Permit CITY OF TIGARD ELECTRICAL PERMIT
! COMMUNITY DEVELOPMENT Permit #: ELC2012 -00022
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/17/2012
Parcel: 2S104DCO3400
Jurisdiction: Tigard
Site address: 13167 SW CLEARVIEW WAY
Project: HENIFF Subdivision: BENCHVIEW ESTATES Lot: 34
Project Description: Bathroom remodel.
Contractor: PDX ELECTRIC LLC Owner: HENIFF, DAVID E & MELLANIE M
7933 WHITFURROWS CT 13167 SW CLEARVIEW WAY
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 01/17/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/17/2012 $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 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 O. 952 - 001 -0090. You may obtain a co of t direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
Issued By: �� -fir- - � Permittee Signature:
f 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.
1/16/2012 6:02 AM (GMT) From: PDX Electric LLC 503-200-1362 To: 15035981960 Page 2 oF 3
RECEIVED_ _
Electrical Permit Application von orricr.i...SE ONLY
13125 SW Hall Blvd.Tigard, OR 97223 JAN 17 2012 Received
City of Tigard
_pate/i3 :: i / 7 /./ / „3,.. zt.... _ Permit Nu.:
, ,,,,..
Phone: 503.718.2439 Fax: 503.598.IVW i I' OF TIGARD Fan Review
Date/13y: Oilier Permit:
...
TI GA RD
Inspection Line: 503.639.4175 BUILDING DIVIQI01\1( Date Ready/By: r tuns 0 Sec Page 2 for
Internet: www.tigard ' - ' ' Notified/Method: 72,6 Supplemental Information
TYPE OF WORK PLAN REVIEW
0 New construction E Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w/iteins checked below).
0 Service or feeder 400 mops or more 0 Building over three stories.
Demolition 0 Other:
where he available fault current 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or 0 Floating buildings.
lessiu ground, or exceeds 14,000 0 Commercial agricultural
El 1- and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KvA or
— 0 banergency system larger separately denved system.
.1011 SITE INFORMATION AND LOCATION
0 Addition of liew motor load of
Job no.. ' Job site address: 13167 SW CLEARVIEW WAY IOW IP or more. occupancy.
„._ 0 Six or inure residential units 0 Recreational vehicle pails.
Cily/State/ZIP: T1GA RD/OR/97223 0 Health-care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: 0 Service or feeder 6110 amps or mole.
_,,...
FEE SCHEDULE,
Cross street/directions to job site:
Dencripituo IIMMI _.. fee. Fetal . 1.7..
--- New residential single- or multi-family dwelling unit.
Includes attached garage.
.. __
_.....
Subdivision:
1 Lot no.: 1,000 sq, ft. Oi less 168.54 4
Ea. add'I 500 sq. It or portion 33.92 1
'Fax map/parcel no.;
limited energy, residential
. 75.00 2
DESCRIPTION OF WORK (with above sq. It)
- — _
Limited energy, multi-family , -- _.......
BATH REMODEL
residential (with above sq. ft.) 75.00 2
Services or feeders installation, alteration, and/or relocation
ALTER (2) CIRCUITS
200 amps or less 100 70 2
,
1:1 PROPERTY OWNER 0 TENANT 201 amps to 400 amps 13356 2
..._
---
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
___ ..... ......
Te services or feeders installation, atteratit;n,
City/Siate/ZIP:
relocation
......... — ... ,........_ „
Phone: ( ) f Fax: ( ) 200 amps or less 59.36 I
.. _.. - , 201 amps to 400 amps (23.08 2
Owner installation: This installation is being made on property that I own which is not
68 54 2 1
intended for sale, lease, rent, or exchange, 401 amps to 399 stops nge, according to ORS 447, 449, 670. and 701,
Branch circuits - new, alteration, or extension, per panel
Owner signattire: _
___ , , Date: A Fee for branch circuits with
_ .. . ...
........_ .
APPLICANT El CONTACT PERSON above service or feeder the,
7.42 2
each branch circuit
Business name: PDX ELECTRIC LLC B. Fee for branch circuits wit/trio! -
— service or feeder lee, fitst 1 56.18
56.18 2
Contact name: MARTY PALMER brach circuit
- Each add'I branch circuit I 7.42 7.42 2
Address: 7933 SW WR1TFURROWS Cl
Miscellaneous (service or feeder not included)
... ._
Each manufactured or rraxiular
City/State/ZIP: PORTLAND/OR/97224
67.84
dwelling, service and/or feeder
..........._ ....... _ ...
Phone: (503) 639-9708 I Fax: : (503) 200-1362 Reconnect only
___ 67,84 2
E-mail: INFO@PDXELECTRIC.COM ...... . Pump or irrigation circle 67 84 2
Sign or outline lighting 67 84 2
CONTRACTOR
Signal circuit(s) or limited-energy
Business name: PDX ELECTRIC LLC , .panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the abov
Address: 7933 SW WHITF1TRROWS CT Additional inspection (1 hr min) .._ 66.25/ hr _
_ .„...._ ..._ .._ --- ...._
Investigation (1 hr min) 66.25/ hr
City/Statc/ZIP: PORTLAND/OR/97224
_. ... _ Industrial plant (1 hi min) 78.18/ hr
Phone: (503) 639-9708 Fax: (503) 200-1362 Inspections for which no fee is
90,00/hr
— -
specifically listed CA hr min)
CCB I,ie.: 192731 I Electrical Lie.: C696 1 Suprv. Lie,: 5612S
ELECTRICAL rERM1T FEES
/1 (
Subtotal: 63.60
Suprv. Electrician signature. required: 414.971 >1
Plan review (25% of permit fee):
47 .-/
Print name: MARTY PALMER Date: / - /-/ 2 State surcharge (12% of permit tee): 7 63
TOTAL PERMIT FEE: 71.23
Auth or ized sign attire:
This permit application expires if a permit is not obtained within ISO
days after it has been accepted 45 complete.
Print name: I Date:
*
..._ Number of inspections allowed per pennit.
_
mnialeaapPurmiiiilliii•PenniiAp due 07g.11 / I o 44o-461mli /OS/COM:WEB
. . . . ._