Permit CITY OF TIGARD ELECTRICAL PERMIT
Per
m COMMUNITY DEVELOPMENT
Permit #: ELC2012 -00223
TEGA R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/19/2012
• Parcel: 1 S134CD10600
Jurisdiction: Tigard
Site address: 11725 SW 116TH AVE
Project: Brown Subdivision: BURLWOOD NO.4 Lot: 39
Project Description: Grounding for water service replacement.
Contractor: BOONES FERRY ELECTRIC INC Owner: BROWN, ALAN LEWIS & TERI J
PO BOX 628 11725 SW 116TH AVE
WILSONVILLE, OR 97070 TIGARD, OR 97223
PHONE: 503 - 682 -4936 PHONE: 971 - 275 -6205
FAX: 503 - 682 -7946
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 04 /19/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 04/19/2012 $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 rules or direct questions to OUNC by calling 503.232 1987 or 1.800.332.2344.
Issued B ,�. _ , — 11111b ittee 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 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.
Apr. 18. 2012 3: 07PM No. 8829 P. 1/2
Electrical Permit Applic oA 1 OR U1 I`IC I t. ONLI
City Ti gar "ri Receiv NA ratPro.: _
• 131 Hall Blvd., Tigard, OR R7M, 1 g 2 12 '
Phone: 503.639.4171 Fax: 503. , „ ; Odr P er= p 0 io� .)trra
T I G '+ r D Interact:w ti 503.639.4175
rd- or.go 5 CITY OF TIG. A '' D NoNotified/Method: . Supplemental Information
roe ,
❑ New construction Addition/alteration/replacement Please meat all that apply (summit I sets of plans Weems checked below):
❑ Demolition Other Cl Service or lamer 400 amps of tame O Building over throe stories.
where the available fault masnt ❑ Marinas sad boatyards.
-n I } z: tweeds 10,000 amps at ISO voles or ❑ Flue bu ldmgs,
.__. ..... . , less m gronad, or exlceeds la, Q Commeecisl -use ageicuthad
_M and 2 family dwelling ❑ Commercciallindushial 0 Accessory building J amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: O Fire pump. O Installation of 75 KVA or
❑ Emergency system lazgar aapsrately dtxived Symlem
. . _ ..'i...;.{ : • 0 Addition of now moror load of i -p., 1.3". -
Job no.: 2,413 0 C lob site address:_ 1 _ ). '7_2 5 5 ,,, ) / 6 ❑ S
100HP or more. occupancy.
ix or mere residential units. ❑ Recreational vehicle pacts.
City /State/ZIP: T if 0 0 0 R O Heatm facilities. ❑ soppy voltage for mots than
❑ Harardous locanona 600 volts nominal.
Suite/bldgJapt. no.: 1 Project name: Rest u e I2, od 4°' 0 Service or feeder 600 amps or more
s ,
;
Cross street/directions to Job site: Dee!<aiplioe Qn i- rot. Tea •
New residential single- or maid dwelling unit:
Includes attached garage.
Subdivision: I 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
/ I 'I .84 2
I r (with above bo�� residential
limited emgy, multi -f$mily 67.84 2
GrnveiA,il y 01 ' ." VI 444 , _ I111/4 re, /a «y.,p resideadal (with above sq. ft) -
Services or feeders insmllation alteration, and/or relocation
200 amps or less 100.70 2
l ' 201 amps 02400 amps 133.56 _ 2
401 amps l0 600 amps 200.34 2
N ame: 601 amps to 1,000 amps 301.04 2
.ddrcss: Over 1,000 amps or volts I 55226 I 12
Temporary es or feeders Installation, alteration, and/or
Y /St d on
Phone: ( ) 1 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 ps to 400 amps 125,54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 r snimpti s - 168.54 _ 2
Branch circuits- new, alteration, or extension, per wand
Owner signature: Date: A. Fee for branch circuits with
- r above service or feeder fee, 7.42 2
'� i I
ad, blanch ClrLnit
Business name: B . Fe for branch t ireuits without
service er s eeded free, fast ) 56.16 5 6 h ' 2
Contact name: branch circuit
Each add'I blanch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
En* memtfachucd or modular
City/State/EP: 67.84 2
dwelling, service and/or feeder
Phone: ( ) RocaOn 67.84 2
I Fax: ( )
Pump or irrigation circle 67.84 2
E-mail Sign or outline lighting 67.84 2
.,., _ :,- ;:r„ r. .„ . . .. . . . „... 1. n..; ...., , ,. ., t , .. .... ,t. ..
i � Signal cittuit(s) of limuedettergt'
Business name: Booties Ferry Electric ..: el, alteration, or extension Page 2 2
Each additional inspection over allowable in an of the above
Address: P.O. Box 628 Additional inspection (111: min) 6625/ hr
Investigation (I hr min) 6625/ br
City /State/ZIP: Wilsonville OR 97070 Industrial plant (1 hr mill) 78.18/ hr
Phone: (503) 682 - 4936 I Fax: (503) 682 - 7946 Inspections for which no fee h 90.001 hr
s. „ill., . listed Yi hr min
CCB Lie.: 88482 Electrical' c : 3 - 223C A Suprv_ Lic.: 31 7b 5 : : . _ ,. : -
Cuprv. Electrician signature, required: , �t Subtotal! S
permit fee):
I (N
, Plan rt vu:w (25% of pe mit fee): —
t'rint came: �T ye , • Date: IV / �� 1 State surcharge (12% of permit fox): 6 , 7 4 J t � � TOTAL PERMIT FEE: 62 _9 2
Authorized signature: 'ibis permit application expires if a permit is not obtained within l80
— days after it has been accepted as complete-
Print name: Date: • Number of inspections allowed per permit,
mvuldloapuu + Lc.PermaApp.dor 10101/09 4404615711/05/COMlWl$