Permit CITY OF TIGARD ELECTRICAL PERMIT
s' COMMUNITY DEVELOPMENT Permit #: ELC2012 -00551
T F G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 09/24/2012
Parcel: 1S125DD09701
Jurisdiction: Tigard
Site address: 9620 SW VENTURA CT
Project: Stinnett Subdivision:VASHINGTON SQUARE ESTATES NO. Lot: 105
Project Description: (3) branch circuits to insstall
Contractor: MILESTONE ELECTRIC Owner: STINNETT, BILL E AND
1281 NE 25TH AVE, STE. T MELBA D
HILLSBORO, OR 97124 9620 SW VENTURA CT
TIGARD, OR 97223
PHONE: 503 - 645 -5323 PHONE:
FAX: 503 -690 -4843
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 09/24/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 09/24/2012 $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 '! i t ay obtain a copy of the rules or direct questions to OUNC by calling 50 or 1.800.332.2344.
Issued By: j f . th l Permittee Signature: o'A ( Li T'f r l 4.0&L
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 503.839.4175 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.
Electrical Permit Application FOlt OFFICE U$1 oNLy
City of Tigard tf;s: ,., Received
Datway; 9 .). i S:r Permit No.: 6 - Le. AD/ .2. 0 0 g.s7
..
,. , 13125 SW Hall Blvd., Tigard, fi t Plan Review
N
PI _,... ''' w - 11 0
1; Phone: 503.718.2439 Fax: 5 3.598196 0f '4- Date/By: Other Pennit:
I I C A RD Inspection Line: 503.639.4175 Data Ready/By: luris: 0 See Pa& 2 for
Internet: www.tigard SEP 2 4 2W2 Notified/Method 11 Co Supplemental Information
.. .....„ . •
• • • . . •• • • . • .
••••:.'.•:':'• . • .'.,.....•..- ,. - ....., -.:•-•::, • ...f.' TYP. ....., ,.. :,.....,-. ,'..,-. 'f '": .,-.:-.-,•••,-•• .::.k ....; grmyvo
•,, 1 1 .. • . i f 4 .
0 New construction tg4 AdditRiPpqrairOWOL Please check all ibat apply (submit 2 seta of plans w/items oheoked below):
- ..• -....',.. i' • / C,,,"1 0 Service or feeder 400 =pa or more CI Building over three stories.
0 Demolition 0 Other: • ' ' "!, • where the available fault current 0 Marinas and boatyards,
•.. ... . . .• .: , . ... . ... ;:'..."....' 'CATEGORY OF CO .
CONSTRUCTION •., - - ........-, •.' exceeds 10.000 amps at 150 volts or 0 Floating buildings.
.
- • — ' - less to ground, or exceeds 14.000 0 Commercial agriculnual
A 1- and 2-family dwelling 0 Commerciallindustrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Fire pump. 0 Installation of 75 KVA or
4 . • — 0 Emergency system. larger separately derived system,
•••• . ... •• .'• '• , JOB.: SITE INFORMATION AND LOCATION. ' • ,• ..- :',.: ..'? :.:::::,.. • ..
. . . 0 Addition of new motor load of 0 "A", "E", "1-2", "1-3",
10010 Or more. occupancy.
lob no.: i4 -714 lob siteaddri
0 Six or more residential units. ['Recreational vehicle parka.
City/State/ZIP: --- CZ , .. 504 ...a _R 9 -704D.- DHealth.care facilities. 0 Supply voltage for more than
0 Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: S.-1.1 fv ylif ?e51'cIQ_ykLe_, 0 Service Or feeder 600 amps or more.
FEE SCHEDULE r r: -: ':... : • i.:.:. ::":-:••;-• ',: :
Cross street/directions to job site: netedidion I Ow. f Fee. I Total I •
New residential single- or multi-family dwelling unit.
Inclades attached garage.
Subdivision: Lot no.: 1.000 sq, ft, or less 168.54 4
- Ea, add'l 500 sq. 6 or portion 33.92 1
Tax map/parcel no.:
Limited energy, residential
. ' ..-; ..- ...:.. '.• .... •-• DIT.--wtok.-ogiiiioikk (with above sq. ft) 75.00 2
Limited energy, multi-family
' 71-ASkelik i - 7 C415 j■,fsW-,C Ci VIT.ce.eicide, c‘Aa _ C, I ') residential (with above sq. ft,)
75.00 2
Services or feeders installation, alteration, and/or relocation
I 11410,_____________ 200 amps or less 100.70 2
. .
I I'R 9$ , : •: • P 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 Volta 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 125.08 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 599 amps
Branch circuits — new, alterati 168.54 2
on, or extension, per panel
Owner signature: . Date: A. Fee for branch circuits with
..I...... . '.:', ...;,.:.. • ......:. :. • I .‘ ,•..• -...... 0 . eoi■rfAct pitisoN:'::,....1....:.:'. above service or feeder fee.
7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee. first I SC. ig 2
563 8
Contact name: branch circuit
Each add'l branch circuit a, 7.42 L'-b1 2
—
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZIP: dwelling, service and/or feeder 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E-mail:
Sign or outline lighting 67.84 2
*'::‘,.,..:;').::::: COlirTILAC.TOR-:::.:..7:: 'f.':f'n7V Sign' al circuit(s) cuit(s) or limited
usiness name: Milestone Electric panel, alteration, or extension. Pace 2 2
B
• ., Each additional inspection over allowable in any of the above
Address: 1281 NE 25th Ave. Suite T Additional inspection (1 hr min) 66.25/ hr ...,
Investigation (1 hr min) 66,25/ hr
City/State/ZIP: Hillsboro, OR 97124
Industrial plant (1 hr min) 78.18/ hr
Phone: (503) 645-5323 Fax: (503) 690-4843 Lispecrions for which no fee is
90,00/ hr
specifically listed CA hr min)
CCB Lie.: 153480 Electrical Lic.: 34-618C • Suprv, Lie.: 5 ; ‘ z 3 5 'It!k944-711'ELECTRItA.V PERMIT': FEE$'::...I.!,
..,
Subtotal: -7 i 0 9,
Suprv. Electrician signature, required:
• e ,./..----, Pan review (25% of permit fee):
Print name: 6 , :' , 9‘,../_ . 5 Date: ,/,/// a __ State surcharge (12% of permit fee): 8, s ... .
TOTAL PERtvliT FEE: - 7 9 , 5 zi
Authorized signature:
This permit application expires it a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • Number of inspections allowed per permit.
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