Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00182
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
Parcel: 1 S 136AD05700
Jurisdiction: Tigard
Site address: 6726 SW PINE ST
Project: SPILLUM Subdivision: VILLA RIDGE Lot: 2
Project Description: Panel replacement.
Contractor: WEST SIDE ELECTRIC CO INC Owner: SPILLUM, RON & SUE
1834 SE 8TH AVE 6726 SW PINE ST
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/30/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/30/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 mules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344
Issued By: ��- s Permittee Signature:
v
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 603.839.4175 by 7:00 a.m. for the next available inspection date.
Thls 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.
13125 SWHa1181vd., Tigard, OR 97223 RECEIVF, ISI-ca0a l Y1(7),
' m Phone: 503.639.4171 Fax: 503,598.1960 n e/ay:
Other Permit:
• t, „ ti a Inspection Line: 503.639.4175 MAR 2 9 Z � uEl1&e Ready/13r Jana: El See Page 2 for
Internet: www.tigard- or.gov Notified/Method: Su C
C _ Supplemental Information
a} L p"(Ir•,...�;'.Fi(r <r•g;,S, ' ;l.' ::,ir''1..` �nd1���f��,-'lid �j [ � ^f .. tit; y .:.,J} M.:
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, �.,.... e. P.:?S�r:,'.:.i..!'•� "a.�...i:� ::.f;:C.. ��tYI�:•e�!a1�A•:'!, rY':1' j�'n. ,• ii i , ‘ f4 Please �f ..L;.,t:- .;t��t.�:..•;i'.'' � ,4.� )•h w- P/:,...
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❑Newconstruction a rt Addition/aheratiotl/rep ( � Please cheek all that apply (submit isms of plans w/items checked below):
D Service or feeder 400 amps or more D Building over three stories.
❑ Demolition ❑ O ther w t available fault current p Marian and hoMyords.
•..;; ; r �;45..rur•��: <: r;;rt:• •t�::" ;w "' • exceeds 10,000 amps at 150 volts or
y�, ,'��;: ,;;'1:'•,,..ii;tis�,,.;yr� ?•..;hkriF�r'.��'�'',�' �r,'.... �, ....:� ' ' t:r~Y`':: ;2; ,, ,r�.?. Dg OFloatingbuildinga,
fees to ground. 4r exceeds 14,000 0 Commereiel.use agricultural
W4- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations, buildings.
❑ Multi- family ❑ Master builder ❑ Other. ❑ Piro pump. Installation of 75 KVA or
a. 0 Jo
ea:.. i • , t�.) , lL .• Fyn t ' system,
�i' � . ..:. �.. . , + � �a��'r� °a'*. ; Ir:;„ ,,.:;�: • '> Emergency system, larger separately derived
°vr.'1::: fe, .,','.'� "^�.:,.::::;•..,.. O r.S�PifA1.f>F`O' �M�1u ' �f"%�"'�. '�'`' �• r : ;�`. ❑ Addition of now motor load of
Job no.: 5 W ' J Job site address: Lob p ( SW nil • S t00HP or mote, occupancy.
� - � - 7 /r 2 D Six or more residential units, 0 Re tonal vehicle parks.
City/State/LIP: ! /' a. t " ( D 14oalttrcare facilities, 0 Supply voltage for more t
^I ['Hazardous location., 600 volts nominal.
Suite/bldg, /apt. no.: Project name: J U k l QL St.t. 0 Service or feeder 600 amps or more,
.: �r , FI' : :: 1.Z: ! /i : a . r.� 4 r :. y ,�_ : :
Cross street/directions to job site: l.g`eurte B : ; , `" '' ' er < y ` ' ' "''�� r
nntrlMien i On. ) pan J Tow I •
New residential single- or multi - family dwelling unit
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map/parcel no.: Limited energy, residential
�r,, <. . f: Y4t ::::;,; r ":,� Y .�' 75,00 2
r, {J w iii. i , fl„; !- . ^ : ' :.,.:::,::.:,� . .10 , .. . " , ..i .:, ;i:i ..; x::.3 > F,�.ti,^ .:It`„'`._ (with above Sq- a.)
�� . w'WQIi�
J I 1 1 Limited energy, multi ihrnily
ifra i ' /, pi • ainnv r residential (with above sq. ft.) 75,00 2
r � Services or feeders installation. alteratl0 all, nd/ reteatioo
I
200 amps or less 1 100.70 I UO :1n 2
:':.::rijr.<:ti aQ :t- 's Vt+. r e .,i .: Y:AVCAr:• : ' i E'. ;'i:;'yi • 0• (n. 201 amps 1 amts. 133.56 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
Ciry /Statc/Z1P: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or less 59,36 I I
made on property 201 amps to 400 amps 125.08 2
Owner installation: This installation is being p petty that I own which is not 401 amps to 599 amps 168.54 1 2
intended for sale. lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Pee for branch circuits with -
-:,, :' ` 1 ;;. r.P':`: '� ;�, l :k gi' : r ,� �. 1. 'i"• above savie or feeder fee. 7.42 2
`��.:'':�`- f:�c:- ��e:'r:�`;�1?l�t.,:, r,:. , :,. r,r ter, :i:�•i'F,.1`ro!tix'+1►�'i0 „•�' :�c; =��{ri
J cash branch e circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: branch circuit
Each add' branch circuit 7,42 2
Address: Miscellaneous jservice or feeder not included)
Each manufactured or modular
City /StatelzlP: dwelling, service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump irrigation circle 67.84 2
E -mail:
l5e v ;':y �^,`:g • {::; .;!,r. r Ire +: ».; �,.: ;i: rt;'p '. r v�' . �::L,r•:1x Sign or outline lighting _ 67.8 2
• S ,.,,1.5., i,,1.,:,. ,r.;:.,.,;Y ' ,::.ur:,•,...:, „ t�ra3.,: ::I.��.r'::�•, ..,.:1 :a ^:,.,,:,, Signa lcircuit(s)or oncrg'
Business name: West Side Electric Co., Inc. panel. alteration. or extension. Paget 2
Each additional inspection over allowable is ally of the above
Address: 1834 SE 8th Ave. Additional inspection (1 hr min) 66.25/ hr
ves
City/Statc/ZIP: Portland /OR/97214 Intigation(Iltrmin 66.as /hr
indusdustrial plant(' hr min) v 7&18/ hr
Phone: (503) 231 -1548 I Fax:(503) 736 -0677 Inspections for which no fee ls
sksecificalfy listed ('/, hr min) 40.00 / hr
CCB Lie.: 13306 Electrical Lic.: 26-13 5 C Suprv. Lic.: 465 4 — S '' F; nr'; i :. /. .'E s1"l l�'?1 ix ,V,''a
K wi W
Suprv. Electrician signature, required: �� Subtotal; / ()() "/ p
Plan review (25% of permit fee):
Print name: Randall F Roberts Date: 5 7 j State surcharge (12% of permit fee): / p 061
TOTAL PERMIT FEE: ./ j9-, 7
Authorized signature: TM. permit application ezpirca if n permit is not obtained within 180
days after it has been accepted as complete.
Print natfC: Date: • Number of inspections allowed per pemtit,
I:19uldins errniu'Si.c- PanmApp.4ne a7/M /16 44o- asi5T(II105/COMAMID
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