Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00132
• TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2012
Parcel: 1 S133DD04600
Jurisdiction: Tigard
Site address: 11555 SW SHOREVIEW PL
Project: PROVANCHER Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 85
Project Description: (1) branch circuit for heated tile floor.
Contractor: CARTON ELECTRIC INC Owner: PROVANCHER, RICHARD A & ANNETTE
PO BOX 860 11555 SW SHOREVIEW PL
AMITY, OR 97101 TIGARD, OR 97223
PHONE: 503 -435 -1600 PHONE:
FAX: 503 - 835 -0539
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo/Purchase 03/08/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/08/2012 $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 through OAR 952- 001 -0090. You may obtain a copy of the i - =s or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �� % Permittee Signature:
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 Ina 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.
•
Hwy 97 Mini Storage 5415041861 p.1
Electrical Permit Application FOR OFFICE USE ONLY
w
City of Tigard e Received / Date'By: 3/3/I Permit No.: 4[ 7 C3 /Z- etO / 301\.."
.1 13125 SW Hall Blvd.; Tigard, OR 972 ' < , Plan Review
Phone: 503.718.2439 Fax: 503.5$8 :4;160 Date,Bv: Other Permit:
T I G A R D .Inspection Line: 503.639.4175, '.:..:41.••,=•- L� ' Date ReadyBy Jvrs: ®See Page 2 for
Internet: www.tigard-or.gov •`} ..„ -�� Notified/Method: •
• L ��.Y• I ' \ � - � SupplemcotaJ Information
TYPE OF Wpm( tcr PLAN REVIEW
❑ New construction ❑ Additionlalteratior tij'cment Please check all that apply (submit a sets of plana wfitems checked below):
\,. V
❑ Service or feeder 400 amps or more ❑ Building over three stories. Demolition ❑Other. N ''' . +
L where due available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 vcits or ❑ Floating buildings.
Sal p� less :o ground, or exceeds 14,C00 ❑ Commercial -use apicoltural
- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ID Fire pump. ❑ Instillation of 75 KVA or
JOB SITE LYFORhIATION AND LOCATION ❑ Emerger.cy systan. larger separately derived system. • ['Addition of new motor load of ❑ "A" "E" "1 "I - 3"
Job no.: I fob site address: ' 5 " J �. to lootrormom. occupancy.
� 1 �!" �s� I� ❑ Six or more residential rotas. ❑ Recreational vehicle parks.
City/State/ZIP: t (c (s o ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazazdous locations. 600 volts nominal.
Suite/bldg. /apt no.: Project name: Ric y e P�v c ❑ Service or feeder 600 amps or fl ote
` Home �/'�/Y 1( FEE SCHEDULE
Cross street/directions to job site: nerertntrnt, I Qty. I Fee rural I •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 I
Tax map/parccl no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. ft.) • 75.00 2
Limited energy, multi- family
residential (with above sq ft.) 75.00 2
Services or feeders installation, alteration, and /or relocation
200 amps or less 1 100.70 2
�
ar-BROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
N ame: - f� P � ��� 101 amps to 1, 0 amps 200.34 2
PR 1 60t amps to 1,000 amps 301.04 2
Address: 41s�� S/ Lr,elj
9-0 �+�ew R., ,00
Over I0 amps orvolts I 552.26
City/State/ZIP: �� Y Temporary services or feeders installation, alteration, and /or
t
G relocation _
Phone: (g)? j2( � Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 1 amps to 599 amps 16854 _
Branch circuits- new. alteration, or extension. per panel
Owner signature: Date: A. Fee for baanch circuits with
APPLICANT I ❑ CONTACT PERSON above service or feeder fee,
each branch circuit I 7.42 2
• Business name: C t`a/.,� _ r r ,(1 _ e„ B. Fee c orf feeder feefirsitharr
service �l '-f¢�+ l ce or feder e rust i 56.18 STioi q) 2
Contact name: � =' ,
ter` branch circuit
I t �,�s Each add'I branch circuit I 7.42 I
Address: f f a ` t.. ``L Miscellaneous (service or feeder not included)
y 1 `�� �� L ^ 1 �'!/�L
Each manufactured modular
Cit /StatelZ[P: 67.84 2
ctw1lir:g, service and/d/ pr Braden
�Z n
Phone: ` 7 82 . ( e3 I Fax: : ( ) Reconnect only 67.84
Pump or irrigation cirdle 67.84 2
E - mail: r1G tire:, ' :
- - , .7 ' mt! t,r Sign or outline lighting 67,84 2
CONTRACTOR Signal ci:cuit(s) or limited- energy
Business name: 4 C — f _panel - altcmtion, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address :? c,. ..9 5 ;1_ I'C n � - . = Additional inspection (I hr min) 66.25/ h:
G� 1 T investigation (I hr min) 66.25/hr
City/State/ZIP:
A L , kn r C2. 1, l e Industrial plant (1 hr min) 78.18 / hr
Phone: ( L � C Fax: (5O7) 83 5 p f31 Inspections for which no fee s
C _ soeeificatly listed (%: hr min) � �! hr
CCB Lic.: » 13 1 Electrical Lic.: "Sto - (7.1-T,., S Suprv. Lic.: 01 ELECTRICAL PERMIT FEES
Suprv. Electric
i a " si required: c . 7 / 1 Q ' t 3 Subtotal:
Plan review (25% of permit fee):
Print name: G`, r• �, 0 ^ ' Date: '3 j i s i 12 State surcharge (12% of permit fee):
Authorized signature: - •
TOTAL PERMrf FEE:
i This permit application expires it a permit is not obtained within 180
Print name: h avrt/ 4 1 '3 ry days after it has been accepted as co mplete.
C G-d C: Date: T I l
• Number of inspections allowed per permit.
r.' Building■Pennils■ELC- Perm :r.epp.doc st /01 /10 440.46157(11/05/COM,WEB
•