Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00456
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/10/2011
Parcel: 2S103CC08800
Jurisdiction: Tigard
Site address: 12130 SW KELLY LN
Project: Clark Subdivision: WHISTLER'S WALK Lot: 35
Project Description: (2) branch circuits for backyard shed.
Contractor: FRONTLINE ELECTRIC INC Owner: CLARK, CHRISTOPHER W
1150 SE LAURA DR 12130 SW KELLY LN
GRESHAM, OR 97080 TIGARD, OR 97223
PHONE: 503 -313 -7620 PHONE:
FAX: 503 - 666 -4845
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 08/10/2011 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/10/2011 $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 i sued sui t to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law All work will
be done i. accordance with - .proved 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. TENTION: Oregon la , requi es ou to follow the rules adopted by the Oregon Utility • . '.n Center. Those rules are set forth in OAR
952 -00 0010 thro gh OAR 952 n1-0090. . ay obtain a co.y of the rules or direct questions to OUNC '' 1987 or 1 800.3 2.2344 •
Issu• . By: ♦ Permittee Signatur• ec.""
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' 4111111110A i � rr9—�� 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.
Aug 10 11 01:47p Frontline Electric 5036664845 p.1
Electrical Permit Application e y to i� FOR OFFICE t.sE ONLY •
III r City of Tigard C a c P W_ i Rec eived if! '^ ....2, 0l e ,6
g Date /Bv: 1 • Permit No.
13125 SW Hall Blvd., Tigard, OR 97223 ! Plan Review
Phone: 503.718.2439 Fax: 503.598.19 G 1 0 2 0i 11 Date /B�e Other Permit:
Inspection Line: 503.639.4175 Date Ready/By. luris Elf See Page 2 for
TIGARD Internet: wwwtieard- or.gov CITY TIGARD OF TD Nolifled/Method: Supplemental Information
OF IC3�t'
TYPE OFLAVRTONG DIVISION PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2, sets of plans w /items checked below):
❑ Service or feeder 400 amps or mom ❑ Building over three stories.
1:1 Demolition ❑ Other:
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 0 Commercial -use agricultural
El 1- and 2- family dwelling Q Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ' ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E ", "1 -2', I -3 ,
Job no.: Job site address: 12130 SW Kelly Lane IOOIiP or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard, OR ❑ Health - care facilities. ❑ Supply voltage for more than
' ❑ Hazardous locations. 600 volts nominal.
Suitefbldg. /apt. no.: Project name: 0 4/2)./.. ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site: Description I OMr. I Fee. I Total
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: 1 Lot no.: 1,000 sq. ft. or less ! 168.54 4
Ea. add'! 500 sq. ft. or portion 33.92 I
Tax map/parcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. f2) 75.00 2
Limited energy, multi - family 75.00 2
2 new circuits for a new backyard shed. residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name:
401 amps to 600 amps 200.34 2
601 amps to 1 ,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
CityfStatefZlP Temporary services or feeders installation, alteration, and/or
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, r cr panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ❑ CONTACT PERSON above service or feeder tee,
each branch circuit 7.42 2
Business name: ! B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'] branch circuit 1 7,42 7.42 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
E -mail:
Pump or irrigation circle 67.84 2
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s} or limited- energy
Business name: Frontline Electric, Inc panel, alteration, or extension. • Page 2 2
Each additional inspection over allowable in any of the above
Address: 1150 SE Laura Dr. Additional inspection I
nspection ([ hr min) 66.25! hr
City /State /ZIP: Gresham, OR 97080 Investigation (1 hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (503) 313 - 7620 i i I Fax: (503) 666 - 4845 Inspections for which no fee is
CCB Li c.: 17I294 ¢ El ectrical Lie.: 196 specifically listed ('h hr min)
90.001 hr
^� CH 96 6 1 1 14 S uprv. Lic.: 52 /o //,f ELECTRICAL PERYIIT FEES
/ ,/
A f ! Subtotal: 63.60
Supra. Electrician signature, required: f .
. ct� Plan review (25% of permit fee):
Print name: Clinton W. Siuerhoff Date: 8/8/11 State surcharge 7.63
ge (12 /o of perm fee):
Authorized signature: /� -- /
TOTAL PERMIT FEE: 71.23
C �� This permit application expires if permit is not obtained within 180
days after it has been accepted as complete.
Print name: Clinton W. Stuerhoff Date: 8/8/11 • Number 0 (inspections allowed per permit.
I :l Building \Permits\ELC- PermiiApp.doe 07101/10 440- 4615T(111o5(COM/WEB