Permit •
• CITY OF TIGARD ELECTRICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00364
T [ G A R D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2012
Parcel: 1 S133DD08300
Jurisdiction: Tigard
Site address: 11624 SW 128TH AVE
Project: Locsin Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 120
Project Description: (5) branch circuits for kitchen remodel
6/14/12 REPRINTED TO CORRECT CASE INFORMATION
Contractor: PDX ELECTRIC LLC Owner: LOCSIN, ARSENIO Z
7933 WHITFURROWS CT 11624 SW 128TH AVE
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 06/12/2012 $85.86
Specifics: Service or Feeder
• 1 ea 12% State Surcharge - 06/12/2012 $10.30
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp: R -3
Total $96.16
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 0 52 -001- 090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: t JL� Permittee Signature: o 4 . f�F'P1"Li CAT"
�O&i
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 603.639.4175 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.
•
CITY OF TIGARD ELECTRICAL PERMIT
3 COMMUNITY DEVELOPMENT Permit #: ELC2012 -00364
13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/12/2012
T[ C, :1 F. P g Parcel: 1 S 133DD08300
Jurisdiction: Tigard
Site address: 11624 SW 128TH AVE
Project: Locsin Subdivision:'ILLAGE AT SUMMER LAKE PARK NO. Lot: 120
Project Description: (5) branch circuits for kitchen remodel
Contractor: PDX ELECTRIC LLC Owner: LOCSIN, ARSENIO Z
7933 WHITFURROWS CT 11624 SW 128TH AVE
DURHAM, OR 97224 TIGARD, OR 97223
PHONE: 503 - 997 -1989 PHONE:
FAX: 503 - 200 -1362
FEES
Quantity Description Date Amount
5 crt Branch Circuits wo /Purchase 06/12/2012 $85.86
Specifics: Service or Feeder
1 ea 12% State Surcharge - 06/12/2012 $10.30
Type of Use: Electrical
Class of Work:
Type of Const:
Occupancy Grp:
Total $96.16
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- 90. You y obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: �" �►C Permittee Signature: DM. rl PPL e4noki
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 Ina 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.
6/11/2012 1:16 PM (GMT) From: PDX Electric LLC 503- 200 -1362 To: 15035981960 Page 2 of 3 S I
Electrical Permit Applica r�� FOR O F1f F: 1 11 n.l.1 D
';,
Cl of Tigard
^'� R eceived r w 1
Date/B : Pc mkt ND.' C� ad .10/ 3- 0 51 ,
• 13125 SW Hall Blvd., Tigard, OR 97 R�1 Plan Review
' 11 Phone: 503.718.2439 Fax: 503.598' 1 1 2012 Date/B : Other Permit: .61.4. 4,2e9r A - QO -II.
I I ci n It D Inspection Line: 503.639 Date Ready /0y: hi: fi7 Se Pa ge 2 for ,
Internet: www.ligard•ur.gov pp��CI nn OFTIGA- D Notified /Method: i t - Supplemental Information
TYPE WI/1>'' 1p DI1 f1 0+ PLAN REVIEW
❑ New construction ® Addition /alteration /replacement Please check all den apply (submit 2 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories
1=I Demolition ❑ Other:
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® I - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
JOB SITE INFORMATION AND LOCATION CI Emergency system. larger separately derived systcnt.
❑ Addition of new motor load of ❑ "A ", "F ", `1.2 ", "1.3 ",
Job no.: 1 Job site address: 11624 SW 128th Ave IOOIfPor more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State/ZIP: Tigard /OR/97223 ❑ Health -care facilities. ❑ Supply voltage for more than
� ❑ Hazardous locations. 60n volts nominal.
Suite/bldg./apt. no.: Project name: V ` LLB O / i ` ❑ Scrvicc or feeder 600 amps or inure.
-- — —
Cross street /directions to job site: titeliiite FEE SCHEDULE Ikaceiptloo 1 Qn•. I Fee. I Total I •
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. II. or less 168.54 4
Ea. add'l 500 sq. R. or portion 33.92 I
Tax map /parcel no.: Limited energy, residential
75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Kitchen Remodel residential (with above sq. R.) 7 _ —
C ` p Services or feeders installation, alteration, and/or relocation
7 J &at 4�C� f � t r S 200 amps or less 100.70 2
1:21 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
Name: Susan Locsin 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 3W 04 2
Address: 11624 SW 128th Ave Over 1,000 amps or volts I 552.26 2
City/State/ZIP: Tigard /OR/97223 Temporar services or feeders installation, alteration, and/or
relocation
Phone: (503)880 -0145 Fax: ( ) 200 amps or less 59 36 I
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
intended for sale, lease, rent, or exchange, according to ORS 447, 449. 670, and 701. 401 romps to 599 amps 168.54 2
Branch circuits- new, alteration, or ex tension, per panel
Owner signature: Date: A. Fee for branch circuits with
® APPLICANT I ❑ CONTACT PERSON above service or feeder foe. 7 42 2
each branch circuit
Business name: PDX Electric B. Fee for branch circuits without
service or feeder fec, first 1 56.18 56 2
Contact name: Marty Palmer branch circuit
Address: 7933 SW Whitfurrows Ct
Each add'I branch circuit 4 7.42 29.68 2
Miscellaneous (service or feeder not included)
City/State/ZIP: Portland /OR/97224 Each manufactur or modula 67.84 12
dwelling, service urui/or feeder 1
Phone: (503) 639 -9708 Fax: : (503) 200 -1362 Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E - mail: info(a�pdxelectric.com
Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited - energy
Business name: PDX Electric panel, alteration, or extension. Page 2 2
— Each additional inspection over allowable in any of the above
Address: 7933 SW Whitfurrows Ct Additional inspection() hr min) 66.25/ hr
City/State /Z1P: Portland /OR /97224
Investigation (I hr min) 66.25/ hr
Industrial plant (I hr mitt) 78.111/ hr
Phone: (503) 639 -9708 1 Fax: (503) 200 -1362 Inspections for which no fee is 90.00 / hr
specifically listed (Vs hr min)
. CCB Lie.: 192731 ectrical Lic.• C696 prv. Lie.: 5612S ELECTRICAL PERMIT FEES
Subtotal; 85.86
Suprv. F.•,Iectrician signature, requiredin — ... Plan review (25% of permit fee):
o
Print name: Marty Palmer i Date: 6 -11 -2012 State surcharge (12% of permit fee): 10.30
TOTAL PERMIT FF.F.: 95
Authorized signature: This permit application expires if a permit is not obtain within 180
Print name: days after it has been accepted as completer /- sr. ",
Date: • Number of inspections allowed per permit. 414, •' '1
t " .DuildtngkP inits \F.).C• Permit A pp.duc 0 440. 44157(1 I /05 /COMAVED
6/11/2012 1:16 PM (61ff) From: PDX Electric LLC 503- 200 -1362 To: 15035981960 Page 1 of 3
PDX Electric
7933 SW Whitfuirows Ct, Portland, OR 97224
(503) 639 -9708
503 -200 -1362
www.pdxelectric.com
info®pdxelectric.com
To: City of Tigard Community Development From: Marty Palmer
Fax: (503) 598 -1960 Date: 6/11/2012 6:16A6 AM
Phone: Re: Electrical Pemit Application /Credit Auth
Comments
facsimile
•