Permit 1 v CITY OF TIGARD
PERMIT
a COMMUNITY DEVELOPMENT Permit #: ELC2012 -00682
•
• • T f G AR D 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/04/2012
Parcel: 25111 CD09800
Jurisdiction: Tigard
Site address: 9860 SW KIMBERLY DR
Project: Petrina Subdivision: KERWOOD ESTATES Lot: 28
Project Description: (1) 200 amps or less, (5) branch circuits - rewire master and hall bath, change panel & add
Contractor: WHISKEY HILL ELECTRIC INC Owner: PETRINA, JACK M & FRANCES M
PO BOX 206 9860 SW KIMBERLY DR
HUBBARD, OR 97032 TIGARD, OR 97224
PHONE: 503 -981 -4640 PHONE:
FAX: 503 - 981 -4643
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/04/2012 $100.70
Specifics: amps or less
5 crt Branch Circuits w /Purchase 12/04/2012 $37.10
Type of Use: SF Service or Feeder
Class of Work: ALT 1 ea 12% State Surcharge - 12/04/2012 $16.54
Electrical
Type of Const:
Occupancy Grp:
Total $154.34
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 obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.8800.332.23444.. , /
Issued By: A J✓(X l 1j Permittee Signature: v *t/DL( t i'�1 r e �`►
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.
•
12/04/2012 09:12 503981484RECEIVE 111 WHISKEY HILL ELECTRI PAGE 02/02
Electrical teiznigApplication DEC 0 4 2012 FON OFFICE 1,ISF: ONLY
City of Tigard Received
DItc/13 - t-
1 13125 SW Hall Blvd.. Tigard. OR 97223 CITY OF TIGARD
Plan Review
• • • Ph° 503.639 Fax: " INS • . , Date/13 : Other Permit:
Ii G A R 1.)
Inspection Line: 503.639,4175 Date Ready/By: Aids! RI See Page 2 for
(0'
Internet: www.tigard-or.gov Notified/Method: TI Supplenientni Information
'..i.• ..:.:,,,•: .--•... - ' .i .•• .,...; ' ''... '. rtiF.Aitati4:: . .•.. ' - '. -. •: ': • '',..: • .• ..'. - ... ....' :.:...•::: '....'...' -''.: OtAt
0 Ncw construction Addition/alteration/replacement ch
Please eck all that imply (mibmit 2 sets of plans w/iteMs checked below):
RI
0 Service or feeder 400 amps or more o Building over three stories.
0 Demolition 0 Other: where the available fault current 0 Marinas and boatyards.
tO*
. i•i': : .:: .' :: -: ' : : - . ' ;! ...., .... " • ':: ' •:'.: ' :': *..litt.C1"4:.0 xc
• ..: ; ' '' ....::. ''.. • .. • ' . :: eeeds 10,000 (1111t1R at 150 volts or 0 FlontMa In Hidings
,
• -,........-----• ........4,... less to pound, or exceeds 14,000 0 Commercial-use apieultyrol
g 1 - and 2-family dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
O Multi-family 0 m builder 0 Other: CI Fire pump. 0 I of 75 KVA nr
larger separately
• derived Aygtenl.
. .. A
• ..:: : • . .;:'. .:',. : - ...!. :'' . Vr9 !'r,`.-m.../ .' .• 'I , , :: ." :•_ . r 0 Addition of ncw motor load of 0 "A", "E". "i.,/^,"1.3",
100HP or more. occupancy.
Job site address: 9s--6e):ii < . h p 1 .,, ,
kw Lk. 1 CISix or more residentinl units, 0 Recreational vehicle parks.
City/Statc/Z1P: Tt . . 0 Health-cam facilities. C3 Supply voltage for more nem
0 Harardous 10ealiOnS. 600 VOHS nominal.
Suite/bldg./apr. no.: O S de
ervice or feer GOO amps or mom,
Prqie namc: e;mkteri)/ nt e v e Pet._ . : .. :. .: , . : . -. .- . .. . . .- .... . . . : ; :y ..:,;:.. ..:..."-,. -11:•:
Cross street/directions to job site: Description _ I 9 I Fee. I Mal I ^
New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 168.54 j 4
Subdivision: Lot no.: ....
En. sdrl'I 500 sq. ft. or portion - 33.92 1
Tax map/parcel no,: Limited energy. ridentia1
75.00 2
:•;.' ,;• ''....'L: '.:..:.,....: ' •:‘, ?,;...:•'. oth*ortit: .. . ':c. • -.:.: .: ' . :: ..: .... -.. : . ...:.. .. (with above sq, ft)
• Limited energy, multi-family 75.00 2
tee -tv (p.a.( 10 wag? to hicra lea HI eice..4.444-Lite„4.,/, residential (with above sq)
t Services or feeders Installation, alteration, and/or relocation
4 f114 4y k-,4 a- 0-8'7. 200 amps or los i 100.70
: ;•••,:..:i • :., i...f .• ‘ ::: I :. .,, ,. ::... ' :..: ' : II .:... . 1 : , ..., . 201 imps to 400 amps 133.56 2
401 amps to GOO amps 200,34 2
Name: 601 amps to 1,000 amps 301.04 2
Address: Over I ,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 59.36 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 amps 168.54 2
intended for sale. lease, rent, or exchange. according to ORS 447. 449, 670. and 701.
nranch circuitA - new, alteration, or extension, r panel
Owner signature: • Date: A. Fee for branch circuit; with
„.
.'.. ..
...: .::: . .. . .. 7 1 - ..: - .':. 1 . . ; ..!1:[ :,..Cotit litt - #tRkk 7:: ... .' .. : .. . above service or feeder fee, $ 7.42 3 7. 1 O 2
• each branch circuit ,
Business name: B. Fee for branch circuit; without
service or feeder foe, first 56.18 2
h
branc circuit
Contact name:
• Each addl branch circuit 7.42 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 Sign or outlinelighting 67.84
2
-
panel, alteration, or extension. Page 2 2
Business name; h , 5 k,,,,,, I , 1 1 /.r ,
s / --":.: r eakr; , Each addition
IL. - —
al intipection over allowable in anj of the abov
Address; PO 6c _ , ,.. Additional inspection (1 hr min) 66.25/ hr
, 66.25/ hr
City/Srate/7.1P: ki 6 r „ * , Pr /Le industrial plant (1 hr min) 78,18/ hr
o e: 2
Phone: 603 1 2151— & A
bv
Fax: 6k3 981 -964/Z
Investigation (I hr min)
ust
inspections for which no fee is —
— specifically listed OS hr min) 90.00/ hr
CCR 1.1e. ..i& g 7 Lie.: C3 4t Suprv. V. I___j1:.5 _ : .: . . : • ......:::.' ...7-ELECTRICALitgIRMIEFF.ES:.'::',.::..;1:.. ;:.•.:
_
subtotal: / 3 7. 2
N Suprv. Electrician signature_ required: •-__...,--..--- Plan review (25% of permit fee):
Print name: IA A, al k i 4 1_&.._ Date: /61. a State surcharge (12% of permit fee): / 6- Py
TOTAL PERMIT FEE: /
Authorized signature: This permit application estiltes If n permit is not obtained within 1140
days after it has been accepted as complete.
Print name: Date: " Number of inspections allowed per permit. 3C
t:\Uuiidin\refmitnli.C.Pr.rmhAp.doe 07/0/10 440.46 5T(I I/05/COM/W2ri