Permit CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00328
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 05/30/2012
Parcel: 2S102CCO2500
Jurisdiction: Tigard
Site address: 13900 SW 102ND AVE
Project: Nelson Subdivision: FRELEON HEIGHTS NO.2 Lot: 10
Project Description: Reconnect only
Contractor: RED'S ELECTRIC CO INC Owner: NELSON, WILLARD & ALICE
6336 SE 107TH AVE TRUSTEES
PORTLAND, OR 97266 13900 SW 102ND
TIGARD, OR 97223
PHONE: 503 - 233 -6467 PHONE: 503 - 639 -3502
FAX: 503 - 233 -1281
FEES
Quantity Description Date Amount
1 ea Reconnect Only 05/30/2012 $67.84
Specifics:
1 ea 12% State Surcharge - 05/30/2012 $8.14
Electrical
Type of Use: SF
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $75.98
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 OA 9 2-001-0 0. You &A-
may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: .VVK ,L Permittee Signature: DM rT pP�i' anal
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.
May. 29. 2012 10:16AM • No. 1321 P. 1 S
Electrical Permit ApplicatifilECEIVEL) FOR OFFICE USE ONLY
Receiver)
City of Ti :I,'d Permit No
t; MAY 2 9 2012 Date/By: a01 -.003 ,...4( t 13125 S15` Hall Hlvd.,'1'igard,OR 97223 PIRO Review Pal /I,�'�m
I hone: 503.718.2439 Fax: 503. 8' 1 k! Date/By: _
- Other Permit: Pa j.0 t
Insneetion Line' 503.639 4175 GAi. , y y See Page 2 for
.11919°?- n 1 No tc ed /M e t t ; bins. (0 I Supplemental Information
• Interact: ll�sw or.gov ��� D � :�,� •v� tn NotificdlMethod: I Information TYPE OF WORK : � ! � ,1 ��� - P I ,A N REVIEW 1 .
❑ New construction g. Addition /alicratiutl/replacement Please check all that apply (submit a sets of plans tvfitems checked below):
❑ Service or feeder 400 arnpc Or more ❑ Building over three stories.
[Ti Demolition ❑ Other: where 111c available fault current ❑ Marinas and boatyards.
---
CATEGORY OF CONSTRUCTION cxeccds 10,000 amps at 150 volts, m ❑ Floating buildings.
less to ground, or exc ads 14,000 ❑ Commrrci:rl. ,se agh icultural
eg_ _tuid 2- limtity dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 73 KVA or
❑ Emergency system. tinge, separately derived system.
JOB SITE INFORMATION AND LOCATION ❑Addition of new maim lead of ❑ "A ". "lr. "1. •`I -3 ",
— 100111' ar atone. occupancy.
Job nu.: p el Jab sue address: O ❑ Recrea al vehicle arks.
� O,� � `�T /� � t� V W � Q 2. � � � ❑ Six o more residential ranks. p
(:icy /Stale /ZIP: ❑llealth.vru2 utilities. ❑ Supply voltage for mute than
- - .. ❑Hazardous locations. 600 volts nurniaal.
Suite/bldg./apt. no.: Protect uaute: itVe lJeji-77 ❑ Service or feeder 600 amps or more.
-- FEE SCHEDULE
Cross streel /diremtinns to job site: ntset - 1 Qtr. 1 Pee. 1 Tung 1 •
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000sq. f. orlcss 168,54 II
La. add'I 500 sq. ft. nr portion 13,92
Tax nip/parcel no.: residential
-„ I.imit energy, residential 73.00 2
' DESCRIPTION OF WORK (w�ithabove sq. ft.)
Luniled energy, rani- family.
'residential (with above sq. I>.) /)g24„7 75An 2
y Services or feeders Installation, alteration, and/or relocation
-- , RE NEE C, D,t' i_ y _ 200 amps or less 100.70 2
0 PROPERTY OWNER ❑ TENANT 7.01 amps to 400 amps 133.56 2
- 401 amps to 600 amps 200.34 2
Name: .. 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts . ' 2 ,y
_
-- ' - 'I'emp0i;ity services or feeders insMllaf alteration, and/or
City /Statc/ZI P: relocation - .
Phone: ( ) Fax: ( ) 200 amps or less _ 59.36 1
,
201 amps l0 400 amps 125.08 2
Owner installation: This installation is being made un property that I own which is not 401 amps to 599 amps 1611.5•s 2
' intended for sale, least, rent, or exchange, according to ORS 447, 449, 670, and 701. . p - P
Broach circuits- new, xlteralloi1, or extension, per panel _
Owner signature: ., • Date: A. Fee for branch circuits with
above s crvicc nr feeder fee,
❑ APPLICANT ❑ CONTACT PERSON each branch circuit 7.42 2
Business name: B. Pee fur branch Circuits wlthnnt
_. service ur feeder fee, first 56.18 2
Contact name: brunch circuit . _
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) .
- Each mnnuthctured Ur modular 67.84 2
City /State /ZIP: dwelling, scrvicc und/ur feeder
Phone: ( ) I Fax: : ( ) _Reconnect only / 67.84 67.8cr 2
•— Pump or irrigation circle _ 67.84 2
• E -mail: ... ._ Sign outline lighting 6"/.84 2
CONTRACTOR - Signal circoit(s)or energy
Business oar panel, thermion, or estetrsion. t'ug 2. 2
Red's Electric Com an Inc. sell additional Ins !cclintrl over allowable in a rty' of the above
Address: p y Additional inspection (I In nsin) 66.25/ hr -
6336 SE 107th Ave. Pdx, OR 97266 —• - investigutiun (1 to into) 66,25/ hr
City/Stale/I. 503- 233 -6467 fax:503- 233 -1281 • Industrial plaid (1 lir min) 711,181 hr
Phone: ( elaina @redseteetrie.eom Inspections for which no fee is specifically listed Alumin)
90.00/ hr
COI Lie.: CCB# 4443 Elect# 26 -152C Metro# 1695 F.I.ECI'RICAl, PERNIiT FEES
Suprv. Eleclrician signature, required: .- _ Plan rest w (25 % 01 Permit far):
Print name: 07-i„,,..... .Q 1 Date: J Z s / State surcharge (12% of permit fee): 9 , I v.
r' � 1 . S I 1 Z,.
• T OTAL PERMIT FEE: 7 S. �'`$ /
Authorized signature: • This permit application spires If a permit is nut ohlained within 1110
days niter it has been accepted as complete-
\ Print na111e: I Date: a NunAhcr of inspections allowed per permit"
'y a +o.l6tST gtrosrcuariaNn ,
gA 0uiltlinel l 07/01010