Permit •
CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT • Permit #: ELC2012 -00651
T t G A.A D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/14/2012
Parcel: 1 S135DD00701
Jurisdiction: Tigard
Site address: 11740 SW WARNER AVE
Project: Nelson Subdivision: HOFFARBER TRACTS Lot: 38
Project Description: (20) branch circuits to replace service and run new home run wires AND (1) 200 amps or less
Contractor: CROWN VOLTAGE , Owner: NELSON, DAVID
609 SW EATON BLVD 11740 SW WARNER AVE
BATTLE GROUND, WA 98604 TIGARD, OR 97223
•
PHONE: 360 - 666 -0995 PHONE:
FAX: 360 - 666 =4673
FEES
Quantity Description Date Amount
20 crt Branch Circuits w /Purchase 11/14/2012 $148.40
Specifics: Service or Feeder
1 ea 12 %'State Surcharge - 11/14/2012 $29.89
Type of Use: COM Electrical
Class of Work: ALT 1 ea Services or Feeders - 200 11/14/2012 $100.70
amps or less
Type of Const:
Occupancy Grp:
Total $278.99
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 may o btain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
o
Issued By: K! Permittee Signature: I�i 4 P LIC)41,D
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.
Cali 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.
Electrical Permit Applicatio �
I hOR O FFICN USE ONLI
City of Tigard d (..t , (1 Permit No. • e- aota•�o(�5�
v 13125 SW Hall Blvd., T i g ard, O R 9722 �(� flan Review
Phone 503.718.2439 Fax: 503.598.19TiU V 1 3 2012 Datc /l3a: Other Permit:
T;IGARD' Inspection Line: 503.639 /��/ Date Ready /13y: )u ® See Page 2 for
=- - - =- 1 1'." Internet: www.tigard- or.gov w OF TG,4 Notified /Method: 1 ( Supplemental Information
T o1 fl N PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
ID New construction ® Addition /alteration /replacement
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault cuncnt ❑ Marinas and boatyards.
CATEGORY OF CONSTRUCTION exceeds 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 othct installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of75 KVA or
- ' J013 SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived system.
❑ Addition of new motor load of ❑ "A" "0" "I_� `I -3"
Job no.: C12160 Job site address: 11740 SW Warner Ave 1001 or more. occupancy.
❑ Six or more residential units. ❑ Recreational vehicle parks.
City /State /ZIP: Tigard, OR 97223 ❑ I-Ieallh -care facilities. ❑ Supply voltage for more than
❑ l lazardous locations. 600 volts nominal.
Suite /bldg. /apt. no.: Project name: ❑ service or feeder 600 amps or more.
FEE SCHEDULE
Cross street /directions to lob site: Description 1 Qt v. 1 Fee. 1 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. add'I 500 sq. fl. or portion 33.92 1
Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. l3.)
Limited energy, multi -family 75.00 2
Replace service and run new home run wires residential (with above sq. ft.)
Services or feeders installation, alteration, and /or relocation
200 amps or less I 100.70 100.70 2
®_ PROPERTY OWNER ❑ TENANT 201 amps to 400 amps 133.56 2
Name: David Nelson 401 amps to 600 amps 200.34 2
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts 552.26 2
Temporary services or feeders installation, alteration, and /or
City /Stale /LIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 59.36 I
201 amps to 400 amps 125.08 2
Owner installation: - Phis installation is being made on property that 1 own which is not
t 401 amps to 599 amps 168.54 2
intended for sale, lease. rent. or exchange, according to ORS 447. 449, 670. and 70I.
Branch circuits — new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT ® CONTACT PERSON above service or feeder Ice, 20 7 47 148.40 2
each branch circuit
Business name: Crown Voltage, Inc. 13. Fee for branch circuits withow
service or feeder fee, first 56.18 2
Contact name: Stacy branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/Z113: Lach manufactured or modular 67.84 2
y dwelling, service and /or feeder
Phone: ( ) Fax:: ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E -mail:
Sign or outline lighting 67.84 2
CONTRACTOR • Signal circuit(s) or limited - energy
Business name: Crown Voltage, Inc. panel, alteration, or extension. Page 2 2
Each additional inspection over allowable in any of the above
Address: 609 SW Eaton Blvd Additional inspection (1 hr min) 66.25/ hr
City /State /ZIP: Battle Ground WA 98604 Investigation (I hr min) 66.25/ hr
Industrial plant (I hr min) 78.18/ hr
Phone: (360) 666 -0995 Fax: (360) 666 -4673 Inspections fix which no fee is 90.00 / hr
� , i13 jiecilically listed ('V hr min)
CCB Lic.: 153934 Electrical Lie.: 37 -984C Suprv. Lic.: 5777S (D ELECTRICAL PERMIT' FEES
Subtotal: 249.10
Suprv. Electrician signature, required: o
Plan review (25% of permit fee):
Print name: Daniel Tucker Date: 11/13/12 State surcharge (12 %ofpermit fee): 29.89
TOTAL PERMIT FEE: 278.99 /-
Authorized signature:
' This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: Date: • Number of inspections allowed per permit.
1:\Building \Permits \IEI.C- PermilApp doc 07/01/10 440 - 461517 /05 /CO\I /w:it