Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00114
Date Issued: 02/24/2012
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Parcel: 2/24/2 A00700
Jurisdiction: Tigard
Site address: 14255 SW 125TH AVE
Project: DALE Subdivision: STANHURST Lot: 4
Project Description: (3) branch circuits for reconnect of heat pump and fumace.
Contractor: WEST SIDE ELECTRIC CO INC Owner: DALE, CONNIE RAE TRUSTEE
1834 SE 8TH AVE BY DONALD W MILLER
PORTLAND, OR 97214 14255 SW 125TH AVE
TIGARD, OR 97224
PHONE: 503 - 231 -1548 PHONE:
FAX: 503- 736 -0677
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 02/24/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/24/2012 $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 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 -0 90. 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: Q /" Zl
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 603.639.4176 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.
2012-02-23 14:04 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit ADalicahon
• RECEIVE I
City of Tigard
11
13125 SW Hall Blvd_ Tigard. OR 97223
Phone: 503.639.4171 Fax 503.598.1960
Inspection Line: 503.639.4175
Internet www.tigard-or.gov Ftercived 1
FEB 2 3 2012 DeItiB • Ag/rAgrine P NEt cc e .,204,2 -00//
Plan RAU '
Date/B ,
CITY OF TIGARD mg. Ready/By
: I I ING DIVISI 1 0'1'66'1'16"k Other • - .. ._/ /a -ea V
OZ111 SS See Page 2 ft*
Suppismansel Indinneuen
7 ' ''''''+'' '. • P..'" n "':': %:,'=
Plena cheek all dial and (submit l MB of picas Wools elleelurd Won*
0 New construction [gi Addition/alteration/replacement — -- ,
Service or Wm 400 amps or neat 0 Maras ova Iluee wines
0 Demolition 0 Other: where the available fault scree 0 Marinas and boatyards
-..g ..ViiaU, ... 5.'0 W. :", exceeds 10.000 amps at 150 volts at 0 Floatisig buittlioss.
- • • '-` • - ' ''''''''' -.1.:1 • M ' I ' z ''' '''` kan to grazed. or exceeds 14.000 Ci Canulacillinc macimittuld
ai 1. and 2-family dwelling 0 Commercialimdustrial 0 Accessory building amps Rir all alter installation: binldings
0 Multi-family 0 Master builder 0 Other: CI Fim pump. 0 lostalbaioa of 75 KVA ot
_ ,,,,, ,.. 0 &sinewy iynalft larger mparately derived system
E111FaMainglini 0 Addition of sew mow load of
lob no.: J 0 ? 1 Job site aen : / ZS .t t / ZS C A/4. 100HP or mon.
0 Six et moil 'addenda' units occupancy.
C3 ReereeMemal vehicle pub&
Ci 77 3 civvi 70t/9 722 V 0 Health-an &alines. CI Until veletas for =Ore than
600 volts nozeimal.
,
Suite/bldgJapt. no.: ... - • / , / I Ci linardwalacatimilL
I Project name: niii/e4//evie tonte 0 savior cc War 600 amp or TIMM.
ilVALIVOMMINOTitiiiteiblirallEMICOM
Cross street/directions to job site: orseriptios I ob. I sw. I row 1'.
New residential Sink- or multi-family dwelling Reit.
Include attached garage.
Subdivision: • I Lot no.: i000 sq. ft or less 16834 4
Ea. add'l 500 sq. Et or portion 33.92 1
Tax map/parcel no.: Limited mom residential ..
tk'Vlir.;/4511 c. .:.' 1 (with above sq. ft) 75,00 2
Limited energy, multi-family 75.00 2
ti ka // ait, ;I-Fick/a /4(1i/we.- residential sq. 11)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
M.",„., ' : ;... ; i - ,4.,.-! , ;, 5.14'-xf,..:? 201 amps to 400 amps 133.56 2
Name: 401 amps to 600 amps 200.34 2
_ 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/StateiZIP: relocadon
Phone: ( ) I_ Pax: ( ) 200 amps or less 59.36 I
s 1
Owner Installation: This installation is being made on property that I own 201 amps to 400 amp
which is nOt 112.5.„. 2 2
I
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
Brands circuits - pew, alteration, or extrusion, per panel
Owner signature: Date: _ A. Foe for branch circuits with
. above servico or finder fee,
51MINMilliaM611°169/15.-ra each branch circuit 742 2
Business name: B. Fee for branch circuits without
Kmiec or fbader fee, first _ / g
Contact name: branch circuit / 56.18 s 4 -- 2
Each add' I branch circuit _ Z, 7,42 / y EY 2
Address: Miscellaneous (service or feeder not ineluded)
Each manufactured or modular
City/State/ZIP: 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:
_ Sign or outline lighting 67.84 2
iditaglliVialig0 IrMigettRiVINOMAtrteAP;';'%Wie?-='iiAti. Signal dienit(s) ni limited-
Pawl, altetalon. or extension. Paae 2 2
Business name: West Side Electric Co., Inc. Each additional Inspection over allowabk in any of the above
Address: 1834 SE 8th Ave. Additional inspection (I hr min) I 6625/ hr
' investigation (I hr min) 662511u
City/State/ZIP; Port land/oR/ 9 7 214 '
- Industrial plant (1 hr min) 78.18/ hr
now: ( 5 0 3) 231-1548 I Fax(53) 736-0677 Inspections for which Ito fee is
90.00/ Ire
specifically listed (Pihrroia) . ..... ,, . .
CCB Lit.: 13306 1 Electrical Lic.: 26_135c I suprv. Lic.: 4654 -5 vcremtez....a.kmas
Subtotal: ....I--
Suprv. Electrician signatme, required:
Plan review (25% of permit fcc): .7/
Print name: Randall F Roberts I Date: 2/ — State surcharge (12% of permit fee):
Authorized si TOTAL PERMIT FEE: 7q
5
pature: -
This wroth applieadon expires Ha permit b not obtained widtia till
. '
Print name: I Date: din Ater it bas been sawed as complain
• Number atiespecrions allowed per permit
LiBtolimg1PeauMELC4ormitAppakm 07/01110 440-4615T(I IRWCOMPAU