281 Investigation (I hr min) 66.25 / hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 624 -3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00 / hr
specifically listed (%: hr min)
CCB Lie.: 75059 Electrical Lie.: 34 -283C Suprv. Lie.: 4226 - ELECTRICAL PERMIT FEES .
C" Subtotal: U) • 70
Suprv. Electrician signature, requ' .
Plan review (25% of permit fee):
Print name: David Fife Date: / -23:_ /( State surcharge (12 %ofpermit fee): /,7 , C) ° 6
Authorized signature: TOTAL PERMIT FEE: / / , 2 P" t Ili
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit,
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