Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2011 -00669
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/30/2011
Parcel: 2S103BB00700
Jurisdiction: Tigard
Site address: 12545 SW 124TH AVE
Project: Yinger Subdivision: BROOKWAY Lot: 7
Project Description: (3) branch circuits for furnace, heat pump & GFCI outlet.
Contractor: WEST SIDE ELECTRIC CO INC Owner: YINGER, KENT L & DEBORAH LYN
1834 SE 8TH AVE 12545 SW 124TH AVE
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 11/30/2011 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 11/30/2011 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 = cor•an ith 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. AT ENTION: Orego. la - • -• you to follow the rules adopted by the Oregon Utility Notificati•n Center. Those rules ar* set forth in OAR
952-001-01 10 thr•ugh OAR 95 ; 101 to • ou may obtain a copy of the rules or direct questions to OUNC by calli 2.41 32.1987 or 1.800.332.2 44.
Issued c : `! / Permittee Signatu
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 IN ALLATION ONLY
SIGNATURE OF SUPR. ELEC' .11111111W
rl 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.
2011-11-29 17:59 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit ApplicationRECEIVED 1-012. Of 1. ICI' I
City of Tigard R„,,,,d
5........• 13125 SW Hail Blvd., Tigard, OR 97223 NOV 3 0 2011 rweR . a Jo / L.T.)1 -----c-e A-
Plan Review
' .. Phone: 503.639.4171 Fax: 503.5913.1960 Dato/II : Other Parrnit: ti _ _
Inspection Line: 503.6394175 CITY OF TIGARD Dam Rcady/By funs: IN See Page 7 fbr
Internet: www.tigard.or.gov BVII,DINi 91VISJO Nnkifiudits4tthod Supplemental Informal=
\*::;''' ' '' l2: :/ i**4;06*.OfiH , qt ;'. .:: :. : ,':: ' :: : :: .:: : .; '" '.,:'''OLA
El New construction i Addition/aiterarion/replacement I Please cheek all that apply (submit :acts of plans wincins decked below).
g
1 In Service or feeder 400 amps or more 0 Building over three stories.
n Demolition ID Other: wham the available fault current ID Marinas and boatyards.
• ,,‘.;•!.:, . .......::,,;:,..::.:..:...,...,.,.. ..,, :: c...d., 10,000 amps 4t I 50 volts or 0 Floating buildings.
_L.. .-,.. .... . .. . , .... . • '' ,.-
' -:L lons to ground, or exceeds 14.000 0 Commercial-use agriculniral
1- and 2-family dwelling 0 Commercialiindustrial 0 Accessory building amps tbr all other installations. buildings.
1:1 Multi-family . C] Master builder 0 Other: 0 Fire pomp 0 Installation of 73 KVA or
larger S6P4intaiy denved aVstcm•
408:10.1 ' , ' ':..' ' .':'" ' 0 McMinn nf new motor load of 0 - A - . - E - . --1-7-.-1-3
r--
Job no.:aMW Job site ad rcss: 1 1 -/ r ,5k) /Z LI — th l0010' or mere
0 SIN. or mom rasidentud amts. out:LT=4.
EiRcz..utional vehicle parks.
City/State/ZIP: T
(1 J 1)/2/ than 0 Heal th•cum fucdities.
0 I fazudous locations. El Supply voltage foe
600 volti itontinal.
Suile/b14./apt.. no.: Project name: y6 j , / f_k / El s.i.,. fonder 600 amps or mom.
" ', .. . .: ... • ' , : , .7.7.7W " i7,77:777..
Cross street/directions to job site: . pescr on 0 ------- 77 --- 17 ---- 1y. cm Totai
.. .
New residential single. or multi-family dwelling unit_
includes attached garage.
4 '
—
Subdivision: Lot no.: l ,000 sq. ft or less 168.54
Ea. add') 500 sq. Ii. or portion 33.92 i
Tax map/parcel no.: . limited energy, residential
75.00 2
''■'''.; ,,: ...:...:A. ..vervoiluc ....:: ••,:..'• .., :....;:...::::.::..;..v.:..• (with above $s . ft )
6 Fez 6„ilot:. Limited energy, multi-family
75.00 2
4trit 1 U117,0 4/02 et a 7 1, residential (with above sq. ft.)
i Services or feeders installationolteration, and/or relocation
200 amps or less 100.70 2
• '
! ., Ng , i '' 4ii,,!..01407;k. ..:;• :,.:1:1,4i14 ••••,.; .' ; • ,...... 201 amps to 400 amps 133.56 2
40) amps to 600 amps 200.34 2
Name:
601 amps to 1,000 amps L 301 04 2
Address: 1 over 1,000 snips or volts [ 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
200 amm. or less 59.36 1
Phone: ( ) Fax: ( )
201 amps to 400 amps 125.0g 2 .
Owner installation: This installation is being made on pmperry that town which is not
99 R 34 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
401 amps to $ amps Branch circuits - new, alterati 16
on, or extenSiOn, per panel
Owner signature: Date: A. Fee for branch circuits wItil
, ,B,:, • ,,, : , ,,, - ., . ...q.,■,...,. ■ .,„, ,,:....,,,:......:...., • ,• :,., ,i: • , 1 , , , "••` . .• : , : ,,.Y: ,..,, above serviceor feeder fee,
7.42 2
; ''::::':!''',:, :. -.• `..• '- ... ;■., ...::: - each branCh cretin
1
Business name B. I'M for branch Circuits without .
;
k service or feeder fee, first
/ S6 is 3 -(f 2
C name:
branch circuit
Each adcrl branch circuit Z 7 42 / y rY 2
Address: Miscellaneous (service or feeder not included)
_ — ,
■ Fach manufactured or modular
City/State/ZIP: dwa m
1 ' • n service rvice andier feeder 67.84 2
Reconnect only 67,84 2
Phone: ( ) I Pas: : ( )
—_, Pump or irrigation circle 67.84 2
Email: __ Or outline lighting 67.84 2
e!.4 ' .."':....:."!::':',.!,..':,.'".'"..!. ...':.i.: A:',; Signal circuit(s) or limited-energy '
panel alteration, or extension. Page 2 1 2
Business name: West Side Electric Co. Inc. Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
-
_
Investigation (I hr min) 66.25/ hr
City/State/ZIP: Portland/OR/97214 Industrial plant (I hr min) 78.18/ hr
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NOM: ( 503) 231-1545 - (5 0 3 ) 7 3 6 - 0 6 7 7 .— 'Inspections for which no fee is
90.00/ hr
specifically lined ( hr min) .
CCB Lie,: 13306 Electrical Lie.; 2 6 - 13 5C SuPrv. Lie.: 4 6 54 - S ,. -...:.'... ..:'''
- Subtotal: '7/
, Suprv. Electrician signature, required; . ..// '10Attr -
Plan review (25°/n of permit fee):
Print name: Randall F Roberts Date: # , Z // State surcharge (12% of permit fee):
_ TOTAL PERMIT FEE: 7 cy
Authorized signature: Mk permit application expireS if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit
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