Permit CITY OF TIGARD ELECTRICAL PERMIT
114 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00077
T f G /y R L7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/02/2011
Parcel: 25111 DB12400
Jurisdiction: Tigard
Site address: 15275 SW 94TH AVE
Project: VanKleek Subdivision: SUMMERFIELD NO.12 Lot: 651
Project Description: (2) branch circuits for bathroom remodel.
Contractor: BECK ELECTRIC INC Owner: VANKLEEK FAMILY TRUST
15600 SE FOR MOR CT #B BY JAMES A & LENORE J VANKLEEK TRS
CLACKAMAS, OR 97015 15275 SW 94TH AVE
TIGARD, OR 97224
PHONE: 503 - 656 -7396 PHONE:
FAX: 503 - 656 -4397
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/02/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/02/2011 $7.63
Type of Use: SF Electrical
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 you to follow the rules adopted by the Oregon Utility Notification Center. Those rules ate set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a copy of thelules-ordirect questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued B �+ tiv ✓ 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.
Feb 01 11 03:29p Beck Electric (503) 656 4397 p.2
Electrical Permit Application ��� FOR OFFICE USE ONLY
C ity of T i a � �\ �t R eceived f Permit No *:
IN _ •J g 111 Date/Be: r v1 i I V
'r 131 25 SVV Ha ll Blvd., Tigard OR 9722 Flan Review
Ocher Permit / l + r��
Phone: 503.6_9.4171 Fax: 53.598.19 DaterBy: V 'v[�PT3
TIGARD Inspection Line: 503.639.4175
ate Ready/By: turn: ® See Page 2 for
Read
Internet: www.tigard- or.gov ,. �G � n W Gi� i - —.mil -
Suppkrreatal Information
. TYPE OF WORK - , 6 ` • • , - PLAN REVIEW
0 ❑ New construction X Addition/alteration/re % KIs' Please check all that apply (submit t sets of plans w /items checked below):
❑ Demolition ❑Other: V P ❑ Service or Feeder 400 amps or more ❑ Building ova three stork s.
where the available fault cersent ❑ Martens and boatyards.
. - . - • . CATEGORY OF CONSTRUC`PION ' . exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
tens to ground. et exceeds 14,000 0 Commercial agricultural
1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps For all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. 0 Installation of 75 KVA or
• JOB SITE INFORMATION` AND LOCATION , i I=1 Emergency system. larger separate!, derived system.'
• 12 o Addition of new moror load of ❑ "A" "E" "I -2 ", "1 -"t ",
Job no.: 1 59 Ott) Job site address: 4 57_1 5 5v,) Cj 4 A'V E 100511' or more. occupancy.
❑
13 Six or mom residential units. Recteaticnal vehicle parks.
City /State/ZIP: tt 9 aeoi ( 0 1L ❑ Health - care facilities. ❑ Supply voltage for more than
❑ Hazardous :ovations. 600 volts nominal.
Suiteibldg. /apt. no.: Project name: VotAl k/. ,tie ❑ Service or feeder 600 amps or more.
i - FEE SCHEDULE • '
Cross street /directions to job site: llearriatina I Qry. I Fer. I Tut! 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 1
Tax map/parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK . (with above sq. ft.) •
Limited energy, multi- family I -1 _ 75.00 i 2
2 . CV-13 v . f� residential (with above i
-tJ 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 r 200.3. 2
Name: 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 1 I
201 amps to 460 amps 125 08 I 2
Owner installation: This 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 i
. . ❑ 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 j 56.18 5 2
Contact name: branch circuit
Each add'/ branch circuit 1 7.43 7,1.2.- 2
j Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured of modular 67 84 1 2
y. d'wel line, service and or feecer
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: Sign or 67.84 2
- . CONTRA OR Signal circuit(s) or limited-energy
t panel, alteration, or extension. Page 2 2
Business name: T.. E k ec((.r C.. • Each additional inspection over allowable in any of the above
Address: t 5 t 0 se m YY) o - ? O ;7- #""� Additional inspectior. (I hr min) 66.25/ hr
investigation (I h- min) _ 66.25/ hr
City/State/ZIP: �0.Gka 9-70 is Industrial plant (1 hrm:n) 78.18/hr
Phone: (6) a S( o _ 34 b Fax: (5 7g) (o.S(o -' 43 r -7 Inspections for which no fee :s 90.00/ hr
soeci lcally listed (4 hr min) i
CCB Lie.: - C Electrical Lie.: 3 - SG Suprv. Lie.:SO i S • ELECTRICAL PERMIT FEES f
, - Subtotal: I .40 -
Suprv. Electrician signature, required: 0 Plan review (25% of permit feel
Print name. c, 6,,,- S ctvN At5 - Date: 2 (, State surcharge (12%ofpermit fee): . - 7 , 63 j
TOTAL PERMIT FEE 1 ""/I, Z 3 i
Authorized signature {+�� _ This permit application expires ifa permit is not obtained within 18 ti
S { J
days after it h been accepted as complete.
Print name & r VR, 11 � ybyl t 5 Die r ( N,. mber cf inspcctionsal lot�wed per perxit.
I inn.ld gi',rnits:F C- PemlitApp.dor 07.'01 /10 440-4615Th I ID5,coM/W'ED