Permit a CITY OF TIGARD ELECTRICAL PERMIT
511: • COMMUNITY DEVELOPMENT Permit #: ELC2012 00664
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 11/20/2012
Parcel: 1 S134CA00515
Jurisdiction: Tigard
Site address: 11820 SW MANZANITA ST
Project: Subdivision: PANORAMA NO.2 Lot: 27
Project Description: (1) 200 amps or less panel replacement
Contractor: HI DEF ELECTRIC Owner: DESTINY REAL ESTATE LLC
1110 NE 19TH CT BY FAIRPLAY FUNDING NW LLC
CANBY, OR 97013
•
5260 CARILLON PT
KIRKLAND, WA 98033
PHONE: 503 - 891 -2231 PHONE:
FAX: 503 - 212 -5516
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 11/20/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 11/20/2012 $12.08
Type of Use: SF Electrical
Class of Work: ALT
Type of Const:
Occupancy Grp:
Total $112.78
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 0 952- 001 -0090. You may obtain a copy of the rules or direct questions to OUNC by calling 232.19 or
1.800.332.2344.
Issued By: Permittee Signature: (
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 Ina 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 1 `I D FO OFFICE USE ONLY
of Tigard ��RR.• Datei"ed Permit No. P-0 I �—
° 13125 SW Hall Blvd., Tigard, OR 97223 ..,n.,. .1 Plan Review
C ' Phone: 503.718.2439 Fax: 503.598.1960 2 O 2 2 Date/B : Other Permit:
Inspection Line: 503.639.4175 ` A p Date Ready/By: 0 See Page 2 for
T I G A R D
Internet: www.tigard - or.gov CITY OFTIGARD Notified/Method: od: Supplemental Information
TYPE OF SIDING DIVISION PLAN REVIEW
Please check all that apply (submit 2 sets of plans w /items checked below):
❑ New construction Addition/alteration/replacement ❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition ❑ Other: where the available fault current ❑ 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
X 1 - and 2- family dwelling ❑ Commercial /industrial ❑ Accessory building amps for all other installations. buildings.
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
❑ Emergency system. larger separately derived system.
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor load of ❑ "A ", "E ", "I -2 ", "1 -3 ",
I OOHP or more. occupancy.
no.: Job site address: 1' 8 S W Ma n Z 4 n o n �4VG El Six or more residential units. ❑ Recreational vehicle parks.
❑ Health-care facilities. ❑ Supply voltage for more than
City/ State/ZIP: T9 • a r d ❑ Hazardous locations. 600 volts nominal.
❑ Service or feeder 600 amps or more.
Suite/bldg. /apt no.: � roject name: FEE SCHEDULE
Cross street/directions to job site: Description I orv. I Fee. I 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
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no.: Limited energy, residential 75.00 2
DESCRIPTION OF WORK (with above sq. ft.)
Limited energy, multi - family 75.00 2
Pa n n..J re, place n nf residential (with above sq. ft.)
Services or feeders installation, alteration, and/or relocation
200 amps or less ' 100.70 0030 2
❑ PROPERTY OWNER I ❑ 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 volts 552.26 2
Temporary services or feeders installation, alteration, and/or
City/State/ZIP: relocation
Phone: ( ) Fax: ( ) 200 amps or less 125.08 2
201 amps to 400 amps
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, p r panel
Owner signature: Date: A. Fee for branch' circuits with
above serviee or feeder fee, 7.42 2
❑ APPLICANT I 0 CONTACT PERSON each branch circuit
B. Fee for branch circuits without
Business name: service or feeder fee, first
branch circuit 56.18 2
Contact name:
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
Each manufactured or modular
67.84 2
City/State/ZIP: dwelling, service and/or feeder
Reconnect only 67 2
Phone: ( ) Fax: ( )
Pump or irrigation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
CONTRACTOR Signal circuit(s) or limited -energy
panel, alteration, or extension. Page 2 2
Business name: ��`� � QQ f � L �- Each additional inspection over allowable in any of the above
Address: 1110 NE, le } h l_ Additional inspection (1 hr min) 66.25/ hr
D / �D J 3 Investigation (1 hr min) 66.25/ hr
City/State/ZIP:CGn Industrial plant (1 hr min) 78.18 / hr
Phone: ( Sb3) gq 1 231 Fax: ( ) Inspections for which no fee is 9000/ hr
specifically listed (/e hr min)
CCB Lic.: 17 Electrical Lic.: C 308 Suprv. Lic.: 2 ! SS ELECTRICAL PERMIT FEES
� Subtotal:
Suprv. Electrician signature, required: / �,L Plan review (25 %of permit fee):
Print name: , e n� D ate: S tate surcha (12% of permit fee):
C TOTAL PERMIT FEE: 1 (. 1 D
Authorized signature: �� „ This permit application expires if a permit is not obtained within 180
days after it has been accepted as complete.
Print name: I Date: • ..- - ^- • - --.. -