Permit ,, CITY OF TIGARD ELECTRICAL PERMIT
. ,• COMMUNITY DEVELOPMENT Permit #: ELC2011 -00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011
Parcel: 2S111 DC11200
Jurisdiction: Tigard
Site address: 15810 SW OAK MEADOW LN
Project: DeGiavassi Subdivision: Lot: 0
Project Description: (1) branch circuit for bath remodel. 1/21/11, reprinted to add (2) additional branch circuits.
Contractor: SQUIRES ELECTRIC Owner: DEGIAVASSI, DARCY
PO BOX 16851 15810 SW OAK MEADOW LN
PORTLAND, OR 97292 TIGARD, OR 97224
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PHONE: 503- 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/19/2011 $56.18
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 01/19/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT 2 crt Branch Circuits w /Purchase 01/21/2011 $14.84
Service or Feeder
Type of Const: 0 ea 12% State Surcharge - 01/21/2011 $1.78
Occupancy Grp: Electrical
Total $79.54
Required Items and Reports (Conditions)
This permi issued subject to the -1 ulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be don in accordance with •roved s. 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 requ �rr you to follow the rules adopted by the Oregon Utility Notification enter. Those rules are set forth in OAR
952- 01 -0010 thr. ugh OAR 452- 001 -00• J ou ay obtain a copy of the rules or direct questions to OUNE•. •. • -- osue• 87 or 1.800 4 32.2344. ii
I ued By: V ', �/, ' Permittee Sig - -. ' . �' ✓�
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:
�r . CONTRACTOR INSTALLATION ONLY
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SIGNATURE OF SUPR. ELEC' / 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.
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00041
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/19/2011
Parcel: 2S111DC11200
Jurisdiction: Tigard
Site address: 15810 SW OAK MEADOW LN
Project: DeGiavassi Subdivision: Lot: 0
Project Description: (1) branch circuit for bath remodel
Contractor: SQUIRES ELECTRIC Owner: DEGIAVASSI, DARCY
PO BOX 16851 15810 SW OAK MEADOW LN
PORTLAND, OR 97292 TIGARD, OR 97224
PHONE: 503 - 252 -1609 PHONE:
FAX: 503 - 253 -5831
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/19/2011 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/19/2011 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 95- 001 -00.0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / / Permittee Signature: ,7�� ,D/ /C4 - 7U/\, 7
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 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.
01/17/2011 09:18 5032535831 SQUIRES ELECTRIC :6695 P. 002/002
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Electrical Permit Application if EcEiv
City of Tigard
D eceived y:
a 7/
I 1. 13125 SW Hall Blvd,, Tigard, OR 97223 JAN 1 8 2011 Plan Revie
Permt: •
; . • 2 ' ' Phone: 503,718.2439 Fax: 503.598.1960 i.)aie/tr . Other i
y:
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Inspection Line: 503.639.4175 Date Ready/By: Ju i / El See Page 2 for '
1;1:0 ARD
Internet: www.tigard-or.gov CITY OF TIGARD Notified/Method: • • Supplemental Information
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1kagiy .. Y.- qpitl• . ,,,,,,, 4 0 ,, ■ glAPZIPMVOlittat ,, ,...; .r...''..3(,( : ''.(.;, . .0440..i ' 1 ,- V; , 24 - .41 , . 0 ', - 3, r ',.,';.'",..", .;,t;'.1) 1.,f,vgammr,Tomswent' . ' . '; . (ir.7
1 t r ,, ,I .``....4.44nit',. 221,fita WI .: ::..,. , 61,r2:, . , io
0 New construction ti AdditiOn/aIteration/roplacemont Please check all tbat apply (submit 2 sets of plans w/items checked below):
El Service or feeder 400 amps or more 0 Building over.duce stories.
0 Demo ition 111 other: . where the available fault current D Marina. and boal
1 ,72M:lfge , ;•0, 2',Y.74.irltfoig$4', ' i ,ii,' ,''" aiT 1 tif amps at 150 volts or 0 Floating buildings.
less to ground, ur exceed>: 14,000 E3 Commercial-use agriculta7a
I 1 and12-family dwell iniz 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
,
• Multi4amily n Master builder 0 Other: 0 Fire pump. 0 i.xialin.lion or 75 KVA or
VM v ait tie r v' ii / Mil fir ft 'T ,470040A .A ,..,,
li,, ..) El Emergency system. larger *L- separately derived system.
0 Addition of new motor load of
ri I) 100HP or more, occupancy.
Job no.: 1 Job site address: T-5 /0 .-;„2,L) /la ." ;7t - .t AP Itilim
I 0 Six or more residential units 1:1 Recreational vehicle p,rks.
.. 0 Flealth-care facilit 0 ieg. Supply voltage for more than
City/SW siZIP: / ;3
0 Hazardous locations, 600 volts riomioal.
.
Suite/bldg./apt. no.: ProjeCt rtartct.crt;pre,c/ ie 4,.e..ilee4„," ID service or feeder 600 amps or more.
71i4/41Mrtaig114 7 ° , ‘ ,.., ' i . ' .•:)0 Wiff:AS014•4
Cross streiet/directions to job site: Deticription ON, I ' Fe, 1 Total
. New residential single- or multi-family dwelling unit_
includes attached prage,
Subd - 1
ivisr: Lot no.: 1,000 sq. ft. or less ,
168.54 4
Ea add') 500 so. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
75.00 2
4(1
'i '115t:V:6' (with above sq. ft)
iirr„ .i....: :NA; .......ii - ,......... • ' ' Jraiamiliabill.' .1. , • ' d:/...,.,.::,,,,::.. — i , ' ....,..r.., ..: , i'....ientaikid . .:G.F. . .
Limited energy., multi 75.00 2
Iffif . .• re. 'off _ residential (with above sq. ft.) • •
Seniees or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
:'''A■i),."■41N''' l'''V('t I 1 . 44iftf •;• • : `•' ) Vra: bii • '''ANV? o. . 4 ', i - i,, 203 ar to 4® --
amps 133.56 2
;.,31T.u7 .3'. .?„.. 4 IA.
401 amps to 600 amps 200.34 2
Name: 1
1 _ 601 amps to 1,000 amps 301.04 2
—
Address: Over 1,000 amps or volts . 552.25 2
Temporary seniees or feeders installation, alteration, and/o
City/Stat/ ZIP: relocation
Phone: ( ) — 1 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) own which is not -
401 amps to 599 amps 1.68.54 • 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 siinaturc: Dale: A. Yes for branch circuits ,vitit
7 , -„ -
"ir' 60" Tffir• il''..7i.'' '.'7F",'"':'4,','"IPIrti above seniee or feeder fee.
7,42 2
each branch circuit _
Business 'ia.rne: B. Fee for branch circuits without
. service or feeder fee, that a.
/ . 56.18 L 06,/,,,., 2
Contact namc: branch circuit
-- -- Each add 'l branch Circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
- fac manufactured factured or mod
City/State/ ZIP: 67.84 2
dw service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84
• .`,
E-ruiel.
,. Signor outline ligbting 67.84 2
An.:'•.:3 „ ‘,:: ;.: mvp.mtaggirt1:t,.;:33 Signal circuit(S) or limited-eneru • ' ,
-..T..._-7--- panel alteration, or e.xtension. • Page 2 2
Business nam- a w r e _ . , . 41 - r ,: ,,,
_ ,
.. Lich additional inspection over allowable in any of the above
AddreSrPb - Ii 2 .. 16 , x 1/ g,51 Additional inspection (1 hr min) 1 66.25/ hr
' Investigation (1 hr min) 66.25/ hr . .
City/State/LZIP .\2 L4.0 b p 9 7 . , t 9
i ... i industrial plant (I hr min) 78.1.8/ hr
(1t3 67 Fax: 6c,3),,a5,3 .... spections fot which no fee is
90.00/ hr
s. cificallyliStal (IS hr min)
/ Lie.= I 3,5 og .5 Vflecnical 1..ic24 ., 11 h LicA9V_,_5 4,:;;;,,,,.,:..mo 5,111trva7koo
Subtotal: ,,,. , .',
Suprv. F.1ctrician si _ nature, requi • —
Plan review (25% of permit fee).
i .
Print narte: ,,.. 1 6 tL i re> Date: //i7li i State surcharge (12 of permit fee): L ri 4,
,
I • TOTAL PERMIT FEE: L ,
Authorized signature: .
This permit application expires a permit Ls not oblaitind within 180
dayatt
sier it 'val y, een accepted a complete.
Print naide: Date: • Number of inopections allowed per perioil.
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I: \Euildirks‘PernrOAELC-Perrnitikrip.eoc 07/01/I n 440441 STO 1 /OS/MA/WEB
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01/21/2011 16:10 5032535831 SQUIRES ELECTRIC #6759 P.002/002
Electrical Permit Application - " -- 1 . FOR OFFICF: I SE ONI.‘'
1 1 e„ig_sl.
City of Tigard I Received
Date/13y: : ' Permit No.:) b 11-bOb if
I _ . 13125 SW Hall Blvd., Tigard, OR 97223 P-V
1 el-nir-fq •
, Phone: 503.718.2439 Pax: 503.598.196 c t- j t . r fl 1 11 .--. ,.. iAl Other Pernik:
T G , A i . 3 Inspection Line: 503,639.4175 0 gito '. &vim 8 V hero lea/0 RoadyfEiy: lids: 0 Cte PI% ..----
Internet: www.tigard Notified/Method; .
SuPPiemental Information
„,,,„„„,„,.. • ... ' .. —
ili2Niii:iiiiiin.i qi, 1% , .i.nillri,(.,,?':Iihr,R i tIV;i7F14i, 1 4 ... 1 "ii :..'0 ,."11:atML .: Melf,4mli r.7"Prl';!.,',MM.,11 ,..:. w,
,,,,,.„,.. ,.,00 Ai ,L.! f • ',.... rethgaistat,,, ,'.•,p :...,,Yi 8*„;,', i ..;wit'Ski',4•'.. ',•44, '.0.0ip OgLda. idAttkORMiltilieViiktAli714;•401 Ne'F4g
7
111 New construction I Addition/alteratio.ntellyeillWnrIGAqD Please check all that apply (submit 2 setS of plans. w/iteins checked below):
i %ill i l
0 Service or feeder 400 amps or more 0 Building over thmc stOrieS.
0 Demolition D Other: R H i n:Kra ' Pt/ISION where the available fault entrant 0 Marinas and iatiardS.
kiii0;k ,,,FF VA P PWW4,7, 1 , , ,,L 'FitiriV%6Tflifair exceeds 10,000 amps :t 150 volts or I:2 Floating buitclings.
,■•■•■ , ••'•?..`:Af):k :, T '..Ma 1 Vc-.M.: 'T,' f•w'll'a:1,4ediatialift''''.. Mgaaj '` n'''!,',1• \g,'N'EV:,.:, talogq ;''
less to ground, or exceeds 14,000 El Commercial-usc agriculturat
RI I - and 2 - fa m i 1 y dwelling 0 Commercial/industrial 0 Accessory building amps for all other in:33113.tiP35. buildinp.
• Multi-family 0 Master builder El Other; ID Fire pump. 0 Itedallation of 75 KVA or
..,E;.?:: mi litmL ' orxiseptpvipplaizt ,,,,,,,,,,, ,,,,, DEmergency .syt:tern. larger separately derived aystem.
171 Addition army motor load of 0
Job no.: Job site address: /502), ,_6 oa_K # et- . /I 10012 or rnore. occupancy.
. 0 Six or mere reideutial units. 0 Recreational , ehicle parks.
..,.—.
City/State/ZIP: t 1 to •• • at I t / 0 Health-care facilitie.%. CI Supply voltage for thorn than
ID Hazardous locations. 600 volts nominal
..
Suite/bldg./apt_ no.: . Project name; .t. , e q . 0 Scrwicc or feeder 600 amps or more.
— . 1 iftda-2-0,...., .palomm.wor,,, .,, ... . • , 11 ., • '' ::1Mr.D..• • '' • '
Cross street/directions to job site:
Decal tin
iiiirien.1 ToMt
New residential single- or multi-family dwelling nail.
Includes attached garage.
Subdivision: • Lot no.: 1,000 sq. ft. or less . . 168.54
- 4 1
— -- Ea. add/1500 sq. ft. or portion 33.92 I
Tax map/parcel no.:
Limited energy, residential
aiii7: '.140 :•-,. „1 ; , r r , r rot. ,1,.,',',gii:r,i. th above sq. fll • 75.00 2
411111 limited energy, muLti-fmily
75.00
II if . P re_ ilk Off residential (with above sq. ft.) 2
1
_.
" Services or feeders installation, alteration, and/or relocation
200 wilps Of less I 00.70 2
ii:Pqil il':',i:gai:UVV....r.Y *it-4!:$M f.l:N •io : 4 i 44 ' 1 7 A , 1 201 amps to 400 amps 133.56 2
Al.:S!:'iN5g.;i:;''i:.). 7,..'NlarmrE1 . ..." ,•,!„. Igthi, y.as,,,i l ' \ ri .A
401 amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps 301.04 2
Address: Over 1.000 amps or volts 552.26 2
1 emporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
—
Phone: ( )
[I'm ( ) 200 amps or less MI 59.36
... 201 amps to 400 amps MI 125.08
Owner installation: This installation is being made on property that I own which is nOt
401 amps to 599 amps MI 168.54 El
intended for sale, lease, rent, or exchange, according to ORS 447, 4.49, 670, and 701.
Branch circuits — new, alteration, or cxtension per panel •
Owner signature: Date: _____ ......... ..,._ A. Fcc for branch circuits with
ft
...
4"! 1 ' ' -- i" , , T."44;:q' ii;v:i;...,. 7 , asfriv, e service or feeder fee, c:7
742 1 4., g 74 2
q. .'4% ; ', ' :. '!. V ,,,4iiiii.V.,...1' each branch circuit
Uusiness name B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
— - Each add'lbranch circuit 7.42 2
Address:
Miscellaneous (service or feeder not inelutied)
— —
Each manufactured or modular
67.84 2
City/State/ZIP:
dwelling, service and/or feeder
Phone; ( ) I : I. Reconnect only 67.84 . 2
Pump Or irrigation circle ' 67.84 2
E
, Sign or outline lighting 67.84. 2
4 ,:..!!!!' iji itio ' GA NR9 1 n■:', '''':':' ,...el5 geMe'W41.1Wft S c ircuit(S) or limited-energy
panel, alteration, or extension. Page 2 2
Business narn-. , i p t a r e_4 4 -- efly„, d ..
Each additiOnal ins • etiOn over allowable in an of the above
r ' „,.' 3
Address: it 160x I t 51
o Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr .
City/State//,117PQAc be_ 9
Industrial plant (1 hr min) 78.18/ hr
Phone:. 603 , keo 9
I Fax er>3) ,....,),5,3 ,.. i Inspections for which no fee is
s• ificall listed 1/2 hr min 90.00/ hr 1
CCE3 Lic.:1 3s Electrical Lic),C lit J e Suprv. Lie.: ,:+,
4 ;°N t';',j;„"ng„,:; ' I ' '.7.75723r1M,&N; ,' , , , ,, , iv „
Subtotal.. ISEC111.
Suprv. Electrician signature, require
Plan review (25% of permit fee):
°
Print name: , , (44 re_4 — Datc:TpTi 1 1 Stale surcharge (12% of permit fcc):
TOTAL P'PRM ft 'FEE: ,
Authorized signature:
This permit application expirft if a permit 15 not obtained within 180
---
days after it has been accepted 35 complete.
Print name: Date: . Number of inspections allowed per permit, •
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I.: 1 Suliding \Pemiits\ ELC-PermitApp.doc 07/01/10 440 TO I/OS/COM/WEB -
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