Permit CITY OF TIGARD ELECTRICAL PERMIT
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A Permit #: ELC2012 -00609
COMMUNITY DEVELOPMENT
• ' •n. ;3 Date Issued: 10/25/2012
1GARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 parcel: 1S133DC07000
Jurisdiction: Tigard
Site address: 13295 SW SHORE DR
Project: Orozco Subdivision: WINTER LAKE Lot: 1
Project Description: (1) 200 amp panel
Contractor: OAKLEY ELECTRIC INC Owner: OROZCO, ALVINO & JEANNE M
12042 SE SUNNYSIDE ROAD, SUITE 500 13295 SW SHORE DR
CLACKAMAS, OR 97015 TIGARD, OR 97223
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PHONE:
PHONE: 503 - 855 -4719
FAX: 503 - 908 -1729
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 10/25/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 10/25/2012 $12.08
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Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
Required Items and Reports (Conditions)
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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 • 2 -'90. Y. • may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. ^/
Issued By: ■ / ,/_l -� / Permittee Signature: e� /G' I
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 603.639.4176 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.
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Electrical Permit Appticatio IECEIVED FOR OFFICE USE ONLI
City of Tigard Received
T 2 2 01 2 Date/: : /0 2s ,fur Permit N o �o/ -io6 0
17125 SW Hall Blvd., Tigard, OR 9722:94_ r 4 Plan Review
Phone: 503.639.4171 Fax: 503.598.19 D .: Other Permit:
TI G AR D
Inspection Line: 503.639.4175 (� • D� Date Ready/By: �yr/�/ 0 Sec Page 2 for
Internet: www.tigard or.gov CITY OFTIGARD Notified/Method: ! t'� Supplemental Information
TYP 0PU11AING DIVISION PLAN ,REVIEW
❑ New construct ion _2-Addition/alteration/replacement Please check all that apply (submit 2 sets of pkms wfiaems checked below):
0 Snivicc or feeder 400 amps or more 0 Building over three clones.
❑ Demolition ❑Otter.
where the available fault current ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 oohs or ❑ Floating buildings.
EL 1 - and 2 dwelling ❑ Commercial/industrial less 10 ground, or exceeds 14,000 ❑ Commercial -use agricultural
❑Accessorybuilding ( amps for all other installations. buildings.
❑ Multi- family 0 Master builder ❑ Other: ❑ Fife pump. ❑ lastallation of75 KVA or
JOB SITE INFORMATION AND LOCATION ❑ Emergency system larger separately derived s}stetr>
❑ Addition of new rotor load of ❑ ••A ", "E" "1 -2 ", "I -3 ",
Job no.: I Job site address: 13,255 5 i-; Or rt � i 1 001 P or more. occupancy.
O Six or more residential mtits. ❑ Recreational vehicle parka.
City/State/ZIP: 7 ' / ❑Health -care facilities. ❑ Supply voltage for more than
/ F. �.
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El Hazardous locations. 600 volts nominal.
Suite/bldg. /apt, no.: Project name: O/e 0 Z ❑Sctvice orfeeder600ampsormorn
FEE SCHEDULE
Cross street/directions to job site:
Description I Qty. I Pee. I Tong I •
New residential single- or multi- family dwelling unit.
PGl"r -( Includes attached garage.
Subdivision: Lot no.: 1,000 sq. ft. or less 163.54 1 4
Ea. add'I 500 sq. ft. or portion 33.92 I 1
Tax mapiparcel no.: Limited energy, residential
DESCRIPTION OF WORK (with above sq. R.) 75.00 2
Limited energy, multi- family 75.00 2
t ( residential (with above sq. fl.)
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 1 C C 2
0 PROPERTY OWNER I ❑ TENANT 201 amps to 400 amps 133.56 2
/� O 401 amps to 600 amps 200.34 2
„
Name: 601 amps to 1,000 amps 301.04 2
Address: 5 4 Over 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 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 168.54 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
A. Fee for branch circuits with
❑ APPLICANT I ❑ CONTACT PERSON above service or feeder fee, i 7.42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first
56.18 2
Contact name: branch circuit
Each add'l blanch circuit I 7.42 2
Address: i Miscellaneous (service or feeder not included)
Each manufactured or modular
City/State/ZI duelling service and/or feeder 1 67.84 2
Phone: ( ) Fax: : ( ) Reconnect only 1 67.84 2
E - mail:
Pump or irrigation circle i 67.84 2
Sign or outline lighting I 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
Business name: T ; _T L'� i =-uc c � .
panel, alteration, or exto tuitm. I Page 2 __ 2
1 Each additional inspection over allowable in any of the above
Address: r2 a, it,s. S S. .,)t'rp, ', e d r. iei ,ac• . S,-. j L, Additional inspeciom (1 hr min) 1 6625/ hr
CICV /StaCe/Z1P , ti �+ _ Investigation (1 hr min) I 6625/ hr
I C...(h _c.. c. I 01 7 Industrial plant (1 hr min) 78.1B/hr
,) Fax: (`.�' ) , -. > - % %? Inspections for tvhlr h no fee is hr
specifically listed (V hr min)
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CB Lic.: / ��,� S / ;� Electrical Lic.: L t' J J Suprv. Lic.: 5 / 76$
ELECTRICAL PERMIT FEES
Suprv. Electrician signature, required: ; '" -°- Subtotal: /
T Plan review (25% of permit fee):
Print name: • 7- -', / r I Date: State surcharge (12% of permit fee): /.. ‘5%
TOTAL a perm FEE: /
Authorized signature: tats
� —� 'rh;, ermita
� � p application expires if a permit is not ob eel within 180
Print name: F ' / /// I Dale' days after it her been accepted as complete. 7e
� �� , / I S'tti; ✓ • Number of inspect
al l owe d per perm
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L'd 6ZL 1 0 1 3 1oe13 Aeple0 0 09:01, Z L . 17Z 100