Permit 4 CITY OF TIGARD ELECTRICAL PERMIT
1111 2 • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00260
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/04/2012
Parcel: 2S102CA00224
Jurisdiction: Tigard
Site address: 13227 SW ASH AVE
Project: Bonge Subdivision: VIEWCREST TERRACE Lot: 21
Project Description: (3) branch circuits for a /c, furnace & outlet
Contractor: TYLER ELECTRIC LLC Owner: BONGE, TRESA K
PO BOX 801 13227 SW ASH AVE
MULINO, OR 97042 TIGARD, OR 97223
PHONE: 503 - 829 -4146 PHONE: 503 -475 -7984
FAX: 503 - 829 -5747
FEES
Quantity Description Date Amount
Specifics: 3 crt Branch Circuits wo /Purchase 05/04/2012 $71.02
Service or Feeder
1 ea 12 %, State Surcharge - 05/04/2012 $8.52
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $79.54
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 t ug R 95 01 -0090. You may obtain a copy of the rules or direct questions to OUNC by callink.5831t2.1987 or 1.800.332.2344.
� iI 2 I
Issued By: � 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' , AT Date:
. 41011111110.. 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 -05-02 14:35 GRF ELECTRIC 5038295747» 5035981960 P 1/2
Electrical Permit Applicath JCEIVED q FOR O 1 1( I. I• I. ONI.\ /� .
City of Tigard Det S O` /� Permit No.: �L(��l �1 i AP
111 I el 13125 sw Hall Blvd., Tigard, OR 972.4Y — 2 2012 Plan Review Other Permit: • - Z Ai/
Phone: 503.639.4171 Fax: 503,598.19 Date/13
Inspection Line: 503.639,4175 Date Ready/By: l Fa See Page 2 for
i it ""' uau• t' Internet w .tigard- or.gov CITY OF TIGARD Notified/Method: Supplemental information
TYPE OF W • r i d . • PLAN R EVIEW
7 - Please cheek all that apply (submit 2 sets of plans :/items checked below)'
❑ New construction ra Addition /alteration/replacement ❑ Service or feeder 400 amps or mom ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION �' cxcads 10,000 amps at 150 volts or ❑ Floating buildings.
Ian In ground, ar exceeds 14.000 ❑ Commercial -use agricultural
G - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps fm all other installations. buildings,
❑ Multi - family ❑ Master builder El Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION • [] Addition of new motor load of ❑ "A "E", "1- 2 ", "1 -3",
100HP or more. occupancy.
Job no.: Job site address: 12_i s . : 5 - ❑ Sia or more residential units. ❑ kecreational vehicle paths.
❑ Health-care facilities. ❑ Supply voltage for mom than
['Hazardous locations 600 volts nominal.
Suite/bldg. /apt no.: • Project name: A ❑ Service or feeder 600 amps or more
FEE SCHEDULE
Cross street/directions to job site: neatriptian 14tr. I rx L retat I
New residential single• or multi - family dwelling unit
Includes attached garage. _
SubdivisiOfl: 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
DESCRIPTION OF WORK (with above sq. ft.) 67.84 2
L imited ener multi - family 67.84 2
• - / ` • residential (wi above sq. ft.) _ _
4 Services or feeders installation, alteration, and/or_ relocation
2 00 amps or less 100.70 2
Y ' ROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2 ,
4(7 amps to 600 amps 200.34 2
r 601 amps to 1,000 amps 301.04 2
Address: ) 3 Z 2 c.,() i c A A • Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City/State/ZIP: t reoucaton
Phone: ( Fax: ( ) 200 amps or less 59.36 1
Owner installation: is installation is bcing 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 with
❑ APPLICANT ❑ CONTACT PERSON above service or Ibeder fee, 7.42 2
each branch circuit
Business name: B. Fee for branch circuits
without service or Iberia fee. I 56.18 SI/, (b 2
Contact name: first branch circuit
- Address: Each add'I branch circuit 1 7.r 7.42 ) 4 _ f 1
Miscellaneous (service or feeder not included)
City /State/ZIP: Each manufactured or modular ` 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
E-mail: pump or irrigation circle 67.84 '2
CONTRACTOR Sign or outline lighting 67.84 2
Signal circuit(s) or limited•
energy panel, alteration, or
extension. Describe: Page 2 2
Address: j 7 • ■ ' _
City/State/ZIP: ' — Each additional inspection over allowable In any of the above
Per inspection 66.25
" Phone: (■50 ?) I( Z. 9 - . ` Investigation per how (I hr min) r 66.25
4 Electrical Lic. • 3 (.C$ • Suprv, Lic.: 0 Industrial plant per hour 78.18 EIIMMEll ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: , to/(H/ Subtotal: 7 1 s 0
Plan review (25% of permit fee):
a Le: State surcharge (12% of permit fee):
Authonzed signature: ., . ? Z ,.. AL TOT NGRt,tIT rcc. s
99
This permit appticsdon expires if a permit is ool obtalnwlalin 180
Print name: ! - Date: days aver It has been accepted as complete. _71 liffl