Permit 11 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00253
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/12/2011
Parcel: 2S103CD05900
Jurisdiction: Tigard
Site address: 11640 SW FAIRVIEW LN
Project: Van Noy Subdivision: TERRACE TRAILS Lot: 19
Project Description: (1) subpanel, (4) branch circuits and (1) low voltage audio system for pool.
Contractor: WILCOX ELECTRIC Owner: VAN NOY, ELDON
300 WASHINGTON ST 11640 SW FAIRVIEW LN
VANCOUVER, WA 98660 TIGARD, OR 97223
PHONE: 360 - 694 -3800
PHONE: 503 -803 -1558
FAX: 360- 694 -3801
FEES
Quantity Description Date Amount
1 ea Limited Energy 05/12/2011 $75.00
Specifics:
1 ea Services or Feeders - 200 05/12/2011 $100.70
amps or less
Type of Use: SF 4 crt Branch Circuits w /Purchase 05/12/2011 $29.68
Class of Work: ALT Service or Feeder
Type of Const: 1 ea 12% State Surcharge - 05/12/2011 $24.65
Electrical
Occupancy Grp:
Total $230.03
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 OA' • 2- 001 -0090. You - :: _ • of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
1 111111P 111° r i 4
Issued By: i '�C — - ermittee 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.
May 12 11 02:OOp Wilcox Electric 3606943801 p.2
Electrical Permit ApplicatiMVSIAl 91\11(111[1a FOR OFFICE USE ONLY
v
IVDl1 d0 A113 Received
City of Tigard DateB : ... / 6 Permit No _ ` a I 9-
'
13125 SW Hall Blvd., Tigard, OR 9722#310 Z Z I xd W Plan Review
Phone: 503.639.4171 Fax: 503.598.1 0 Dateff3y I Other Permit: 10
' In —t�� 4
Inspection Line: 503.639.4175 , p /� � Date Ready/By: El ee Page for
TtGARI} p ` I AI R'3311 ►Jt A I t�otified/Method: Internet: wrvtv.tigard or.gov 1 � a , f di [l Supplemental Information
TYPF, OF WORK N PLAN REVIEW
•
Please check all that apply (submit 2 sets of plans wfitems checked below):
❑ New construction S. Addition/alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
1 ❑ Demolition ❑ Other: l where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14,000 Ql Commercial - use agricultural
1- 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
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new motor load of ❑ "A "E ", "1 - 2 ", "1 3
// r . IloHPormore. occupancy.
Job no.: Job site address: 7/ , (7 v / ) / ' z 0 Six or more residential units Cl Recreational vehicle parts
City/State./ZIP: :O, C` r �) °p' ❑ Health -care facilities. ❑Supply voltage for more than
� - t? lJ� ❑ tlazazdaas locations. 600 volts nominal.
Suite/bldg./apt no.: Project name: 0 Service or feeder 500 amps or MOM.
FEE SCHEDULE j
Cross streeddirections to job site: /7,'S' n aA . ' nntripuon I Qty. l Cm.. 1 Total I - i
<Te J 1 New residential single - or multi- family dwelling unit.
Includes attached garage..
Subdivision: Lot no.: E,000 sq. ft. or less 168.54 4
Ea. add'l 500 sq. @- or portion 33.92 l
Tax map /parcel no.: — Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) 67.
af, 1 ..--- tirp tn) - Limited energy, multi-family
ft
residential (with 67.84 2
s frA
i o Services or feeders installation, alteration, and/or relocation
_ 9 � jlj t t) 200 amps or less I / I 100.70 /Dd. 2
0 PROPERTY OWNER . ❑ TENANT 201 amps to 400 amps 133.56 2
y� �J (//7",7 401 amps to 600 amps 20034 2
Nye.
/ �/" 3 / /� 601 amps to 1,000 amps 30 L_04 2
Address: c-,,e4kx_.. / 4 .4-64,-- - Over 1.000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP:
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that 1 own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for brunch circuits with /,,- /
0 APPLICANT [ 0 CONTACT PERSON above service or feeder fee, 4
7_42 +j
�CI� Z
each branch circuit oC
Business name: `- / .4' (dR .,� /- ` c �'✓ B. Fee for branch circuits
lust branch feeder fee,
Contact name: 7:642,50/- Cirst bra branch cirit cuiui t 56. 18 2
•
Address: 306 J � ` " � Each add'I branch circuit 7.42 2
>! � / Miscellaneous (service or feeder not included)
�i /.�
City /State /ZIP: ° .-r �/i Z./ a 9 $.,
Each manufactured or modular
67.84 2
�/ /y t / .c dwelling, service and /or feeder
Phone; { ) .6gr'3 } Fax:: K3$2 6 L y 3 R Reconnect only 6784 2
E -mail: Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting 67.84 2
/ Signal circuit(s) or limited -
Business name
/�`zZ, 1 � (�, �„‹�- energy panel, alteration, or
{{ � , extension. Describe: Page 2 � 2
Address: 30(-)
City /State /ZIP: Each additional inspection over allowable in any of the above
�f����� �� Per inspection 66_25
Phone: (30) , 99- - - 31� Fax: ( ) 4/.- J ) Investigation per hour (1 hr rain) 66.25
CCB Lie,: /// Electrical Lic.: n �7 J f� 1 Su rv_ Lie.: Industrial plant per hour 78.18 -
((�6� ` I `7l �� 7f P `� ELECTRICAL PERMIT FEES ._
Suprv. Electrician si Y4uired:t��� 1/1) 10 !V if 17 Subtotal: '�
"r ,Z Plan review (25 %ofpermit fee):
Print name: i Date: - - /
�� 1� +� = �' '�. // Slate surcharge (12% of permit fee): 4..1)
Authorized signature: .0.' - TOTAL PERMIT FEE: • - --�' • > This permit application expires if a permit is not obtained within 110
Print name: �� Q Date: I` L' �� days after it has been accepted as complete.
' ' T umber of inspections allowed per permit. )30'03
1.).Builditmlpetmits1ELC- PermitApp.doc 10/01)09 440- 46tsrlt lros/CONIVES