Permit rt CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2012 -00698
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/12/2012
Parcel: 2S 111 DD03800
Jurisdiction: Tigard
Site address: 15615 SW 88TH AVE
Project: Stark Subdivision: STRATFORD Lot: 20
Project Description: (1) 200 amp service
Contractor: PARKIN ELECTRIC INC Owner: STARK, CHARLES T
14001 FIR STREET 15615 SW 88TH AVE
OREGON CITY, OR 97045 TIGARD, OR 97224
PHONE: 503 - 657 -4958 PHONE:
FAX: 503 - 557 -1059
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 12/12/2012 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 12/12/2012 $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 -4 ! 10 ' 0 ou may obtain a copy of the rules or direct questions to OUNC by calling 503 232 1987 or 1 800 332 2344
Issued By: / �/ r� Permittee Signature: d/Cf 197 e /I7
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.
From: 12/11/2012 15:32 #801 P.002/002
RECEIVED
Electrical Permit Application DEC 1 1 2012 FOR OFFICE USE ONLY
- City of Tigard Received
e p Datem : /.Z iii: • , •t No.-
• 13125 SW Hall Blvd., Tigard. OR 9722 ITY OF TIGARD Plan Review r,�� / �DtS ?F
Phone: 503,7182439 Fax: 503.598. Div' Date/B : Other Permit:
TIC A R D Inspection Line: 503.639.4175 I �D IN G UI V I S t J Date Ready /By: ® See Page 2 for
Internet: www.tigard or,gov Notifred/Method: FiarM Supplemental Information
, ,.. _',1 ;TYPE, OF.°WORlf - . „ C ,r,, , ,' :::'==,:, £PLAN'REVIEW �. ,
❑ New construction Addition /alteration/replacement Please check all that apply (submit 3 sets of plans w /items checked below):
❑ Service or feeder 400 amps or more ❑ Building over three stories.
❑ Demolition Other: where the available fault current
❑ Marinas and boatyards.
;'CA GO.lt *`-OF >CON b -CTION - ~ " !° f4, ie ''''` ' exceeds 10,000 amps at 150 volts or ❑ Floating buildings.
�' Is 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 0 Other: ❑ Fire pump. ❑ Installation of 75 KVA or
z - - _ - ❑ Emergency system larger separately derived system
_ -- ',.'s,',''
- . TOBi INFORMi1�N.. AM) ,LOOM ON� ` .,, ID Addition of new motor load of ❑ A E 1.2 l _9"
Job no.: `�(� {� Job site address” �, A 1 r IOO or or more. mcupamy.
❑
Ohl J V�� ' C , t/V C t Q �t/ I J ❑ Six or more residential units Recreational vehicle parks
City /State/ZIP: %),;(1/1(4.., 10Q� ❑ Health -cafe facilities. ❑ Supply voltage for more than
❑ Hazardous locations. 600 volts nominal
Suite/bldg. /apt. no.: Project name: ['Service or feeder 600 amps or more.
_ - i FEE S�U_LE ` ','' ; ,
Cross street/directions to job site: Descr 1 Qty. 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
Tax map/parcel no.: Ea. add'I 500 sq. ft or portion 33.92 I
Limited energy, residential
75.00 2
;,`' . JC _ DESCRI fION_ OF u WORK': ' -. = ;55,:,i2,:::',.‘:-' (with above sq. ft.)
U n Limited energy, multi - family
C CIR� n _i residential (with above sq ft.)
75.00 2
`� Services or feeders installation and/or relocation
200 amps or less ( 100.70 J (LJ , 70 2 •
, , ' Q ,PROPERTY..OVPNER;, - ', - ❑ TENANT, " . m:, 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
City /5tate/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
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
=
above service or f fee,
n . ,:
_ ..� r = I _ . Q�- CONTACT PERSON.' _ :' - 7 42 2
each branch circuit
Business name: B. Fee for branch circuits without
service or feeder fee, first 56.18 2
Contact name: brand[ circuit
• Each add•1 branch circuit 7.42 2
Address' Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modular 67 84 2
Y dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or imgation circle 67.84 2
E - mail: Sign or outline lighting 67.84 2
• = - COMIRACroR: '-`' - •• " • Signal circuit(s) or limited- energy
Business name' Parkin Electric panel, alteration, or extension. Pag 2 2
Each additional inspection over allowable in an of the above
Address: 14001 Fir Street Additional inspection (1 hr min) 66 25/ hr
City /State/ZIP: Oregon City, OR 97045 Investigation (1 hr min) 66.25/ hr
Industrial plant (1 hr min) 78.18/ hr
ne: (503) 657 Fax: (503) 557-1059 Inspections for which no fee is 90
specifically listed (14 hr min)
CCB Lic.: 3515 Electrical Lic.: 34-4C %�Suprv. Lic.: 4241-S ' _ - ;: ' :1 enucAIL< PERMIT.FEES ` - ' `:=. = '
Suprv. Electrician signature, required: � Subtotal: - �(%) i'7C7
Plan review (25% of permit fee):
Print name: David B Parkin Date: State surcharge (12% of permit fee):
TOTAL PERMIT FEE: 11 7.
Authorized signature: This permit application expires if a permit is not obtained within 180
Print name: Date: • days after it has been accepted as complete.
Number of inspections allowed per permit.
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