Permit CITY OF TIGARD ELECTRICAL PERMIT
to . COMMUNITY DEVELOPMENT Permit #: ELC2012 -00180
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/30/2012
• Parcel: 1S133DB00104
Jurisdiction: Tigard
Site address: 11450 SW WINTER LAKE DR
Project: Summerlake Park Subdivision: ARI GREEN Lot: C
Project Description: (2) branch circuits for alarm system.
Contractor: MR ELECTRIC OF CLARK COUNTY Owner: TIGARD, CITY OF
418 NE REPASS RD B -5 13125 SW HALL
VANCOUVER, WA 98665 TIGARD, OR 97223
PHONE: 360 - 574 -7200 PHONE:
FAX: 360 - 546 -2158
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 03/30/2012 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 03/30/2012 $7.63
Type of Use: COM 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 OAR 952- 001 -0090. You may obtain a copy of the ru t questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: 1�i - Permittee Signature:
4/OP
• 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.
Mar. 30. 2012 2:01AM No. 9058 P. 1
Electrical Permit ONLY
Applicatio 1 FOR OFFIOFFICE tUSE Ci of Tigard •� , I " `z R eceived • ,
� .,--- 13125 SW Hall Blvd., OR 97223 p 2012 plan Revimv
Phone: 503.718.2439 Pax: 503.598.1960 AR 2 9 Dane/R : OlherPermir:
,
TIGARD Inspection Line: 503.639.4175 Dale Ready/1y: Atria: El See Page z nor
Tntemcl; www.tigard- or.gov CITY OF TIGARD Notified/Method: (/y Supplemental Informalton
— TYPE or r W1'DING DI ISION PLAN REVIEW
ID New construction Addition /alteration/replacement Please check all Aral apply (submit sale of plane w /items checked below):
❑ Service or f 400 amps or more ' ❑ Building over three stories.
❑ Demolition ❑ Other: lvhere the available !huh cunenl 0 Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10.000 amps at ISO volts or ❑ Floating buildinga.
less to ground, or oxceeds 14,000 ❑ Consmercial -uae agricultural
❑ 1- and 2- family dwelling RI Commercial /industrial ❑ Accessory building amps for all other installations. buildings,
❑ Multi family ❑ Master builder El Other: 0 Fire pump. ❑ Installation of 75 KVA or
.1011 SITE INFORMATION AND LOCATION ❑ mergen system. larger separately system.
0 Addition o fne'v motor load of ❑ "A'', "B", "1- 2 ". "l -3 ",
Job no.: 8q 88 l Job site address: I 1 450 )13;1' r'Io ko 10011P or more. occupancy.
❑
❑ Six or more residential units. Recreational vehicle parks.
City /State/ZIP: "( ; ^' Q Heahh.care facilities. 0 Supply voltage for more than
`�y.' ^ Cr! � �2� ❑Hazardous!ovationa. 600 volts nominal.
Suite/bldg. /apt. no.: J P roject name: Mph `p l( 0 Service or theder 600 amps or more.
PEE SCHEDULE
Cross street/directions to job site: Description I Orr. Fee. I Tara'
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. R or less 168.54 4
Ea. odd'1 S00 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION Olt WORK (with above sq. ft.)
1 Limited energy, multi- family 75.00 2
I 1. - r t h. 1 f • [ residential (with above sq. ft.)
Services or fccders'instnitation, alteration, and/or relocation
W 1 9) 0001Q-cl'upiq 200 amps or less 100.70 2
{. PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
401 amps to 600 amps 200.34 2
.. Name: C �� y o (� my-a, (a; a.. 11k Ss i 1 601 amps 10 1,000 amps 301.04 2
Address: Vbxts a,,3 t \ah't:1m, Over 1,000 amps or volts 552.26_ 2
Temporary services or feeders installation, alteration, and /or
t
Cily/State/Z1P: c k I qr relocation _
Phone: (Sol) ' 7de 0 B F ax: ( ) 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. 401 amps to 599 amps 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits trirh
above service or theder fee.
APPLICANT I [] CONTACT PERSON' each branch circuit 7.42 2
' B. Fee for branch circuits 'When"
Business Home:
mC • �<< P • c.- .. service or feeder feel first
Conte name branchcircuit branchcircuit 56.18 , 1 2 .
-Ti — K�� per Each add'1 branch circuit ( I 7.42 1 / 2
Address: I-1113 NE 1 �]�t s S ,2nl Z- Miscellaneous (service or feeder not Included)
Ci Each manufactured or modular
ry /State/LIP: r �►- '��' '''i 5 67 84 2 dwelling, service and/or feeder _
Phone: rL ,�, (J Fax: : ( ) 574._ 7 o ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail: CS Q @ Mre l ec +ri _a_ . C O M Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: panel, alteration, or extension. _ Page 2 2
Each additional Inspection over_ allowable in Any of the above
Address: 3 ling e 43 t:: IL_ Additional inspection (I hr min) 66.25/ hr
City /State /ZIP: �1��� Investigation (1 hr min) 6625/ hr
Industrial plant (1 hr min) 78.18/ hr
Phone: ( ) Pax: ( ) Inspections for which no fee is
90.00/ hr
� j specifically listed ('A hr min)
ry CCII Lic.: J Electrical Lie.: u' 3(,Q I Suprv. Lie.: y58A5 ELECTRICAL PERMIT PEES
3t , / Subtotal: ( e 3' (p
Suprv. Electrician 1 n e, required: _ / . Plan review (25% of permit fee):
� State surcharge (12% ofpennit fee): 7 (
Print name:
Date: 3 ~2.9��'f� r. 1,S TOTAL PERMIT PEE:
Authorized signature: This permit application expires if a permit is not obtained within ISO
Print name: Date: days after It has been accepted as complete.
N um b er of inspections allowed per pent.
l; t3ui ldingtPere'hs1LLCSmnitApp.doc 07/01/10 440.6157(1l/OS/COM/WP.a