Permit CITY OF TIGARD ELECTRICAL PERMIT
• COMMUNITY DEVELOPMENT Permit #: ELC2012 -00379
T [GA R. C7 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 06/25/2012
Parcel: 1 S 135CA00301
Jurisdiction: Tigard
Site address: 9645 SW NORTH DAKOTA ST
Project: Ericksen Subdivision: MEADOW VIEW Lot: 8
Project Description: (1) branch circuit and (1) 200 amps or less for garage
Contractor: WEST SIDE ELECTRIC CO INC Owner: ERICKSEN, GLENN
1834 SE 8TH AVE 9645 SW NORTH DAKOTA ST
PORTLAND, OR 97214 TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 06/25/2012 $100.70
Specifics: amps or less
1 crt Branch Circuits w /Purchase 06/25/2012 $7.42
Type of Use: SF Service or Feeder
Class of Work: DEM 1 ea 12% State Surcharge - 06/25/2012 $12.97
Electrical
Type of Const:
Occupancy Grp:
Total $121.09
Required Items and Reports (Conditions)
•
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952- 001 -0010 through OAR 9 , 00 A 1- 0000090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. 14-17
.23 44.
Issued By: _A ^`.l /1 e Permittee Signature: V t 1
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent.
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' Date:
LICENSE NO.
Call 503.639.4175 by 7:00 a.m. for the next available Inspection date.
This permit card shall be kept In a conspicuous place on the job site until completion of the project.
Approved plans are required on the Job site at the time of each inspection.
2012 -06 -21 11:48 WEST SIDE ELECTRIC 15037360677 » 5035981960 P 2/2
Electrical Permit Annlicatio J � t c i u l I III. t `l . i 1 .
gi
City of Tigard
��'"� � D rr I it No.: (�L� ' a O /� QC� 37
13125 SW Hall Blvd, Tigard, OR 9722 Plan Review
Phone: 503.639.4171 Fax: 503.598. � 1 N 2 2012 b> Other Permit:
Inspection Line: 503.639.4175 Data Ready/ay I �1 68 bas Pap 2 for
Internet: www.tigard- or.gov a QG' �. s s ' Notified/Method: y/
Supplemental lnfwmatmn .
1. `!� �'i ;f d.R.r�'l�s rv. -r. �..�. - ,p. r .ri •�'� A .. 5: .r -. �.-mqu Y . r,; M. - •J.r
"�is...,P'''S�. �°'r ''n.2"f 'r� rte+ 'i, 71:WiAXI �.ti . vF. 'SI. i...Zi ^'* ti Fa�i1T._iQ i+ " ^ `w.'. ?��e.,.,R: {:
• ,. � i...��'.C..1�,'1. +1µb>� ::' ":.• ,.:'.' :. ..... i F � .., �•�..r...t. .$'��.r o.e�- +r.•cw.o....i. .. a •.- ..'C� .
❑ New construction I� Addition/alteration/replacement t v v • Please check all that apply (submit a ens of plane writuns checked below):
❑ Demolition `] Other: 0 Service or feeder 400 amps or more 0 Building over three stories.
, ' . where the available fault current D Marinas and boatyards,
',..14474141.i. 1�..f f' :t _'' •.-r g . - - _....,... ,. Y .: :'� 1 � '''t ' r exceeds 10,000 amps at 15 le or 0 Floating boa :., r;, •. ;:: >. • .•:. teas eo g rpamd, u caeaeda 00 ❑ dings. r oar ; ��
FS 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building .trips for all outer installations. buildings.
❑ Multi - family ❑ Master builder ❑ Other: D Fire pump. O Installation of75 KVA or
�} a n h v nm,,Tp y �.�!gr�u.C� Ai .-_' • w '�"' . . 'r aa s ^ . � • . , , i . ❑ Emergency system, larger i�dy derived system.
1a
Xa't "y. i ixa i >. -... .. ' 7...s .37' -� +t,.a: -.iii -a�' DAdditionofaewmoeorload ❑ ^,"E", 1.2',-L3",
( / ..- ' 100HP or more. occupaaa y.
Job no.: . 3 — E7 7 $ I Job site s: S 3 r, TA �jL
D $Ix or teat: residential lmltr. ❑ Retaeaniaaal rellide Peres
City/State/ZIP: r;t y er oci Q 7 2 Z.7 D H azardo ar ue locations. facilities. O Supply voltage for more than
❑ Harardo 600 volts nominal.
L
Suite/bldgJapt no.: Project name: Ran / a / f rk 66,,,/ D Service or tb two amps or more.
street/directions ' "� a 4 ;` ;. '$~� .
Cross to job site: ~ tom r oe. r 1 . a I •
New residential single- or molt- family dwelling unit
Includes attached garage.
Subdivision: i Lot no,; 1,000 sq. ft or less I 168.54 4
Es add'1500 sq. ft or portion 33.92 1
Tax map/parcel no Limited energy, residential
i 1 �v7- - 7CF" � �,,' 2:.f •'S ' :- ,}, r a ,pp y e c (with above sq. R) 75.00 2
Limited clergy, muin family 75.00 2
e'f f' , ' 4/.2. 1 (Ire tr a residential (with above sq. R.)
Services or feeders Installadokalteration, And/or relocation
200 amps or lass j 100.70 1D0 II 2
—', :� f- ,••.,.Vv'O 201 amps to 400a14ps 13356 2
401 amps to 600 amps 20034 2
Name:
601 amps to 1,000 amps 301,04 2
Address: Over 1,000 amps or volts 55226' 2
Temporary services or feeders installation, alteration, sod/or
City/Ststt 21P: relocation
Phone: ( ) I 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 m 40D amps 1 2518 2
intended for sale, lease, rem, or exchange, according to ORS 447, 449, 670, and 701. 401 amps W 599 amps 168 .54 2
Branch circuits - new, alteration, or extension. par Panel
Owner signature: Date: A, Pee for blanch circuits with
v ` t v -, . ., �ti . "a(j�s f . x?.'? ,. • •.r . / 7.42 7 r 2
re )7- . lx ''E : w •. „ 1. , St ies : eadhbrand+ circuit r above service or feeder fee,
Business name: , d. Fee for branch circuit' without
service or feeder fee, first 56.18 2
Contact name: h.anrh circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included) _
C' /SffieIL1P: Each maaufeCtured Or modular 67.84 2
City/State/ZIP: dwelling, service and/or feeder
Phone: ( ) I Fax: ; ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail Sign or outline lighting 67.84 2
,'. '. i ,4:.7P . - gy m 7 4,t7•a.:7, (��'n t .�,' ! 7'' 5XX � r - .. Signal cirurit(s) or limited energy I
pa ch a ddi t io nalins te ct i on Paget 2
Business name; West Side Electric Co. , Inc.
Each additional inspection over allowable in any of the above
Address: 1834 SE 8th Ave. Additional inspeaxion (1 hr mire) 6625/ hr
City/State/ZIP: Portland /OR/97214 industrial plant (1 78.18/ hr
industrial plant (1 hr min) 78.187 hr
Phone: (503) 231 -1548 I Fax: (503) 736 -0677 Inspections for which no fee is 90.00/ la
listed % hr min
' B Lie.: 13306 f lccbical Lic.: 26-135C ;ON. Lic.: 4654 - S " `y " ;` . ='' . { ` • " ,
Suprv. Electrician signature. required Subtotal: l� / - ` —
J Plan review (25% of permit fee):
Print name; Randall F Roberts Date: 6 2/ /Z s� sur charge (12% of permit fee): / 47
TOTAL PERMIT FEE: / L 1 p "
Authorized signature: This permit spoliation expires if. permit b not obie1Md within MO
days after it has hem accepted as complete.
Print name: Date: i • Nambexoroaeaeaiom allowed per pmmit.
F aildin 1P,r itaar•PaaatitASadoc 07701/10 440.461 sat hosioOWWID
•