Permit CITY OF TIGARD ELECTRICAL PERMIT
2 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00084
Date Issued: 02/07/2012
'TIGARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439
Parcel: 1S133DA03300
Jurisdiction: Tigard
Site address: 12635 SW GLACIER LILY CIR
Project: Eaton Subdivision: AMART SUMMER LAKE Lot: 55
Project Description: (1) branch circuit for relocation of heat pump.
Contractor: BOONES FERRY ELECTRIC INC Owner: BANK OF NEW YORK MELLON, THE TR
PO BOX 628 BY RECONTRUST COMPANY
WILSONVILLE, OR 97070 400 NATIONAL WAY
SIMI VALLEY, CA 93065
PHONE: 503 - 682 -4936 PHONE.
FAX: 503 - 682 -7946
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 02/07/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/07/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 throug A ° 401-090. You may obtain a copy of the rules or direct questions to OUNC by calling 503 232.1987 or 1.800.332.2344. /
Issued By: ` � � Permittee Signature:
B� ,/°/°G. ic. 9 7OtJ
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.
Feb. 6. 2012 3:20PM No. 8391 P. 1
Electrical Permit Application f � � o I ()1:1;1(.. USE ONLY
City of Tigard
13125 S W Hall Blvd., Tigardc0 9' i� ,%\k, `- D B //� . . permit loo. Lt!' —000� !
` . . Phone: 503,639,4171 Fax: 503S981.-'1969-1 '� t � o� cam\ pi Other Perimt:
I lt�:�RD Internet; www,tigard- or,guv �� % s t \ - `.\�� ® \" Notified/Method: • 1 1 V S p pI e , . fo ., rm sih w
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r +C J a� , u h� � a, [ r r 1[ r va
u •" i W rR r rr r e ,•
.!" 9 .�._.. ,... ._!_. _ .,,:. .. ✓. ..'....,.� .:.: ,. .a..w ;,'�; s .:, �,`.a_;:. .. ,' .'.o ",; .,... i� ,v � ?�..A_:i � , M , j T l . � �^ ° . ; i i
E3 New construction Addition/alreratii/`yeplacement Please check all that apply (submit 2 sets ofplabc wiitoms cLoclocd below) N
CI Service or feeder L] Demolition 0 Other: where the available fault current more ❑ adding over storms.
Cl Marinas three Masioas tmd boatyards.
a s `K • '' r ` / > , ', exceeds 10,000 snips at 150 volts or 0 Floating buildings. . Y we . ,.,.0 . __ . �.,,w. •...., .... ',":2" ..! . . - ,: .. , , e' ICES to ground, or exceeds 14,000 ❑ Commercial -use agticultutal •
1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder [� Other. O Fare pump. O installation of 75 KV or
1i ? : , 1 4 , r t + � + o r5 r ❑ Emerg ncy system. larger separately derived system.
. „,, r ' ,, "„ ['Addition of new motor load of
..:,.:. ..._.,.. -,,. .;.. ..,_ -....,.. ❑ A',"E", "14 , - 1 - 3 ",
1001IP or more. owupancy.
Job no_: Z O 6 2 i Job site address: ) 2 6 S s w G I , 9_, i s? ) . c i Q Six or more residential units. ❑ Recreatitonat vehicle parks.
City /State/ZIP: •r 1 j ay, O ❑ Health facilities.
❑Simply volmp� for m ore than
! ❑ hazardous locations. 600 volts nominal.
Suite/bldg. /apt no.; I Project name: t - d4 di Service or feeder 600 amps or more.
Cross street/directions to job site: riptiaa .._ .. _
Qom. Fee. Total •
New residential single- or multi-family dwelling unit.
Includes attached garage.
Subdivision: I Lot no_: 1,000 sq. ft- Or less • 168.54 4
Es. add'l 500 sq. R or portion 33.92 . 1
Tax map /parcel no
Limited energy, residential
1 'N x 71 �� r -84 2
r , r . a o , � v} r.,. � ,p �> a � 7: d (with above
11 7 Limited energy, multifamily 67.84 -- 2
1'` 2.) p he, h e s T 1 p rcidenrial (with above sq. ft-)
Services or feeders installation, alteration, and/or relocation
200 amps or leas 100.70 2
„al] " '". T -•^•7:, , h •: ' ,1N t ' . V / . >, . 1 -Y' - -".ice
�L; � � � 1 r i ( ] r �� � � � 201 amps to 400 amps 133.56 2
::e ...� .r .. < ,,:. r, ,m.,w.. ,.., . ..., . ,. a . ..,.,, ,..d..6,2.,..,,.„:, 'f .. c ....ma .. ..._
Mx ,A, , -
Name;
401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 30L04 2
,ddress: Over 1,000 amps or volts 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 5936 1
Owner installation: This installation is being made on property that I own which is not 4 0 1 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 panel
OwnCr Sigliattlre: Date: A. Fee for branch circuits with
1 ✓' 1 ra ✓, r r '� ... above St: ai a Or feeder fee,
rr !. r • "� t 1 7.42 2
1 "-1: ''' _ a.., .,r,f., 'r..., ✓..,, . , ' '. ...., .._...._xr -. a:i . , o „ . �, .::,.._ Fee ehbranch h C i r L
Business name:
B. F for branch circuits without
service or feeder fee. fuss
Contact name: branch circuit ) 56.18 2
Each add'l branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67.84 2
ty dwelling, service and/or feeder
Phone: ( ) I Fax:: (' ) Raconneet only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
, [ •. . J.: , „ > ° w w ...:a,'' , ' ; Signal circuit(S) 0? limited- energy
Business name: Booties Ferry Electric panel, alteration. or extension_ Page 2 2
Each additional Inspection over allowable in any of the above
Address: P.O. Box 628 Additional inspection (1 hr min) 66,25( for •
Investigation (1 hr min) 6625/ br
City /State/ZIP: Wilsonville OR 97070
_ Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 682 -4936 ! I Fax: (503) 6;: -7946 Inspections for which no fee is 90.00/hr
s final' hated '4 hr mm)
/ CCB Lie-: 88482 Electrical Lie.: 3 - . 3C ✓ Suprv- Lie.: 9-7 I (3_f ,e,,,,' ... , ..,, `,:..,� .: r `' ,,2 '^': . :;'''::‘!'
.. ,,..
Suprv. Electrician signature, required /�
�
Subto 5 6 . I
Plan review (25% of permit fee): --
--
- 4. State surcharge (12% of permit fine): 6.7 )
r'rint name: 5 +0., iel , Date:
TOTAL PERMIT FEE: 6 .z . 9 I
Authorized signature:
This permit application expires if a permit is not obtained within 180
Print name: Date: days after it has been accepted as comple
Number o f inspections allowed Per permit. 1••••"---..-
1:1 BuildinglPermitAELC- PUIrdWpp.doc 10101/09 • 4444615T(11ro5/COM/WEB