Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00567
Date Issued: 10/12/2011
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503.718 2439 Parcel: 2S102C606200
Jurisdiction: Tigard
Site address: 10475 SW GRANT CT
Project: Horowitz Subdivision: WINSOME TERRACE Lot: 6
Project Description: Panel change and (1) new outside plug.
Contractor: ABC ELECTRIC Owner: HOROWITZ, ALAN R & JUDITH BERMAN
135 NE 9TH AVE 10475 SW GRANT COURT
PORTLAND, OR 97232 TIGARD, OR 97223
PHONE 503 - 233 -7551 PHONE 503 - 639 -5772
FAX. 503 - 233 -7552
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/12/2011 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 10/12/2011 $7.42
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 10/12/2011 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121 09
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 obtain a copy of the rul rest questions to OUNC by calling 503,232 1987 or 1 800 332 2344 c
Issued By: % Permittee Signature:
Ar
I
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.
10/12/2011 11:02 AM FROM: ABC El ABC Electric TO 503-598-1960 PAGE: 002 OF 003
Electrical Permit ?.■
APPlic'a ,if \N\\ ii;,,.7
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,,,,,-- i. 4 v . :2. ,,,,,, t- , 2 ,, FOR:0FFICEISEONLY=ff:.'..41:
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- .=2. City of Tigard to x 14
,,t
`1.% Received
Datc/fly: iD AVM I No • 2 o/ - &: • 6 .
• 2 a t liii . 13125 SW Hall Blvd,, Tigar , 9 d, 0 9 22A c \ '' t ‘ Plan ReView
7l_ • 41 :•" : Phone: 503,718 2439 Fax: $03.598.1007' ,•\\ ' Datc/f3y• _ Other Permit:
Inspection Line: 503 c p
.639 4175
r .,N• 17a Ready/By. Judy Et1 SerRage 2 far
-- tntemot: WWW.i igard cci , NotifiedNelluxl: Supplemental Information
-
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A'TfPllr'rjrlr"arrrrPWWgi.tPb:-'7stt'ofq.oWh4ZAFg, .. - . - - . = .., .x ^ ,,, . i . , . + sic ...,-, •,..... • ...--...•
%,...ii•?wiVzi..i.ti2.7 A -- ,:ii:.i.iztatult=viw...;,...4....ti=tit,:t • ....k•ott.m.,...,..Aitit,......-ts..,"*..4,..is.. . i,iiii..- . - •..... • • • - ., .- . .
Please check all that apply (submit 2 sets of plans \villeins checked below):
0 New construction a Add itiOn/al terat IA/replacement
0 Service. or Geode] 400 amps or more 0 Building over Once Stones.
0 Demolition 0 Other: where the available fault marent 0 Marinas and boatyards.
AiiiiviltatarA exceeds 10,000 amps at 150 volts or 0 Floating buildings.
• -(4 : 4 M-fr ,04 ' ,. < 4 ‘"'"'''''' ,9 ' . 1'l's:: 4 .' l'" . ' .r.l , . ' - ' ''s • ''''' - ' , , ' . ' . - " ... '''''' ' ' less to ground, or exceeds I4,000 0 Commormabuse agrIcultural
•
II I - and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all othet installations. buildings.
0 Multi-family 0 Master build
—aster 0 Other: 0 Fire pump. . 0 Installation of 75 KVA ol
0 Erneigeney system. larger sepaiately derived system
J more
ob no.: - . "- c'• ', • Job site address: / /elt,, li7 A 1 - j f ) A , ,t,. ,,, ,, .
0 Six or more icsidential units 0 Recicalional vehicle palks
City/State/ZIP;
- 4 - r\ 0 Health facilities. 0 Supply voltage for more then
' ':'-'1' 4 4 A ( '/ 6 ' ' 4 CI 9 0 7: - - 2 0 Hazardous locations. BOO volts nominal
Suite/bldg./apt. no.: Project name •.. •, 0 7, 0 Service ot feeder BOO maps or more,
."-•,. ..,.ti,eMilMijaariWt. 0.45
Cross street/directions tojoh site: /..2,7 Dcacri . [ion _ . Ittglik
— — New residential singleo or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: Loon sq, ff, or less 168.54 4
— — - Ea. add°1 500 sq..II. or portion 33.92 1
Tax map/parcel no.:
4.7Am Limited energy, residential
..M.S'Wv.T - figh 113 -11.70.40,Ajw,:::4-ic.Fi, (with above sq,Lt..2 5.00 .11111
0
-. ' —.., ii- *-116 - -'" *. - '''''''‘ Limited energy, nub-family III 5 00 EMI
■4...,... 7 , ... . , ..,, ••,„. ,
Lc..... • ) '- ' t ii . residential (with nbove o. ft
_.
i .,, , J . , Services or feeders installation, alteration, and/or relocation
I:-. '" , 0) .„“1„,,4 V if ': C 200 amps or less 111 10030 t - El .7
.. : -,....gri..opx„.q,..."..-...:-vrr..,:.-:fftoc,l 201 amps to 400 mnps
:.;',.:::SIBINit.13-5"-0"rAlt.!.i, '. ,:j .,.: 4..* , 111111 33.56 Ell
Name A LL r::./
. ■ . 401 amps to 600 amps 00. 4 n
: ,, „ i ._. ,'1. . - ' ,.'
/ 3 601 amps to 1,000 amps 301.04 -- ggi
,.
Address: i - V. 1.— I- I/ v. or/ . Over 1,000 amtp or volts 1111 552 26 11I •
- • Temporary services or feeders installation, alteration, and/or
City/State/ZIP: t' 0 1/ C C1 j l'.,. .,y( , . relocation
....... . ,
Phone. ( ) 7.7'- #t" r .1,.. -7- 572, 7 1 Fax: ( ) • 200 amps or less 59 36 1
201 amps to 400 amps 125 08 • •
Owner installation; This installation is being made on proper ty that I own which is not 4 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 extenaion, per nand
Owner signature: Date: • A. Fee for branch chants with
4 A= , ' rAm".... ...MN - ** , "*" .. PaMitgr."‘ •1;7Zr' above service or feeder fee,
* • no'alts,c--.11.. .. - c . *V if.. ,,, > - r - - 9: ; .. 4 4.1:r.:>, , 4 --• , ..
" k .;.RA,A4,.4„irSj each bmmii ei rcuit t 7.42 7 1 . 7 /) , 2
A
Business name: . B. Fee For branch circuits without
. ..., , ,
service or feeder fee, limo
56.18 2
Contact name: / . r branch crawl
Mir f Each acid' I branch circuit 7.42
Miscellaneous service or feeder not includetI42 2
Address: ' 4
• ... * /.4,-
City/State/ZIP; . ..
AP . , •, (7 7 3 ,7, - Each roanufactuted or modular
67.84
dwelling, Serviee and/er feeder
•
Phone: ( .Y ) ,,, ' '''' - 1 only Reconnect
Fax: : (5 ) .. 2 66 . . 67,84
3 MI
C- Plinio or irrigation eircle 67,84 2
• b-mail; 0 . .A 0 .... „4111 ,,, • /• ••••••••.. : s„. . „L./ . . „:„.• sign or outline lighting 67.84 2
ki . - aia e TirrZ V Ai . ZS t' g2M l aXinMIVIAT.Uiritl.tSiMire4t : ttYd Signal circu Os) or limited energy
Business name: /
• i panel, alteration, or extension. Page 2 2 •
, . Each additional ins ection over allowable in an of the above
Address: - 3 5 ''''''' ," • . . I 6i,,,,':,(L ' • Additional inspection (I hr min) 66,25/hr NMI
0 / • investigation (1 hr min) 66.25/ hr MIN
ci ",)
t Id • • _ ' .k` i , i , '7 1 3a - Industrial plant (1 hi 78,18/ hr
?hone: (5)3) ,.. ,. 17 4: - ' i Fax; ( - 4■0,..:> ) 623 3 V J.: — 4 Inspections for which no fee is
90.00/ hr MO
..,
so eificail listed (4 hr rent . . _ ,,,,, _ .,...,,........m..„_.
CCB Lie .: # ' Electrical Lic.: , - ,., Sttprv, Lie.: ' .41 ,1.14iiniJ4WW.111trie.$171,1-1_10,;Likila.,•..Mit't;,E.,•.:,.in;.,..2.1„.titiAtliF.;-,.:-:
Subtotal: •
Suprv. Electrician signature, required,
' Plan-review (25°A'of permit fee):
,,---.....,
- State surcharge (Irk of perinitfee): ... IP
Print name: 4), - . 4 . _ ,,.. i i t a , : Date:
Ati
TOTAC;PERNIIT FEE: WiMik '
Authorized signature • 10 1 " ...„• . 0 ''' This i '
MEN ' lie/alit a
epplication expires it a'permit IS not obtained Within 180
..-
days after it has been accepted as complete.
,... i i'l ) A
Pr bit - 114 "0 ti...\;ij ) • 1,4 ro. 1 c (A, 4. , 0,,oe /9/ ' ,
- ,- hhachet wintpectfonxallowed perliennit, ' , . -
• • LtAullainOemlitall:C.IN:milApp.tiouO7/01/1O ' , ,449,4515T(Ii/osicot47.vga . _ , 0 , • , , .
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