Permit CITY OF .TIGARD ELECTRICAL PERMIT
2 .' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00250
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 04/27/2012
Parcel: 1 S136AA07100
Jurisdiction: Tigard
Site address: 7081 SW LOCUST ST
Project: Tanz Subdivision: AUM DOWNS Lot: 5
Project Description: (2) branch circuits
Contractor: PRO CIRCUIT ELECTRIC LLC Owner: TANZ, GUY H AND
PO BOX 3948 BADZIK, KATHLEEN M E
WILSONVILLE, OR 97070 7081 SW LOCUST
TIGARD, OR 97223
PHONE: 971 - 563 -8211 PHONE:
FAX: 503 - 266 -1349
FEES
Quantity Description Date Amount .
Specifics: 2 crt Branch Circuits wo /Purchase 04/27/2012 $63.60
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. 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 -001 rough R 9 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 232.1987 or 1.800.3 '
Issued By: • _b 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' i � J i b 1/7/ �✓ 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.
- .Electrical Permit AppiicatJ CEIVED
FOR OFFICE USE ONLY
City of T igat d Q�(� Received
d: 13125 S W Nall Bird,, Tigard; OR 97223 ' 2 6 2012
DatelBy: 7 k / 02 / Pest No. e 04, _60x 5— U
11 Phone: 503.639.4171 Fat: 503.5 9 m Other lxxP.
T I C AR D Inspection Line: 503.639.4175 C 9 I Y F TIGARD Dace Ready/By:
ea j Suppl e m ental ma lien
E OF WORK PLAN REVIEW
❑ New construction Ai Please cheek all that apply (submit 2 sets of
plans a /itmts checked below):
❑ Demolition Other: Service or feeder 400 amps or more 0 Building over three storks.
where the available fault current ❑ Mminas and boatyards.
CATEGORY OF CONSIRUCTION exceeds 10,000 amps al ISO volts or ❑ Floating buildings.
2 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building less to ground, or exceeds 14,000 ❑ Commercial -lac agricultural
El Multi-family 0 Master builder Fiepumpllatlltr�ta]Iatioas. buildings.
❑ Other: ❑ Fire pump. ❑ Iastalhtion of 75 KVA or
CI Emergency system. larger derived systec
JOB S.[ WE INFORMATION AND LOCATION
Job no.: Jolt site addrt ss'?p 1 J ❑ OOHP mre motor load of
Vv OC/ J -- ce°gnno
City /Stale/ZIP: ❑ Six
t or mo ae r units. ❑ Recreational vehicle parks.
❑Health-care facilities. ❑ Simply voltage for more than
SuiUrJbld !a t, no.: ❑ Hazardous locations. Goo volts nominaL
& h Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job :ate: _ FEE SCHEDULE
nesnlprbn I ors. I For_ J Tarot I•
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: l Lot no.: 1,000 sq. ft. or less _ 168.54 1 4
Tax map /parcel no.: - Ea_ add'I 500 sq. ft. or portion 33.92 1
_ DESCRIPTION OF WORK Limited energy, residential
67.84
('' �c 2
�^ T t ✓ Co C !,e p 'r f t " lTrr i Limited energy, rmrhi- family
Ef " " `' 1� rV r ? �/V _ residential (with above sq. n.) 67.84
graCiD Z
` f �, Services or feeders installation, alteration, and/or relocation
OPERTY OWNER 1 ❑ TENANT 200 amps or less I 100.70
201 amps to 400 amps I33.56 , 2
Name: -- er _Icy
�` [t . 401 amps to 600 amps 200.34 2
Address 601 amps to 1,000 amps 301.04 2
Over 1,000 amps or volts 55226 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
Phone: ( ) relocation
Fax: ( ) 200 amps or less 59,36 I
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps
i
I
ntended for sale, lease, rent, o. • exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps 125.08 2
168 2
Owner signature: Date: Branch circuits — new, altcrafion, or extension, per panel
❑ APPLICANT A. Fee for branch circuits with
❑ CONTACT PERSON above service or feeder fee ,
Business name: each branch circuit 7.42 .7, q2 2
B. Fee for branch circuits
service or feeder fee, 56.18 9b 1 V 2
Contact name: wlJrour ri
Address:
first branch circuit �
Each aeld'l branch circuit 7.42 2
City/State/ZIP: Mbeelianeous (service or feeder not included) '
Each manufactured or modukir
Phone: ( ) Fax: : ( ) — dwelling, service and/or feeder 67.84 2
E -mail: Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
CONTRACTOR Sign or outline lighting
Business P �❑ l g 67.84 2
c CJr E ll( 1 ^� S ignal circuit(s) or limited -
Address: F orgy panel, alteration, or
S9 LIR extension. Describe: Page 2 2
City/StateraP: id . 501a((ie. 0{ C 67
Each additional inspection over allowable in any of the above
Pilot= (� S�
() gill 1 Fax: (Sbl)) ZCoCo ( Pori t loo 6
P
CCB Lie.: Electrical Lie.: — 6,0( c... p 349 Investigation perhour(I hr min) 6625
Suprv. Lic: 6 67 5 Industrial plant per hour 78.18
Suprv. Electrician signature, regt.ired: ELECTRICAL PERMIT FEES
Print name: Q - Subtotal: 0 '3, (p 0
� L I � " . ,\ ‘ r Date: I O _ 2z_ a p Plan review (25% of permit fee):
Authorized signature: I State surcharge (12% of permit fee):
TOTAL PERMIT FEE: '71
Print name: This permit i
Date: P mitnppkaatioo expires urn permit is ant obtained within
days after II has been accepted as complete
t: -Pamir App.dac 1040148 • Number of inspections allowed m
440.-0615-0 Ua5/COMM1VEa P
Z 617£t99Z£OS 01.110813 11r10.110 aid db£ Ol ZL 5Z ad`d