Permit CITY OF TIGARD ELECTRICAL PERMIT
� COMMUNITY DEVELOPMENT ELECTRICAL
ELC201 1 -00109
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/24/2011
Parcel: 2S102AA03902
Jurisdiction: Tigard
Site address: 8915 SW COMMERCIAL ST 27
Project: DAVIDSON Subdivision: Lot: 0
Project Description: Service for manufactured dwelling
Contractor: PARKIN ELECTRIC INC Owner: DAVIDSON, WILLIAM G & DIXIE L
14001 FIR STREET 8915 SW COMMERCIAL ST
OREGON CITY, OR 97045 TIGARD, OR 97223
PHONE: 503 - 657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
1 ea Manuf / Modular Services or 02/24/2011 $67.84
Specifics: Feeder
1 ea 12% State Surcharge - 02/24/2011 $8.14
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 O& 52 - 001 - 0090. You may obtaitt.ar ales or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. .
Issued By ✓ „ � --''> Z- - �� Permittee Signature: 4 G i -..
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.
From: 02/23/2011 14:50 #515 P.002/002
to IN �
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Electrical Permit Application �� x 110 \\ FOR OFFICE t'.St: ONLY
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DateDate/8 : , / �M. _
1
•
MERIMI
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
2 Phone: 503.718.2439 Fax: 503.598.1960 Date/B , Other Permit:
T I V A R D Inspection Line: 503.639.4175 Date Ready/By: ® See Page 2 for
Internet: www.tigard or.gov Notified/Method: WM Supplemental Information
TYPE OF WORK lP'LM REVIEW:;'
❑ New construction Addition /alteration/replacement Please check all that apply (submit 2 sets of plans w/itetns checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
. " CA GO ' OF ttOgliR)I71L'1'ION , exceeds 10,000 amps at ISO volts or ❑ Floating buildings.
"- less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
M 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
14)1i S 1 11ON 4D L Cgl1lOg4 ❑ Emergency oof s m. larger separately derived system.
� ID Addition of new motor load of ❑
I 100HP or more. occupancy.
Job no.: Job site address:
9 /5 SLR Gamine i 4-0 5 f. ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: i � / a Og ❑ Health-care facilities. ❑ Supply voltage for more than
v!1 / ❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: -i Project name: ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description J Qtr. I Fee. 1 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 1
Tax map /parcel no.:
Limited energy, residential 7506 2
DESCRIPTION OF WORK (with above sq. ft.)
�/ Limited energy, multi - family 75.00 2
' T7 l/ l residential (with above sq. ft.) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
PROPERTY OWNER 1 • ❑ TENANT .' 201 amps to 400 amps 133.56 2
� /� � 401 amps to 600 amps 20034 2
Name: O U 1 Cx SOS ` �J S L 1 �i Cx 601 amps to 1,000 amps 301.04 2
Address: l? (� 9 J S c S1 Over 1,000 amps or volts 552.26 2
6/ Gt � �nr�Pi'C _d G
Temporary services or feeders installation, alteration, and/or
City /State/ZIP:
'T ,,-,,,9 01 2 9 -1 } 3 relocation
Phone: ( ) /j (L� 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
461 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 ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
El APIZICANT ) 0 c m cr P ER S above service or feeder fee, 7 42 2
i 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)
City /State/ZIP: Each manufactured or modular 67.84 _7 (V 2
lli d/
dwelling, service and/or feeder
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: Parkin Electric panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 14001 Fir Street Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Oregon City, OR 97045 Investigation (I hr min) - 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 657 - 4958 Fax: (503) 557 - 1059 Inspections for which no fee is 90.00/ hr
specifically listed (rfr hr min)
CCB Lie.: 3515j idol //.. Electrical Lic.: 34 -4C Suprv. Lic.: 4241-S ;ELECTRICAL PERMIT EES
Suprv. Electrician signature, required: �
Plan review (25% of
Xi i Subtotal G, t E y
,e_e_.../
permit fee):
Print name: David B Parkin Date: State surcharge (12% of permit fee): / /
TOTAL PERMIT FEE: 7 5 . 9 f
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.
N um b er of inspections allowed per permit.
I:\ Building \ermits\ELC- PermitApp.doc 07/01/10 440- 4615T( 1 I/05/COM/WEE