Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00194
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/13/2011
Parcel: 2S 103 DC04700
Jurisdiction: Tigard
Site address: 13855 SW 114TH AVE
Project: VATERNICK Subdivision: VIEWMOUNT Lot: 35
Project Description: (2) branch circuits for heat pump and exterior GFCI outlet.
Contractor: WEST SIDE ELECTRIC CO INC Owner: VATERNICK FAMILY TRUST
1834 SE 8TH AVE 13855 SW 114TH AVE
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 04/13/2011 $63.60
Specifics:. Service or Feeder
1 ea 12% State Surcharge - 04/13/2011 $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 are set forth in OAR
952- 001 -0010 through OAR 952- 001 -0090. You may obtain a cop o the r or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
c • ` 1
Issued By: c/ Permittee Signature: 11111Fr
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.
Apr 12 2011 5:14PM West Side Electric 503 - 736 -0656 p.2
Electrical Permit Application
RecL' City of Tigard C:.(C1:11' , r� d Permit Na.:�� i� — ) I G ` 1
u 13125 SW Hall Blvd., Tigard, OR 97 q� 1.%\\ Plan '7' "
Phone: 503.639 4172 Fax: 503.598 't, Y DetdBv: Other Permit
Inspection Lino: 503.639.4175 PQ� hate ReadyBy. runs ®se. Paget for
Internet www.tigard or.gov 1^ 4 �tifi eadYI yr ayr .. Supplemental Information
d' + ffi-rei'.....�...s,t4A .` our i �, ✓ • y� zr4 f t ?`: G '" „"' 1 S n M �pap-iy�y� ,�1, -"M7. to 7 d
r.�: f�i'Jnnn,:,'vPk xl r . ....i..... -,.... .t �..;.., .:fi+r1t .,, �'"L . .'a: _;...J +' I d.. ,., -"4l .a. -s�?3 c- .�... l 7-.��. -e�,
❑ New construction Addition/altetation/r V�y Please check all that apply (submit 1 sets of plans wtittrns checked below):
❑ Sere= or feeder 400 amps or more ❑ Building over three
El Demolition Other. ironies.
where the available fault current 0 Marinas and boatyards.
. ^4 S , .(*. *,,r ?, v `tR .! °
. e r ` r ,, vt!:. . _ ; k� f s exceeds 10,000 amps at 150 volts or ❑ Floating buildings. ground,
- ' less ro ground, or exceeds 14,000 0 Commercial-use agricultural
p 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for an other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.r_r. m .3 ❑ Emotgency system. le get selw derived syuem
rna4r, „a ,
a ,uz •� r 4,:.., , . _.. _ . , , ,F!3* wr.. . . �t� ❑ Addkfion of ne m otor load of
Job no.: �►^ / II Job site a ess: / yU
r
J S-� .c{? 3 l l�/ eye , _C 4i / r ! ❑ Saxor more ore. residential units. ❑ Recreational vohick parks.
City/State/ZIP: 0'7' 1 ` l e / 4 17 7 7 ❑ Health -care facilities. ❑ Supply voltage for mom than
1 !! I f ` ❑ Hazardous locations 600 volts nominal.
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Suite/bldg./apt. no.: Project name: - - /C-•G /(x.,, 6 ' CI Service or feeder 600 amps or more. F
Cross street/directions to job site: ties .nta ±, ' ,.t”„ s �,„T-. ,r . ,..
1 Qtr- 1 tee. 1 1 Total 1 •
New residential single- er asalti- family dwelling unit
Includes attacbed garage.
Subdivision: Lot no.: 1,000 sq ft or less 16834 4
Ea. add'I500 sq. R. or portion 33 -92 1
Tax map/parcel no.: Limited energy, residential
' .11 1kl 4"*,w.n�1�.l t ::��+.'�.... 1 . rR t.. .', h i w *:• 75.00 2
;,�; 1 � 1���ri;., ., t 1. ,. +t�t�rr (with above s4. R-)
Limited energy,multi- family
/174.504/149to ex vfve 6 t , residential (with above sq. ft .) 75.00 2
Services or feeders installation, alteration, and/or relocation
200 amps or Its 100.70 2
4 - , ' ^ ,j n A t } r w s1 201 400 2
amps to am 133.56
s i +. y a a
; rzR4 . alt - :. .,. ,.t .. t( .�.s+ q 4 . t 1' . .:140T k
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
Phone: ( )
Fax:( ) 200 amps or less 5936 1
201 amps to 400 amps 125.08 1 2
Owner installation: This installation is being made on property that 1 own which is not 401 to 599
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. amps 168'54 2
Branch circuits - new, alteration, or extension, per pastel
Owner signature: Date: A. Fee for branch circuits with
y ,. .. q , , r, r r w •Y e:' h { above service or feeder fee,
((�� r ✓r 5 3E 3,e v t :;,,,,,.''4A1,','„,',.'
a 742 2
r,; .;�,�, ... _.. g i,.� ...... 4 ;�� ._,..,.__. eac2ibrmchcircuit •
Business name: B Fee for branch circuits without
service or feeder fee, first / 56.18 �6 !
branch circuit
Contact name: / 2
Each add' I branch circuit / _ 7.42 7 lit 2
Address: Miscellaneous (service or feeder not included)
Ci lStatetZlP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.54 2
• Pump or irrigation circle 67.84 2
E - m a i l :
Sign orotnli
,_.1 t !11" k � r �� •� t _ 14 ' w � r outline lighting 67.84 2
'.."- , i , 4 , islesv ; , ".o ..1.'1' •„ ... : -r ..,..:r; , _ lt,t ..;: . . .!. Signal cireuit(s) or limited energy
Business name: West Side Electric Co., Inc. pa ch a ddld oa, li inspection Page 2
Each additional iaslxctioa over allowable is any of the abov
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
City /State/ZIP: Portland /OR/97214
Investigation d i (I hr mm) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: (503)231 - 1548 Fax' (503) 736 - 0677 inspections for which no fee is gppp/hr
s ifical listed h hr rain
CCB Lic.: 13306 Electrical Lic.: 26- 1 3 5 C Suprv. Lic.: 465 4 - S ' : k ,;;; ,Fe ,,•rr;
�/ Subtotal: �3 t—
Suprv. Electrician signature, required: ,7 e ./G, /„,c
Plan review (25% of permit fee):
Print name: Randall F Roberts Date: y /3// State surcharge (1 2% of permit fee): 7 63
nature: TOTAL PERMIT FEE: .2 r Z
Authorized signature: This permit application expires if • permit is aot obtained within 180
days alter it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit .
t.\Bu tewa&PermiesELC- PematApp doe 07/01 440-4615T(I I /0510 OMAVE6