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Permit V CITY OF TIGARD ELECTRICAL PERMIT 1111 8: COMMUNITY DEVELOPMENT Permit #: ELC2012 -00251 TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2012 Parcel: 2S 103CC00900 Jurisdiction: Tigard Site address: 12045 SW ROSE VISTA DR Project: Brumley Subdivision: COLONIAL VIEW Lot: 4 Project Description: (2) branch circuits for furnace installs. Contractor: GRF ELECTRIC Owner: BRUMLEY, JANINE K 15460 S PARADISE LN 12045 SW ROSE VISTA DR MULINO, OR 97042 TIGARD, OR 97223 PHONE: 503 - 829 -4146 PHONE: 503 - 706 -9357 FAX: 503 - 829 -5747 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 04 /27/2012 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 04/27/2012 $7.63 Type of Use: SF 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. ATTENTI . regon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952- 001 -0010 rough OAR 9 2- -0 0. You may obtain a copy of the rules or direct questions to OUNC by calli 987 or 1.800.332.2344. Issued By: tQ 4/1/LAALO Permittee Signatu 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' r MINIM �I 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. • 2012 -04 -27 07:53 GRF ELECTRIC 5038295747» 5035981960 P 1/1 Electrical Permit AD r lication , �f e n�'�" City of Tigard � Rece l: ;vee • 13125 SW Hall Blvd.. Tigard, OR 97223 •��'(/`� DaraBv: ' � 7 l� Permit No. �'I�Co�l��s� Plan II Phone: 503.639.4171 Fax: 503.598.196f�1 P R 2. O' Datt�y `w Other Permit; r t c, .A R D Inspection Line: 503.639.4175 Date Rea twit. Internet: www.tigard-or.gov RI Page 2 for t'ITX OF TI a,;fiedrMnROd Supplemental Information TYPE oFrAlymuhING DIVISION PLAN REVIEW ❑ New construction Addition/alteration/replaeement Please check all that apply (submit a sets of plans w /it atom betow): ❑ Demolition ❑Other: ❑ Service or feeder 400 amps or more ❑ Building over three stones. where the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑ Floating buildings. and 2•famll dWellin less toground, 14,000 C Commercial-use agricultural Y g ❑ Commercial/industrial ❑ A ccessory building ❑ Multi amps for all other installations. buildings. Y ❑ Master builder ❑ Other: 4 Fire pump. d Installation of 73 KVA or JOB SITE INFORMATION AND LOCATION ❑ Emergency system' larger separately derived system ❑ Addition of new meter load of ❑ - A", "E", - 1 .r. "I 3 Job no Job site address: L p S OS t'. loottp cx m°". occupancy. t ❑ Sin or more residential units. ❑ Recreational vehicle parts, City/State/ZIP: '' 5 4,,, Y �- el 7 L7.- 3 brr, d Healrbtars facilities. 0 Supply voltage for more than ❑ Hazardous locations. 600 volts nominal. Suite/bldg./apt. no.: Project name: Y f c 1 ^t+• y 1 et. ❑ 'tt or feeder amps ur more. Cross street/directions to job Site: a FEE EDULE oe,rrtaw t7t:. Fe. taut • New residential single- or mold- family dwelling unit Includes attached garage. Subdivision: • Lot nu.: 1.000 sq. ft. or less 168.54 4 Tax map /parcel no.: Fa add'I 500 sq. ft to portion 33.92 _ , Limited energy, residential -- DESCRIPTION OF WORK (with above sq ft.) 67.84 2 - — Limited energy,multi-family r _ • • ,1i /,, / ;'. residential (with above sq. R) 67.84 2 Services or feeders installation, alteration, and/or relocation 4 .s ,) . - 200 amps or less 100.70 El PROPERTY OWNER ❑ TENANT 201 amps to 600 amps 133.56 a Name: - 401 amps to 600 amps 200.34 _ 601 amps to 1,000 amps MI 301.04 Address: 77 '' I b f 4 '1`41 c(� �A) r• Over 1,000 amps or volts _ $52.26 MIEN City /State/Z1P: r � .7 i-2 Temporary services or feeders installation, alteration, and/or relocation Phone: ( ) ,' /) Lo - ‘i 3 5 7 Far: ( ) 200 amps or less 59 36 I Owner installation: This installation is being made on property that I own which is not 201 am to 599 amps 125 2 intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps �� 2 Branch r rcuits - new, alteration or extension, . -r .- eel Fee fo Owner signature; _ Date: A. Fee for branch circuits with ❑ APPLICANT it CONTACT PERSON above service or feeder fee, 7 42 each branch circuit 2 Business name: B. Fee for branch circuits without service or feeder fee, time Contact name: branch circuit 56.18 5t r Each add' I branch circuit Address: 7.42 1� 4 2 Miscellaneous (service or feeder not included City /St ate /Z]P: Each manutacnued or modular • 67.84 • dwcltin Sepia and/or feeder I Phone: ( ) I Fay:: ( ) Reconnect Only 67.84 2 E - mail: Pump or irrigation circle = - 67.84 � © i CONTRACTOR Sign or cud= lighting 67.84 L.S. n Signal circuit(s) of limited-energy �� Business name: J l e P r . / ir, el alteration or extension. 2 Each additional ins• ction over allowable hi an of the above ' Address: _ L/ s r _ L t Additional inspection (I hr min) 66 . 25/ hr �■ — City/State /ZIP: M u n ' GZ 0 Z. Investigation(Ihrmin) NM 6615/hr �■ ~• - industrial plani (1 hr min) 78.18/ hr Phone. (9.: z j i - I /Hi Fa (st 3 $24 ' r "] t7 I for which no fee is 90.00 / hr I CCB Lie.: 1 4. , 5' Electrical Lie.: Suprv. — spfically listed CA hr min) ( 7 - � 4•; � p Li c.: ! S -- 5 eci ELECTRICAL PERMIT FEES Suprv. Electrician Signature required; 1� Subtotal: , '�' Plan review (25% of permit fee): Print name: tNi t' I + ii 5 pate / lin hen , 711 • V / 2- State surcharge (12% of permit fee): 41 • Authorized signature: f J TOTAL PERMIT FEE:' w s _ Tbis permit application expires If a permit Is not obtained/Fri 180 Print name: i Date: days after it has been accepted pted complain L � ^ j Number of inspections allowed tree permit. lid . • 1:\ Building \ Forms \ PaymentAuthorization.doc 10/31/u7