Permit q CITY OF TIGARD ELECTRICAL PERMIT
1 . COMMUNITY DEVELOPMENT Permit #: ELC2011 -00563
Date Issued: 10/12/2011
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503 718.2439 Parcel: 2S103DC00500
Jurisdiction: Tigard
Site address: 13705 SW 110TH AVE
Project: ROGERS Subdivision: FAIRHAVEN COURT Lot: 4
Project Description: Service replacement
Contractor: WEST SIDE ELECTRIC CO INC Owner: DAVIS, JANET E
1834 SE 8TH AVE ROGERS, MARK W
PORTLAND, OR 97214 13705 SW 110TH AVE
TIGARD, OR 97223
PHONE 503 - 231 -1548 PHONE •
FAX 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/12/2011 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 10/12/2011 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 0 : 952- 001 -0090 You may • • - i .. o. of the - or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: ��l. __ - - «�� .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.
Oct 11 2011 6:08PM West Side Electric 503 - 736 -0656 p. 2
„:: RECEIVED . .
Electrical Permit Application I ()(; 1,1.1 I I tit „1
OCT 1 Z011 Received
City of Tigard
Date/3 : i. II ��� PermitNo.: ! '' � ��
13125 SW Hall Blvd., Tigard, OR 9 OFT'GARD
Plan Review
Phone. 503 639.4171 Fax 503.598. + D��g : gther Petmit
Inspection Line: 503.639.4175 F31 DI �' DIVISION Ready QI ScePagezfor
w� Internet www tigard -or gov Notified/Method: Supplemental Information
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El New construction � • Addition/alteration/ replacement
Please check all that apply (submit a sets of plans w /items checked below):
❑ Service or feeder 4.00 amps or more ❑ Building over three stones
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards
�:i_iaA.hi,I ;
`•1�.� a �' %r,- , � 'r�+, Li '`�': • exceeds IO000am , at I50 volts or
❑ Floating
" .., ; ,''r ir rail��� ;�. , 'ix: i; .y�s�;, �p,d:'t•�ags:�'e�.�;` - ,.- ....,._. '� ?`s' ar> amps o buildings.
_..' Y . , ' '' ' { • <' ^ less to ground, or exceeds 14.000 ❑ Conanerci al -use agricultural
1E1 I - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for alt other installations buildings
❑ Multi- family ❑ Master builder ❑ Other: ❑ Ftre Pump. ❑ Installation of 75 KVA or
, .. s ;,M ` . ✓+A5 "^N 4 *, •r u r ❑ Emergency system larger separately derived system
ti f 9 %,e i ,t �.: . , I n ',' a* t, • z'�; a A,. ae s: w•. 3 AV ,V i ; "•, -
:. SS" I.C��t °r�,�`' L . - ,t,r.�Ygt;•, S..:t;'.S�f��:':. -r.v� ❑Addthonofncwmator load of
❑.. » ,.
r Job s ite add 100HP or morn occupancy.
Job no.: SY S 7 or S1�1 I /�t'
❑ Six or more re identral units. ❑ Recreational vehicle parks.
City /State/ZIP: Tinap 70 9. ]'�Z ❑Health raze fantities ❑Supply voltage for torte than
❑ Harardous locations 60Q volts nominal.
Suite/bldg./apt. no.: I Project name: , 7Q e C} er:_r ❑ Service or feeder 600 amps or more. `+
Cross streetidirectio ns to job site: ne,�l a X:71 '' S,: :,,:,r. ,
_ I Qty. (�` ,
— Fee. ... 1 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'I 500 sq. ft or portion 33 92 L 1
Tax map/parcel no.:
Limited energy, residential
�cf,
�� a�' �y't �„'�,: t :, ;u 1 a' - , to ,. : ^ " d - " . Iii•r;a:c��•. -:L_,t ,i ;� a:..� '��', (with above sq, ft.) 75 00 2
;:iedl :i= s. >t,.s'y,> . G .: 3 _r u,i..4 :. Limited energy, multi -family
r 75.00 2
.3 eio. Q /ige residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less / 100 70 /60 ! U 2
w4 .'' - '"
" _ -. a •,.. , . . r .;, m,,I ... ,i',.t t? ia '-5 ' ' 14 :`<, c ,S. !
i ; 1 41, t:• ,
'113' x: @ 4 ,a . _ , fin k • ": r : , - 201 PS to 400 amps 13356 "'PS p, 2
dps : r. ., .. $: jti'�: n.d 'li �'il: .� * .n'. .,, '<:'r':.,.v _
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: ( ) I Fax: ( ) 200 amps or less 59.36 It I 1
Owner installation: This installation is being made on property that I 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 pane)
Owner signature: Date: A. Fee for branch circuits with
fee,
;rr, ";"asp � - 3 -. z, y' a r. Y• „ . }"'""2 ',11 " lf- 1: above service or feeder
' l a tge, Y A¢ , :=- '; , o.,,; ;..40:,. a7:;, A-,,,, ' � , nlrl: r.,I; ,XP . . each branch arcult 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first
56 18 2
Contact name: branch circuit
Each add'1 branch circuit 7,42 2
Address: Miscellaneous (service or feeder not included) _
Each manufactured or modular
City/State/MP: dwelling- service and/or feeder 67 84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
-'?:' :r `'r,' :' "ai,` 'r9 , ,:p r,- t ' ;eft, t; >tt� e ( .+ ' _.t 't1.:' Sign or outline lighting 67.84 2
a�. - ,� .4 ;.... ;. o7es 0'5' " ;K ,' =,' .• .. (.-
' 'N :: :".4 < , . Signal circuit(s) or limited- energy
panel, alteration, or extension- P e 2 2
Business name. West Side Electric Co., Inc. Each additional inspection over allowable in any of the abov
Address: 1834 S E 8th Ave. Additional inspection (1 hr min) 66.25/ hr
City/State/ZIP: Portland /OR/97214 Investigation (1 hr min) 66 25/hr
lndustnal plant (1 hr min) 78 18/ hr
Phone: (5 0 3) 231 - 154 8 Fax: (5 0 3) 7 3 6 - 0 6 7 7 Inspections for which no fee is
sp listed Nil: hr min) 90.OG/ hr
CCBLic., 13306 [ Electrical Lic. 26 - 135C SuPrrvv.L 4654 - S - ? '" , ``'''`:,,= 3?>!t >' x ° i:z '<A-;;'
P signature, required: �i� a + ,.. ....2.1-j-
Su rv. Electrician si ature, re uired: r Subtotal: /(?(}
Plan review (25 /e of permit fee):
Print name: Randall F Roberts Date: /0//21 State surcharge (12% of permit fee): / Z
ew
TOTAL PERMIT FEE: // 2 7If
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: ate: • days after it has been accepted as complete.
Number of inspections allowed per permit
IAawldingPu tntslELC•Psrmi 1App doc 07/01/10 440-4615- 111/Q5/COMIWEa