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Permit CITY OF TIGARD ' ELECTRICAL PERMIT 11 1 COMMUNITY DEVELOPMENT �� Permit #: ELC2011 -00062 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011 Parcel: 1 S134DC11300 Jurisdiction: Tigard Site address: 11530 SW GALLO AVE Project: MERCER Subdivision: CASCADIAN PLACE Lot: 2 Project Description: (5) branch circuits for lights and receptacles in family room. 2/2/11, reprinted to add (2) services and (5) branch circuits. Contractor: WILLAMETTE ELECTRIC INC Owner: MERCER, SCOTT D & PO BOX 230547 MERCER, VALERIE GAY TIGARD, OR 97281 11530 SW GALLO AVE PORTLAND, OR 97223 PHONE: 503 - 624 -3631 PHONE. FAX: 503 - 624 -2938 FEES Quantity Description Date Amount 5 crt Branch Circuits wo /Purchase 01/27/2011 $85.86 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/27/2011 $10.30 Type of Use: SF Electrical Class of Work: ALT 239 Electrical Permit 02/03/2011 $238.50 29 12% State Surcharge - 02/03/2011 $28.62 Type of Const: Electrical Occupancy Grp: Total $363.28 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. ATTE • • -. • • law requires you to follow the rules adopted by the Oregon Utility Notification ' -nter. Those rules are set forth in OAR 952- 001 -0. 0 through OAR 95 '01 -0 You may obtain a copy of the rules or direct questions to OUNC b calling '- .1987 or 1.800.332.2144. Issue. y: k Permittee Sig g � 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: ONTRACTOR INSTALLATION O LY 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 II I COMMUNITY DEVELOPMENT Permit #: ELC2011 -00062 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/27/2011 Parcel: 1 S134DC11300 Jurisdiction: Tigard Site address: 11530 SW GALLO AVE Project: MERCER Subdivision: CASCADIAN PLACE Lot: 2 Project Description: (5) branch circuits for lights and receptacles in family room. Contractor: WILLAMETTE ELECTRIC INC Owner: MERCER, SCOTT D & PO BOX 230547 MERCER, VALERIE GAY TIGARD, OR 97281 11530 SW GALLO AVE PORTLAND, OR 97223 PHONE: 503 - 624 -3631 PHONE: FAX: 503 - 624 -2938 FEES Quantity Description Date Amount 5 crt Branch Circuits wo /Purchase 01/27/2011 $85.86 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/27/2011 $10.30 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $96.16 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 Ot '. ;52- 001 - 0090. a ain a cop the rul • • - t questions to OUNC by calling 5032321987 or 1.800.332.2344. � Z 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 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. 01/26/2011 WED 11:37 FAX 5036242938 Willamette Electric (002/002 • Electrical Permit Application � '� ' : OR' ° OGFICE USE ONLY Received � _ r y . City of Tigard � 11 Date/B I a sf' iI �(Jl / Permit No.: �L� C. I i_C,C.M� " 13125 SW Hall Blvd., Tigard, OR 97223 *° 6 1. Plan Review Phone: 503.639.4171 Fax: 503.598.1'40 Ps" ,� ■Date/By: Other Permit: TIGARD' Inspection Line: 503.639. 175 J qt ✓Date Ready/By; tun a Ready/By; s. See Page 2 for Interact: www.tigard- or,gov �l c `` ' {{\ , cTjofificdlMethod: %" Supplemental Information ralrl ,v TYPE OF WORK G \% * ��va PLAN REVIEW P lease check all that apply (submit 2 sets of plans w /items checked below): ❑ New construction [Addition /alteration /replacement ) ❑ Service or feeder 400 mops or more ❑ Building over three stories. ❑ Demolition ❑ Other: _ 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 21- 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. 30B SITE INFORMATION AND LOCATION. /C t`i-/ ; L (j ❑ Addition of new motor load of ❑ "A ", "Ei ", "1 -2 ", "1 -3 ", Job no.: / Z 3 $' Job site address: / / S 3 D S 6,..6,..... G _ 2 // e Six or or more. occupancy. ❑ Six or more residential units. ❑ Recreational vehicle parks. City/State/ZIP: T / ` , .al , /L 9 7 2 Z 3 ❑ Health -care facilities. ❑ Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite /bldg. /apt. no,: Project name: C.1 e f` G v ❑ Service or feeder 600 amps or more. FEE SCHEDULE Cross street /directions to job site: Description i Qty. I Fee. I Total i New residential single- or multi- family dwelling unit. includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4 Ea. add'I 500 sq. ft. or portion 33.92 I Tax map /parcel no,: Limited energy, residential 75.00 2 DESCRIPTION OF WORK (with above s q ft.) Limited energy, multi- family 75.00 2 A f J /t f A 1.4- 's 7 cr a ,lei fe r 14,3•4, /'d .«, L v residential (with above sq, ft.) / / Services or feeders installation, alteration, and /or relocation T R oot,.., G JnnevF D/7 /+ , ,4 � GA , / 200 amps or less 100,70 2 ❑ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 401 amps to 600 amps 200.34 2 NamC: 601 amps to 1 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 1 201 amps to 400 amps 125.08 2 Owner installation: This installation is being made on property that I own which is not 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. Fee for branch circuits with ❑ APPLICANT .10 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 i 2 Contact name: branch circuit / Each add'I branch circuit L// 7.42 'Z. 6+1 2 Address: Miscellaneous (service or feeder not included) Each City /State /ZIP: dwelling, modular 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. _fie 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 (1 hr min) 66,25/ hr Industrial plant (1 hr min) 78.18/ hr Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90.00/ hr - specifically listed (' /a hr min) CCB Lie.: 75059 Electrical Lie.: 34-283C Suprv. Lie,: 4226 - . • - ELECTRICAL PERMIT FEES . :' :•.: .‹.--° Subtotal: 8 s Y6 Suprv. Electrician signature, requif'ed' -- Plan lan review (25% of permit fee): Print name: David Fife Date. / 2 6--) State surcharge (12% of permit fee): / 3 TOTAL PERMIT FEE: 9' 1 Authorized signature: This permit application expires if a permit is not obtained within 180 days after it has been accepted as complete. Print name: Date: * Number of inspections allowed per permit. IABuitdin0\Permits'LLC-PcrmitApp .doe 07 /0t /t0 440.46157(1 I /OS /COM/WEB 02/02/2011 WED 14:29 /L FAX 5036242938 Willamette Electric Q002/002 •f -'1 d ( I r e > p e „ — 2 " . 1 1 „ t Electrical Permit Application I ^ /e. 2/_ , �� ( c FOR OFFICE usi ONLY City of Tigard Received f 2 r -_ Date/By, Permit No.: e of/-.4%e. tr 13125 SW Ball Blvd., Tigard, OR 97223 Plan Review ' C Phone: 503,639,4171 Fax: 503.598.1960 Date/By: Other Permit: • TIGARD Inspection Line: 503.639.4175 Date Ready/By: orris: 6'1 See Page 2 for Internet: www.tigard or.gov Notified/Method: Supplemental Information _ TYPE OF WORK PLAN REVIEW : P lease check all that apply (submit 2 sets of plans w /items checked below ❑ New construction ,[] Addition /alteration /replacement below): Service or feeder 400 amps or more ❑ Building over three stories, ❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION • exceeds 10,000 amps at 150 volts or 0 Floating buildings. - . . less to ground, or exceeds 14,000 0 Commercial -use agricultural ® 1- and 2- family dwelling 0 Commercial /industrial 0 Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: D Fire pump. 0 Installation of 75 KVA or 0 Emergency system. larger separately derived system. JOB SITE TNORMATI!ON AND LOCATION 0 Addition of new motor load of ❑ ' A” "E” "1 -z^ "] -3" 100IP or more. occupancy. Job no.: / ,!.?, Job site address: //s _ 3 c 5cs 6 - 6 // 4 Y ❑ Six or more residential units. ❑ Recreational vehicle parks. Cit /StatelZlP: C (,--41,..67 �/ c' •- ❑ Health -care facilities, El Supply voltage for more than y / l c2 1 t f r2. 2- 0 Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: r , 1 e C , 0 Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description I Qty. I Pee. I Total l New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or Less 168.54 4 Ba. add'l 500 sq. ft. or portion 33.92 1 Tax map /parcel no.: Limited energy, residential 75,00 2 • DESCRIPTION OF WORK ( with above sq. ft.) _ Limited energy, multi- family 75.00 2 residential (with above sq. ft.) WA/ �� f v L ' n G1 q (I v i ' , `�/ f Services or feeders installation, alteration, and /or relocation f d l ` ,` � (� ( L.. 200 amps or less 100.70 . 26 1 Yom' 2 ❑ PROPERTY OW NNE � ❑ TENANT 201 amps to 400 amps 133.56 2 401 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 City/State/ZIP: Temporary services or feeders installation, alteration, and /or tY relocation Phone: ( ) Fax: ( ) 200 amps or les 59.36 1 201 amps to 400 amps 125.08 2 Owner installation: 'Phis installation is being made on property that I 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 ❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee 7.42 3 7 ' 2 each branch circuit Business name: 13. Pee for branch circuits without service or feeder fee, first 56.18 2 Contact name: branch circuit . Each add'l branch circuit 7.42 I 2 Address: Miscellaneous (service or feeder not included) _ City/State /ZIP: Each manufactured or modular 67.84 2 dwelling, service and/or feeder Phone; ( ) Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 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 Investigation (I hr min) 66.25/ hr City /State /ZIP; Tigard, OR 97281 Industrial plant (1 hr min) 78.18 / hr Phone: (503) 624 - 3631 Fax: (503) 624 - 2938 Inspections for which no fee is 90,00/ hr specifically listed ('4 hr min) CCB Lie.: 75059 Electrical Lic.: 34 -283C Suprv, Lie.: 4226 -S ELECTRiCAL PERMIT FEES Subtotal: 3 3 -,' Suprv. Electrician signature, required:" - '"� - - Plan review (25% of permit fee): Print name: David Fife Date: 2/7.2 -1/ State surcharge (12% of permit fee): 32> ` TOTAL PERMIT FEE: i 7l, 7 /. _ Authorized signature: 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. 1:1 BuildingWermits \ELC-PermitApp.doc 07/01/10 440- 46157(11/05 /COM/WEB