Permit a CITY OF TIGARD ELECTRICAL PERMIT
`` . 2 • COMMUNITY DEVELOPMENT Permit#: ELC2012 00497
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 08/23/2012
Parcel: 1 S 125DC08400
Jurisdiction: Tigard
Site address: 7120 SW ASH CREEK CT
Project: Nagy Subdivision: ASH CREEK ESTATES Lot: 17
Project Description: (1) branch circuit
Contractor: BOB'S ELECTRIC Owner: NAGY, BRENT J & KRIS
2700 NE BURTON ROAD STE A 7120 SW ASH CREEK CT
VANCOUVER, WA 98662 TIGARD, OR 97223
PHONE: 360- 254 -7200 PHONE: 971- 242 9836
FAX: 360- 254 -8219
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 08/23/2012 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 08/23/2012 $6.74
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $62.92
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 may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 987 or 1.800.3
Issued By: Permittee Signature: oN APPu (All 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.
FROM (THU)AUO 23 2012 3:37/ST. 3: 36 /No. 9302925013 P 2
S �
Electrical Permit A s t hca s 1 _. ,, l (iK OI I.I( l: l tit: 11\1.1
Received
City of Tigard Permit No.:
�' g g11G 2 2 2012 Da
. g D. 1. �[�sOl��tao�F4
• 13125 SW Hall Blvd., Tigard, OR 97 C 20« - .
1 1 W
I Phone: 503.639.4171 Fax: 503 , .,, ; Other Permit: �
T Inspection Line: 503.639.4175 T ® Date Ready/By: 'Luis: ® See.Page 2 for
Interne www tigard -0r gov !'«{ Notified/Method: Supplemc.tal Information
°' 1 t 1 t l x
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r A ` ,, T la ! ;,-!: ' ._ ' r , `d,.qy` . ,e i , 2 -
4 _ f 1c..t , d -,- `;.mot:^ t il,.. , emsu. ,;�.:_,_1 .. ., axa.�st..,.w <.�,.,7,,. �,, , . _ . _o . i. _s l .,Y .t, ....#'s
El New construction n Addition /alteration/replacement Pksse check all that apply (submit isets ofplam w/itet checked below):
['Service or feeder 400 amps or more CI Building over three stories.
El Demolition ❑ Other: where the available fault current ❑ Marinas and boatyards.
� ,y- t i . , 3. i �i , i n c , , 3.1 Y - u 2 r exceeds 10,000 amps at 150 volts or floating buildings
- r2. -� ' .,, .�,' .2n _.,_; , , . s:+� :,>w.J. u , m_ ;..r. n�.... , .,ter. ,.3 .....,.i ,,� - r, . ,... _,. less to ground, or exceeds 14,000 ❑ Comercial -use agricultural
® 1- and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other installations. buildin
❑ Multi- family ❑ Master builder ❑ Other _ pump. ❑ Installation of 75 KVA or
� a >st� a l ❑ Emergency system. larger separately derived system.
- 4-.. , , } § 4 t '� • ■ .- ` " 0, ❑ Addition of new nssror • l o f ❑ "A , „F., .1-2.,,"1-3",
Job no.: Job site address: 100HP or more a ecupa,xy.
12 - 9".5 7190 cla AQh ('.rrapk f:t- ❑Six or more residential units
. ❑ Recreational vehicle parks.
City/State/ZIP: /$tate/ZIP: ❑ Health -care facilities. ❑ Supply voltage for more than
ty Tigard OR 97223
❑ Hazardous locations. 600 wits nominal.
Suite/bldg. /apt. no.: 7 Project name: ❑Service or feeder 600 amps or emee
t� .�-... ; � } a. .., ; ..,,�.C., g z ui li•y '3 si
Cross street/directions to job site: onatptlon Qty. Fee � Total .
New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: I Lot no.: 1,000 sq. ft. or less 168.54 4
Ea. add'1500 sq. ft. or portion 33.92 1
Tax map/parcel no.:
Li energy, re s ide n tial
t # -, y a . H .�n 4 s . y "' 67.84 2
. ` . � F U N 1- � a ,r. '_ ..i. z 4:-. S M,k1 v , s .4. .F.- > . :.,_..ua,_.7 Limited energy, . tin
- fam
Limited emergy, multi 67.84 2
residential (with above sq. ft.)
1 - 40 amp Cir. Services or feeders installatlon,alteration, and/or relocation
200 amps or less 100.70 2
st vi s t F s° ,. 2� s t rr rs c J i m
y; , 4 x 20l amps to 400 amps 13356 2
�i rvsd�. w, ash.. r, -. .,r ,4. ....7,V,. -.;.. E44A.- _.�.• 7,1_ :: ,, .. ...,.. . err _ -
40I amps to 600 amps 200.34 2
Name: Brent & Kris Nagy 601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
7120 GW Ash Creek Cr
City /State/ZIP: Tigard OR 97223 re on services or feeders installation, alteration, and/or
Phone: ( ) I 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 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, per panel
Owner signature: Date: A. Fee for branch circuits with
a nn ,1 sik. v ' Ts ,r , • _ z , t r s ' y , a b o ve service or feeder f
x 7.42 2
> ?�� �: ,.;ssr ;.",; ' " ¢ S - ..�.rw ' :�. ? ^.. .�i; 4 .A�. :_..:, . ,. ..-. W i ._ .._ each branch circuit
Business name: B. Fee for branch circuits w
service or feeder fee, first
Contact name: branch circuit 1 56.18 56.18 2
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
or modular
City/State/ZIP: dwelling, u service and/or feeder 67.84 2
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail: }C (q Sign or outline lighting 67.84 2
` i, ..�._� - . ._., A L,-., .._ mot, :u.■.4 . t ``)., r.., -. ,, M.. r_ ,._r_. _,_s.} Signal circuit(s) orlimitedtner@y
Business name: t panel, alterat or extens Page 2 2
Bob s Electric Each additional inspection over allowable in any of the above
Address: 2700 NE Burton Rd., Ste. A Additional inspection (1 hr min) 66.25 /h
City/State/ZIP: Investigation (I hr min) 66.25/hr
Vancouver. WA 98662 Industrial plant (lhrmin) 78.18/hr
Phone: ( 360 ) 254 - 7200 Fax:( 360 )254 - 8219 Inspections for which no fee is 90.00 /hr
ificall lister{ z hr min
CCB Lic.: 53136 Electrical Lic.: 37 - IC Suprv. Lic.: 4322S --b - `� -; `' ` ` '
Suprv. Electrician signature, required:.
Plan review (25% o
� J o Subtotal: 56.18
/o f permit fee):
Print name: Kevin Broselle Date: 8/21/12 State surcharge (12% of permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: 67 99 ../
Tbls permit application expires If a permit is not obtained within 180
Print name: Date: days after It has been accepted as complete.
• Number of inspections allowed per permit.
t:' tButdin g \Pamits\ELC- PetmitApp.doc la/01109 440- 46157(t1105/COMIWEB