Permit CITY OF TIGARD ELECTRICAL PERMIT
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a • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00474
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/09/2012
Parcel: 2S 111 CC20000
Jurisdiction: Tigard
Site address: 10255 SW GREENLEAF TER
Project: Muller Subdivision: SUMMERFIELD NO.5 Lot: 259
Project Description: (1) circuit branch and (1) 200 amps or less for panel change and to connect water heater
Contractor: TEAM ELECTRIC Owner: MULLER, REGIS R & NEOMI JEAN
9400 SE CLACKAMAS RD. 10255 SW GREENLEAF TER
CLACKAMAS, OR 97015 TIGARD, OR 97224
PHONE: 503 - 557 -7180 PHONE:
FAX: 503 - 557 -8201
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 08/09/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 08/09/2012 $12.97
Type of Use: SF Electrical
Class of Work: ALT 1 crt Branch Circuits w /Purchase 08/09/2012 $7.42
Service or Feeder
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 5 -001 -0 0. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. l I
Issued By: Permittee Signature: Oki 14 -PPL' 6A - r
•
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.
08 - 08 - 12 ;16:10 ; Team Electric ;503. 557. 8201 # 1/ 2
Electrical Permit Application RECEIVE '
FOR OFFICE K i. 1 tiE U\1.1
City of Tigard AUG 8 2 01' Received • R 2/ � PcrmitN /I..# >O /a - 00
tY g P. U Date/B .
13125 SW Hall Blvd., Tigard, OR 97223
C Phone: 503.718.2439 Fax: 503.598.1960 n h . Other Permit:
- r I G .n R e� Inspection Line: 503.639.4175 C l Z L "� 1 art b � ' . : BI See Page 2 for
Internet: www.tigard-or.gov BUILDING D1VIS Supplemental Information
TYPE OF WORK PLAN REVIEW
❑ New construction ® Addition/alteration/replacement Please check all that apply (submit 2 sets of plans w /items checked below):
❑ Demolition El Other: ❑ Service or feeder 400 amps or more ❑ Building over three stories.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION - c'rPMs 10,000 amps at 150 volts or ❑ Floating buildings.
less to ground, or exceeds 14,000 ❑ Commercial -use agricultural
® 1- 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 ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A ", "E", "l -2 ", "1 -3 ",
Job no.: 6123 Job site address: 10255 SW Grenleaf Terrace IOO11P or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City/State/ZIP: Tigard Or 97224 ❑ Health -care facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldgJapt. no.: Project name: Muller ❑ Service or feeder 600 amps or more.
FEE SCHEDULE
Cross street/directions to job site:
Description I Oh• ) Fee. I Total I
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 168.54 4
Tax map /parcel no.: Ea. midi 500 sq. ft. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi- family
75.00 2
Panel change and connect water heater residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less l 100.70 100.70 2
❑ PROPERTY OWNER I ❑ TENANT 201 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 552.26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) I Fax: ( ) 200 amps or less 5936 1
201 amps to 400 amps 125.08 2
Owner installation: This installation is being made on property that I own which is not
401 amps to 599 amps 168.54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits — new, alteration, or extension, per3anel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, 1 7 42 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
Contact name: branch circuit 56.18 2
Each add't branch circuit 7.42 2
Address: 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
Pump or irrigation circle 67.84 - 2
E -mail:
CONTRACTOR Signor outline lighting 67.84 2
Signal circuit(s) or limited -energy
Business name: Team Electric Company panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 9400 SE Clackamas Rd Additional inspection (1 hr min) 6625/ hr
City/State/ZIP: Clackamas or. 97015 Investigation (1 hr min) 6625/ hr
L Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 557 - 7180 � 3 - k 1 i. I1'T Fax: (503) 557 - 8201 Inspections for which no fee is 90.00/ hr
Q i specifically listed (6 hr min)
CCB Lie.: 172043 11 Electrical Lie.: 3 -225C Suprv. Lic.: 4416S ELECTRICAL PERMIT FEES
Ili t kil Z � Subtotal: 108.12
Suprv. Electrician signature, required: i'r/6�e Plan review (25% of permit fee):
Print name: Michael Trusheim Date: 8/8/12 State surcharge (12 %ofpemiit fee): 12.97
74 J n�� TOTAL PERMIT FEE: 12
Authorized signature:,/ This permit application expires if a permit t is not obtained within
180
Print name: Michael Trusheim Date: 8/8/12 days after It has been accepted as complete.
• Number of inspections allowed per permit.
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