Permit CITY OF TIGARD _ ELECTRICAL PERMIT
1 4 2 COMMUNITY DEVELOPMENT Permit #: ELC2011 -00532
TEGAR1 13125 SW Hall Blvd., Tigard OR 97223 503.718 2439 Date Issued: 09/28/2011
Parcel: 2S110AD06300
Jurisdiction: Tigard
Site address: 10550 SW DEL MONTE DR
Project: Coiner Subdivision: LANG HILL NO 2 Lot: 55
Project Description: Replacing existing wiring.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: COINER, MICHAEL
14300 NE 20TH AVE. D102 -313 10550 SW DELMONTE DR
VANCOUVER, WA 98686 TIGARD, OR 97224
PHONE: 360- 574 -7200
PHONE 801- 668 -4579
FAX: 360- 546 -2158
FEES
Quantity Description Date Amount
15 crt Branch Circuits wo /Purchase 09/28/2011 $160 06
Specifics:, Service or Feeder
1 ea 12% State Surcharge - 09/28/2011 $19.21
Type of Use: MF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $179.27
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 ob - • - • • • the rules or • - t questions to OUNC by calling 503 232 1987 or 1.800 332 2344
,••••■ -
Issued By: Permittee Signature:
O WNER 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.
Sep. 28, 2011 12 :21AM
: > ' � �/ FOR � i No, 8211 P. 2
c�t�on
Electrical Permit Aupli FiFe 1, 11 � OFFICE u5r, ONLY
City of Tigard SEP 2 7 2011
13125 SW Ixnll alvd,, Tigard, OR 97223 Plan R m�/ r III ,,
l .' Phone; 503 7182439 tax: 5 1596(1860' 'I Other Permit,
0 73 , n A.7)n I 7nte/D
T1 GA Itn Inspection Line: 503,639.4IZ5 r� ! DateReady /By: BI See Page 2 for
Internet: wtvw.tigard- or.gov �'1� DING tJf / i r ,.( � d 1 `,� Notified/Method 7 Supplemental Information
TYPE OF WORK PLAN REVIEW
' Ploaso check all char apply (submit 2 acts of plans whtems checked below)
❑ New construction ® Addition /alteration /replacement
1=1801 or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Mannas and boatyards
CATEGORY OF CONSTRUCTION exceeds 10,000 amps nt 150 volts or ❑ Floating buildings,
less to ground, or exceeds 14,000 ❑ Commercial -me agricultural
® 1- and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings
❑ Multi- family ❑ Master builder Li Other; ❑ Fitt: pump. 0 tnslallahon of 15 KVA or
IOC] SITE INFORMATION AND LOCATION ❑ Emergency system. larger repnrately derived system.
DAddition of neW motor lead of 12'W', "E ", "1.2 ", "l -3 ",
Job no.: 8520 Job site address: 10550 SW Del Monte Dr — rooHr or ewe, ocanpnacy.
❑
6` El Six or more residential units Recreational vehicle parks.
City/State/ZIP: Portland OR 97224 ID Health-care faoililies. El Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg. /apt. no.: Project name: $920 W i � �--+ i ❑ Service Or feeder 600 amps or more,
FEE SCHEDULE
Cross street/directions to job site: De,crtprlon I On I Fen I Total I •
New residential single- or multi-family dwelling Unit,
includes attached garage,
Subdivision; � Lot no.:
1,000 sq. R or less 168.54 4
� 6 t I C pet 2 � L edd'I 500 or 33.92 1
Tax map/parcel no.: , ('� Li mned energyy, , residential idential tial -�
DESCRIPTION OF WORK (with above sq, f).)
75.00 2
Limited energy, multi- family 75.00 2
15 branch cir residential (with above sq ft.)
Services or feeders installation, alteration, and /nr reloca
200 amps or less _ 10070 2
® PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200 34 _ 2
Name: Michael Coiner 601 amps to 1,000 amps 301.04 2
Address; 10550 SW Del Monte Dr Over 1,000 amps or volts 552.26 2
Temporary Services or feeders installation, alteration, and /or
City /State /ZIP: Portland OR 97224 relocation
_
Phone: (801)668 -4579 Fax; ( ) 200 amps or less 59 36 1
201 amps t0 400 amps 125 08 2
Owner installation: This installation is being made on property that 1 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.
Itraneh circuits— new, alteration, or extension, per panel
Owner signature: Date: A fee for branch circuits with
® APPLICANT above service or feeder fee,
1 ICANT ❑CONTACT PERSON each branch circuit 7.42 2
Business name: Mr Electric dbn Advanced Electrical Concepts B. FCC for branch circuits without
service or feeder fee, first 1 561 s 56,18 2
Contact name: Jim Kleiser branch ctrvurt
Each add' l branch circuit I 14 I 7.42 103.88 12
Address; 14300 NE 20 Ave Di 02 Miscellaneous (service or feeder not included)
City /State/ZIP! Vancouver WA 98686 Each manufactured or modular 67.84 2
dwelling. service and/or feeder
Phone; (360) 574 -7200 Fax:: (360) 546 - 2158 Reconnect only 67.84 2
Pump or irrigation circle 67 84 2
E -mail: ear mrelectriccc,com Sign or outline lighting 67.84 2
CONTRACTOR Signal eircuit(s) or limited- energy �
panel, alteration, or extension. Page 2 I
Business name: Mr Electric dba Advanced Electrical Concepts E ach Each inspection over allowable i L
any of the above
Address: 14300 NE 20 Ave D102-313 Additional inspection (I hr min) 66 25/ hr
City /State /ZIP: Vancouver WA 98686 Investigation (I hr min) 6625 /hr
Industrial plant (I hr min) 78 18 /hr
Phone: (360) 574 - 7200 Fax: (360) 546 - 2158 Inspections for which no fee is 90.00 / hr
specifically listed (16 hr nun)
CCB Lie.; 168324 Electrical Lie.; C136 1 014 Suprv. Lie.: 45885 ELECTRICAL PERMIT PEES
j Subtotal 160.06
Suprv. Electrician signature, required: ��
Platt review (25% of penlrit fee).
Print name: Jim Kleiser Date; 9 -27 -2011 State surcharge (12% of permit fee). 19.21
Authorized signature:
TOTAL PERMIT PEE: 179.27
This permit application expires if a permit is not obtained within 180 —
days after It has been accepted as complete.
Print name: Date: 9 - - 2011 • Number of inspections allowed per permit
Imulldinglpe rmltuwLC.permliAApp.eoe e /10 440- 46i5T(i1/O5/COE,i/Wuo