Permit v CITY OF TIGARD ELECTRICAL PERMIT
I , COMMUNITY DEVELOPMENT Permit #: ELC2012 -00398
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 07/02/2012
Parcel: 25101 DCO5000
Jurisdiction: Tigard
Site address: 13410 SW 76TH AVE
Project: Albertina Kerr Centers Subdivision: PACIFIC RIDGE Lot: 2
Project Description: (3) branch circuits for TI
Contractor: CLACKAMAS ELECTRIC INC. Owner: ALBERTINA KERR CENTERS
PO BOX 51 ATTN: JERALD A HOFFERT
BEAVERCREEK, OR 97004 424 NE 22ND
PORTLAND, OR 97232
PHONE: 503 - 969 -5684 PHONE: 503 - 239 -8101
FAX: 503 - 632 -2421
FEES
Quantity Description Date Amount
Specifics: 3 crt Branch Circuits wo /Purchase 07/02/2012 $71.02
Service or Feeder
1 ea 12% State Surcharge - 07/02/2012 $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 through OAR 952 - 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232. P 1987 or 1
Issued By: ` ) C� MI Permittee Signature: PR-M A -A
- n om
/ 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.
vl a-I o- 9r amrar� '
37
RECEIVED kcs7 o; ooi& W
JUN 2 9 2012 _f(
�t�9 i ,ru t ., , Please check all that apply (submit 2 sets of plans w /items checked below):
a .. rr' y r i b lE 3'YvY Taie}iai ; ioe.is rs ,, ' - 6 � , 4, - V A n 4: 4 r. ?. Service or f ee d er 400 amps or more
,� p Building
ari iag over
bo tryo
New construction s.
Addition /albtxation/replaeemeq�� I where the available fault current Marinas and boatyards.
Demolition Oth exceeds 10.000 amps at 150 volts or Floating buildings.
x ++ less to ground, or ex 14,000
y '+IMM d .. e tt r +" " , 8 Commercial-use ings agriculhrral
e zal � Lw a � � i atY[y� amps for all ether installations. buildings.
I and 2 - famil dwelling CommerciaUindustrial Accessory building Firoptmrp. Installation of 75KVAor
Emergency system. larger separately derived system
Multi r Y � Master builder Other Addition of new motor load of A°, "E~ occupant
1 -z ", "t -3 ", upon,
Wit rl' x ° ; . r t } ' '4061.,.4,i,-
`" r ' 6 1.,.d+r , " , . r °' o , 100HP or more. Recreational vehicle parks.
. 1. :.. ii O i .ii.o. C dr' . ' ' ` ` "`;,.,. i'` "' Six or more residential units. Supply voltage for more than
ob no.: ob site address; / ) 710 •• C.- Healthcare facilities. 600 volts nominal.
Hazardous locations
tf�
ity/St�z g! ; mo d b 97 Setrieear feede600 am ormorn
f R 7$ '� "4� � +t+yaume'::4i dr�n .5. �- f >d: a ' htb .t
, uite/bldg. /apt. no.: ,Project name: pl — 0 76,44.__ - � . ' :, 4 ,.. E i } tli .,er• ii ;
Description Qty. Fem rota)
ross street/directions to job site: New residential single- or multi - family dwelling unit.
includes attached garage.
1,000 sq. ft. or less 168.54 .
ubdivision: Lot no.: Fa add'1500sq. R. or portion 33.92 .
f Limited energy, residential
ax map/parcel no.: (with above sq. ft.) 75.00 .
t r?c rr
M1 v ... "
w; alt. '� 'fir r r k. -, „ j � 'b ?' �'� �`T • , e i ;,, r : ,z l . ,.. F Limited energy, ,rrwt�4 n°��oLxt rv� rri ; Y;.s „;� :i., BY multi -f
1y .
residential (with above s9. ft.) 75.00
II � a t A Services or feeders installation, alteration, and /or relocation
200 amps or less 100.70 .
� �kaa.r•; w ssr fl n ,. ; s • f 4} 201 amps to 400 amps 133.56
d c. vrss�n..:.` 7. 471 t`s-at� rF y � -1 it c•�suii..�i'3 '�.' � iii `A;:i.i'k"Ym7 4
401 amps to 600 amps 200.34
I tittle: 601 amps to 1,000 ants 301.04
• ddress: Over 1,000 amps or volts 552.26 . •
Temporary services or feeders installation, alteration, and/or
ity/State/ZIP: relocation
r hone: ( ) frax: ( ) 200 amps or less 59.36
201 amps to 400 amps 125.08
t , er installation: This installation is being made on property that I own which is not 4ot amps to 589 amps 168.54
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per panel
• net signature: A. Fee for branch circuits with
above service or feeder fee, each
ID ate: branch circuit 7.42
,•.; �^ .�S:vx¢•w.'�jae�t4 A a� 's,ueur .. ,.:r l s : ti u { I °` A B. Fee for breech 6Z: is raMiSorer
,�T....w serv of f eeder fee, fvst brooch
it usiness name: circuit - 1 56.18 5 4 ,
ontact [tame:
Each add' I branch circuit c:al— 7.42 /
Miscellaneous (service or feeder not included)
• ddress: Each manufactured or modular
ity /State/ZIP: dwelling, service and/or feeder 67.84 I .
Reconnect only 67.84
I' hone: ( ) IFax: : ( ) Pump or irrigation circle 67.84 .
I - mail: Sign or outline lighting 67.84
yQfi r: °a'f'.0 5 m _ Signal circuit(s) or limited - energy
iii 4 "A E ,` . ..+'�.°•f+.g, � r f ; ,
: w , sc > t • „ -,C;. .., . .,.s.. ".in ;'y`?t �C ,::f,! Martel, alteration, or extension, Page 2
11 usiness name: 0_1u_ 0, 6 E. A / r i A Each additional inspection over allowable in any of the above
d�� Additional inspection (1 hr min) 66.25/ h
dress: 5 Investigation (1 hr min) 66.25/ h
ity /State/ZIP: 1 _ ei'i~Xee. i e...._ p/rI6 Industrial plant (I hr min) 78.18/
I' one: �.3 J � 4 ' , m Inspection for which no fee is
-oa��J �: ��� ��, � � � s : ifieslly listed 44 hr min) �u. 90.00/
lectrlelll L A - i ,"41' "���+�. 5 rrs i`r )-.....,•y!7r43 7:. ysr.�. ,l l4 r
ic., �le (pe. rv. Lic.:�O 4, 6j s"�l t n., -'= 1 l '>c" Lic.:
uprv. Electrician signature, req . {
Subtotal: 1 , p a
5 4Y` Plan review (25% of permit fee):
I' int [tame: A � 0 h ..6 0 n
!Dale: I d ti "1 J/ (� Jj �� state sus charge (12% of permit fee): rl g, 5
I 1 TOTAL PERMIT FEE: ICI ,
uthorized signature:
This permit app s ccatloa expires Ira permit is not obtained within 180
day s after It has bees a us mmplete.
I' riot name: ,Date: • Number of inspections allowed per permit.
t.x it s. " ,i.. l , 4 . P + : ' � a n . : P R ?ft .�k'i .14 . ": ; '( t ;:
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