Permit CITY OF TIGARD ELECTRICAL PERMIT
Ise COMMUNITY DEVELOPMENT Permit #: ELC2011 -00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/01/2011
Parcel: 2S 103 BA00140
Jurisdiction: Tigard
Site address: 12035 SW LYNN ST
Project: METZLER Subdivision: LERON HEIGHTS NO. 2 Lot: 30
Project Description: Bath and kitchen remodel, (1) panel and (8) branch circuits.
Contractor: CHANCO INC Owner: METZLER, ERIC G
3521 SW CARSON 12035 SW LYNN ST
PORTLAND, OR 97219 TIGARD, OR 97223
PHONE: 503 - 245 -7774 PHONE:
FAX: 503 - 244 -4804
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 02/01/2011 $100.70
Specifics: amps or less
8 crt Branch Circuits w /Purchase 02/01/2011 $59.36
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 02/01/2011 $19.21
Electrical
Type of Const:
Occupancy Grp:
Total $179.27
Required Items and Reports (Conditions)
This permit ' • • . •'-ct to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be do in accordance with - pproved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
day-. ATTENTION: Oregon la • requi : you to follow the rules adopted by the Oregon Utility No ' -n Center. Those rules are set forth in OAR
9' - 001 -0010 through OAR 952 •01r00�, Y.0 may obtain a copy of the rules or direct questions to c s IC by 4.1t1232.1987 or 1.800.3 '.2344.
Issued By: /LL �r� 7 Permittee • • • re: . — �' / l
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. &,gg 5
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.
Jan 31 11 03:14p Leslie Chandler 5035790677 p.2
Electrical Permit lication
City of Tigard ECEIVED felt 01 1-lc l' t SF ONl.1
Q 1 2 011
,, . 13125 SW Hail Blvd., Ti ei
DaRectdB ved �Ot�
C Phone: 503.7182439 Fax: 03.598 60 i3 Plan Review - /� Permit No E^4Q(pl �Cr� 7
TIGARD Inspection Line: 503.639.41 Date1R Other Permit:
Internet. www.ligard or.gov Date Ready /By: L - t/ �l 0003 CITY OF TIGARD Notified Method: ill See Page 2 for
TYPE OF i t i ; ' , ' r • Supplemental Information
❑ New construction f? dditi .. / aheratian /replactxnent • PLAN REVIEW
Please check all that apply (submit 2 sets of plans w; items checked below)
Ftoa
❑ Demolition Other: ❑ Service or feeder 400 amps or more
where the available fault current 0 Marina Building and three stories.
CATEGORY OF CONSTRUCTION 0 Marinas buildings.
bud b
exceeds
r - an exceeds 10,000 amps at 150 volts or 0 ang ngs,
less
family dwelling [] Con ercia!/industttiai to ground, or exceeds 14,000 0 Commercial-use agricaln
0 Accessory building ral
❑ Multi-family 0 Master builder Outer amps for al/ other installations. buildings.
Fire pump. ❑ Installation of 75 K VA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system.
larger separately '1 derived system.
lob no.:� c i lob site address: ❑ Addition of new ,actor boa of ❑ °A �� . I
S t ri 1 • 1001iP or more. occupancy.
City/State/ZIP: OIL. 0 Six or more residential units. ❑ Recreational vehicle parks.
3 ❑ Health -care facilities. ❑ Supply voltage for more than
Qiiazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name:
0 Service or feeder 600 amps or mote,
Cross street/directions to job site: FEE SCHEDULE
Dery ' tier
New residential single- or multi- faraily dwelling nit.
Subdivision: Includes attached garage.
Lot no.: 1,000 sq. ft or less 111111 168.54 a
Tax mapiparce! no.: Ba. add'l 500 sq. ft. or portion
33.92 111111111111 t
DESCRIPTION OF WORD Limited energy, residential
F� l with above s.. ft.) 75.00 MO
.. ;^ `.. L I, Cc;YL Limited energy, multi - family 1111 �ti'�. ., residential with above .. $. 75.00 �
Services or feeders installation alteration, and/or relocation
❑ PROPERTY OWNER 200 amps or less Iva 100.70 main
❑TENANT 201 amps to 400 amps 111111 133.56 �
�
Name: 401 amps to 600 amps MINIMISE' Address: 601 amps to 1,000 amps 11111 301 0 B
Over 1,000 amps or volts 552.26 e
CityiState!ZIP: Temporary services or feeders installation, alteration, and /or
relocation
Phone: ( )
Fax: ( ) 200 amps or less 111. 59.36
400
Owner installation; This installation is being made on property that I own which is not 201 amps to 599 amps
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. l2s o8 8
401 amps to 599 amps 168.54 2
Owner signature: Branch circuits — new, alteration or extension, i r ■ and
Date: A. Fec for branch circuits with
above service or feeder fee. _ ]]•
❑ APPLICANT ❑ CONTACT PERSON
�
Business name: each branch circuit i 42 .� 4 Ja7
B. Fee for branch circuits without
Contact name:
branch or fu circuit
fee, first ®
Dra t 56.18
Address: Each add'l branch circuit IIIII 7 -42 MIIIIIIIIMI
Miscellaneous service or feeder not included
City /State/ZIP: Each manufactured or modular
dwellir :, service andlor feeder
Phone: ( ) 67 84 2
f Fax: ( ) Reconnect only IINNEICIIIIII
E ___,III or irrigation circle 6 $4 Il
CONTRACTOR Sign or outline lighting
INIINIMIMININ
Business name: C �/ Signal circuit(s) or limited- energy _11
0_1,1 L ;1t v� coot -�/iei " - 0 C el, alteration, or extension.
Address: E ach additional ins ( ection over allowable in a n • of the above
l -' ' • , c - & -. Additional inspection (I hr min) 11111111232:1 ■ IIIIIIIII
i
City/State/ZIP: ,`S-k �� 't ,j C t C
Z
i 'Uc0 cy Investigation (1 br min) mg 66.25/ hr
Phone: ( t
)� Industrial plant (1 hr min) � J Fax: (.56 ) `( . L (•� [� lrtspectious for uhieh no fee is 78.18) hr ■
CCB Lic - 7 ; �1 G I � 0 �r lectrieal Lie. ( -'ecificall listed (i4 hr mitt) 00 hr ��
J Supr . Lic,: , �` ELECTRICAL PERMIT FEES
Strprv Electrician signature, required: �/\il j'� ��_ 1 } 1
Subtotal:
Print name: Plan review (25 %of permit fee):
u- t • . Gi : : Date: „•^ ,� i f State surcharge (l2 %of permit fee)_
Authorized signature: 1� ! t r ,�i i�� L`' / TOTAL PERMIT PEE: A
is r � � fhia permit apptieat en ecpi ���r�r
res it a permit is not obtained within l80
Print name: I Date: �' • days after it han been once
pted as complete.