Permit CITY OF TIGARD ELECTRICAL PERMIT
III s COMMUNITY DEVELOPMENT Permit #: ELC2012 -00589
Date Issued: 10/11/2012
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S103AC04000
Jurisdiction: Tigard
Site address: 12590 SW 114TH TER
Project: Burns Subdivision: WALNUT GROVE Lot: 9
Project Description: (3) branch circuits for bathroom remodel
Contractor: PRECISION NW ELECTRICAL Owner: BURNS FAMILY TRUST
12020 SE ANNA CT 12590 SW 114TH TER
DAMASCUS, OR 97009 TIGARD, OR 97223
PHONE: 503 - 413 -9870 PHONE:
FAX 503 - 594 -2873
FEES
Quantity Description Date Amount
3 crt Branch Circuits wo /Purchase 10/11/2012 $71.02
Specifics: Service or Feeder
1 ea 12% State Surcharge - 10/11/2012 $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 952-001-0090 You ay may obtain a copy of the rules or direct questions to OUNC by calling 503.2 1987 orr 800.332 2344
Issued By: , I C """ ` — ""_' a Permittee Signature: AC i i La/C ►7"/ /D/ .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.
10/10/2012 00:18 FAX 5035942873 PRECISION NW l002/002
Electrical Permit Applicatio ECEIVE r( („ 1 sl. O\I.1
City of Tigard Received
q Date/n to 1(y Sf Perrot No. Ce bra- cbs811
13125 SW Hall Blvd., Tigard. OR 97223 OCT 1 0 2012 Plan Review
' , • Phone: 503.718.2439 Fax: 503.598.1960 D ; Otter Permit:
1 I :: ,\ t:'l :, Inspection Line: 503.639.4175 ()FIORD rat Ready/By: 1 ®
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❑ New construction I Addition/alteration/replacement pie= check all that apply (submit j, sue of plans w/nema checked below):
❑ Demolition (}Ih ❑ Service or feeder 400 amps or more ❑ Building over three stories. .
� ; l Ins { t y r rr ;? , m 8 nv ti », , `{yy wberc the available Fault cwrent ❑ Marinas and boatyards.
I IIW ilIb 1111; . w �r �J1!soNi•.,itv tv ai ,u 1 t �+s r i +.,� _T• ' �.... ,n 1t1 t1n( "I''.1.1.'1''' :: 1i 4 r {{11J{Jkl(�`l mweeds 10,000 =Ps at 130 wits or ❑ Floating buildings
. :,.'it Il -'r„ less to ground, or exceeds 14,000 ID Cummectal - use agricultural
`q 1- and 2 - family dwelling ❑ Commercial /industrial El Accessory building amps for all other installation buldiug.i.
❑ Multi-family ❑ Master builder ❑ Other Fire pump. ❑ Installation of 75 KVA UT
W l4 I 1 !' a }104'1 ' /at! ss T , •t 1711 ,
„i. ll�, , ,i Wt. ` + 1 ' { I r t l 1 f s ) 4 + . t r + ` I t, fl ❑ Addition o new motor "A".' ', "I-2", derived system,
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Job no.: Job site address: I t 5c1 0 SW 1l4so^. - e.4,✓A tootle or more oecwwmcy.
❑ Six or more rearaential units. ❑ Recreational vclucle parks.
City /Statc/ZIP: 't'l .p 8 CIL 4 ) U e) a ❑Healthcare facilities. ❑ Supply vottagc for more than
� • ❑ tlaffidotu locations 600 volts nominal.
Suite/bldg./apt. no.: Project name: Q 1' �7�.►
— vv.) $ In Service or fender 600 amps or more.
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Cross $treC1/dlleCt10n5 to job site: Dacritrtton Qb. Vs.. Total •
New residential :tingle- or multl-family dwelling unit.
Includes attached garage. _
Subdivision: Lot no.: 1,000 sq R. or less 168.54 4
Tax m / - La. add'I 500 sq. R. or portion 33.92 1
` d ap parcel no . ,
j (,i ," iJ'� i ' r�� � i ` f �" ti c I n l t 1 ! I Limited energy. al
`gg++ }}�� 44��� ( Lt mrt rgy residential
75,00 2
:14,.... .c 6 :: , � '.J f�1c:. 6.1w ' , r' ..d •,,, ,,ir., l,Mlft:Ii.,s U,„cti I ti,',.1 • i s + , 1 II 1 d 1 1. 1' (nth „ bow sq. ft.)
" „ L energy, must - }artily
a boN/ 14 ` h residential (with above sq. ft.) 7500 2
_ Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
�.: �}�p1M 'ri Ol'�, 1 n TOIf �� iwU, ry 1� „ ti r ,
jlP$±ifG�it�y!'1�1 r 1 ,< )', , ti i I , " I 7, I Iii i I 1 0 Y , '1)1},s,,:,:6; i ,. rJ ; Ill 1 filar i r : .q, t' 1 201 amps to 400 amps 133.56 2
I i...iJi•st ... :,,S,. _i t, r ...inif t ..i':.1 '��.�Id4.r, :. ..:.:x. .:.11 : ::. L, 1 Lf 1 r:
Name: 401 amps to 600 amps 200,34 2
601 amps to 1,000 amps 301 04 2
Address: Ova 1,000 amps or volts 552 26 2
City/State/ZIP: Temporary services or feeders installation, alteration, and/or
relocation
Phone: ( ) Fax: ( ) 200 amps or leas 59.36 F 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
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. °Q 168.54 2
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for brunch circuits with
1 44 ;�� ti� ; ;F) CL'r " KW � ,f t{ l i} l` j 1 3., �Itl l I 1 r` i.1 t 1,1 1 1 1 ,I . ' [ i t '' k above service or feeder fee.
f :!. r11` `I c....,,rt11,1u, hn.7',1.∎1 4 .!..;Fi iu i..dlit. . cuttjIl di i__'i �' i ^ each breach circ _
,.,,, � ,.+!. ,..ni! + ±... _..!;�..J 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first l 56.18 5( jig 2
Contact name: branch circuit
Each add'I branch circuit 2 7.42 I4rQ4 2
A ss; Miscellaneous (service or feeder not included)
Each manufactured or modular
City /Slate/ZIP: dwelling, service and/or feeder 67,84 2
Phone: ( ) Fax: ; ( ) Reconnect only 67.84 2
E or irrigation circle 67 84 2
r i,l u �Y1C) t 4f rr, �p� a'/ r r � pis ) (1 » t�'� ++ (t( vl Signor outline lighting 67.84 2
, i, i .fgd101tl1r�!t!vl+gtl�:'C:tR i, JiJ' liE�1, 40 ,.Ryr,IM1r. .i. �'nL� ir ;1 .. ,.. ;;' ,, .�r l. l.+.i:: � Signal cinvit(s) or limited_energy
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Business name: G i i ()NJ N \J) le V t C/ Panel, alteration or inspection Page 2 2
Each additional inspection over allowable In any of the abov
Address: 1 203 20 SE /NNW Pt c--r Additional inspection (1 hr min) 66.25/ hr
/� --
Investigation (1 hr min) 66 25/ hr
City/State/ZTP: , . L. • t_ 41 O B Industrial plant (1 hr min) 78.18 / hr
Phone; (5p3) 4-t C'1 -+ (..) Fax: (433 ) 6 C 4 - 2 81..3 inspections for which no fee is 90.00/ hr
s • - iftcall Gated 45 hr min
CCB Lic.; %(9 1 Electrical Lie.: J. q- Suprv. Lic.: (p :' : , ' hl " , r ;. :, ' !.',r,u., t lt ,.; 1 ' `, ,w. ;,�'1na ^1,,x,,1 „ i`
Subtotal: 7 I (17 (17 Supt,'. Electrician signature. required.
� A k•-'1/ Plan review (25% of permit fee):
Point name: 4 Date: 10 -. IV - I'1, State surcharge (12% of permit fec):
1.►
Authorized TOTAL PERMIT FEE: " 14 , 5
uthorized signature: ,
wrt,/t V This penult appileadon ezplres H a permit is not obtained within 18D
days after it has been accepted as mmpIete
Print name: • w `�.Ie� lA Date: I. p N
-- i0 '-- I a
i _ umber of inspections allowed per permit. ` i ce / sr
r\ Build'urg1Pmmits4ELC- PernutAppdec 07/01/10 440 not/ns /CUMAV58 J `t