Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00248
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 2S110DD06600
Jurisdiction: Tigard
Site address: 10650 SW SUMMERFIELD DR
Project: Summerfield Golf Course Subdivision: SUMMERFIELD NO.4 Lot: F & LOT
Project Description: (3) branch circuits for room by pro shop.
Contractor: WILLAMETTE ELECTRIC INC Owner: SUMMERFIELD CIVIC ASSN
PO BOX 230547 10650 SW SUMMERFIELD DR
TIGARD, OR 97281 TIGARD, OR 97224
PHONE: 503 - 624 -3631 PHONE:
FAX: 503 - 624 -2938
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 05/12/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 05/12/2011 $8.52
Type of Use: COM Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 • 952- 001 -0090. Yqu may o. _ - _ I- or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
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.
•
05/12/2011 TH11 8:22 FAX 5036242938 Willamette Electric Z002/002
Electrical Permit Application - . FOR • O U ONLY
City of Tigard �y ��
Received j r/ — Permit w
® Date/Byc „>, Pet No .
13125 SW hall Blvd., Tigard,OR 9' " . �J Plan Review
N. Phone: 503.639.4171 Fax: 503.598 .0 % Date/By: Other Permit:
TIGARD Inspection Line: 503.639.4175 4 14 Date Ready /13y: )uri5: to See Page 2 for
Internet: www.tigard- or.gov M P \ R ') N o tified/Method: ' E a' Supplemental Information
•
TYPE OF :WORx �y q�� 5� .. PLAN. R yr w :
A� New constructionAddiiion / alteratio , Please ch all th(submit at app ly (s 2 sets of plans w /items checked below):
❑ Demolition ❑ Other: B ❑ Service or feeder 400 snips or more ❑ Building over three stories.
T s g
where the available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
s less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑ 1- and 2- family dwelling 1 �Commercial /1ndustrtal El Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: 0 Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system, larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A" "E" "1 -2" "1 -3"
Job no.: ,6 9 7S Job site address: / 06,) sw I-I P or more.
occupancy.
S� y» ✓ _ Q�,riv /, !f% lOO ❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: }- c L/ a o -2 `j 2 ad ED Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: q o 1 G I e , s e 0 Service or feeder 600 amps or more.
::FEE SCHEDULE . .
Cross street /directions to job site: Description I Qty. I Fee. t 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 75.00 2
' DESCRIPTION OF `WORK (with above sq. ft) _
Limited energy, multi family
o w residential with above s ft.) 75.00 • 2
4e) (.9 (3J r�� cPya� /cs He ����c ( q� _
, Services or feeders installation, alteration, and /or relocation
C u M f `e// i , / , u ✓.. 5 y / p /� s 4 r 0. 200 amps or less 100.70
0 PROPERTY OWNER • . . :0 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
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
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
• 0 .APPLICANT . • . 0 'CONTACT PE above service or feeder fee 7A2 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first ( 56.18 „S"'‘ t 2
Contact name: branch circuit
Each add'l branch circuit I 2 7.42 I / `/ 1 ? -Y 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
Pump or irrigation circle 67.84 2
E - mail:
Signor 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
City/State /ZIP: Tigard, OR 97281 Investigation (I hr min) 66.25/ hr
Industrial plant (1 hr mm) 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. Lic.: 4226 -S . .ELECTRICAL .PERMIT-TEES
_- _. -.._
• - Subtotal: .7/ o t
Suprv. Electrician signature, requireel -""' —
Plan review (25% of permit fee): ,
Print name: David Fife Date: s'- /x--</ / State surcharge (12% of permit fee): 8 --=
Authorized signature: TOTAL PERMIT FEE: 7l y -
This permit application expires if a permit is not obtained within 190
Print name: Date: days after it has been accepted as complete.
Number of inspections allowed per permit.
lA lluilding \Permits\ELC-PermitApp.doc 07/01/10 440- 4615T(11/05/COM/WE1