Loading...
Permit CITY OF TIGARD ELECTRICAL PERMIT 14 S • COMMUNITY DEVELOPMENT Permit #: ELC2012 -00719 • T WARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 12/18/2012 Parcel: 2S103CD01700 Jurisdiction: Tigard Site address: 13775 SW FAIRVIEW CT Project: Lyons Subdivision: HOLLYTREE Lot: 15 Project Description: (1) branch circuit to install new grounding electrode system Contractor: PRO CIRCUIT ELECTRIC LLC Owner: LYONS, JENNIFER PO BOX 3948 13775 SW FAIRVIEW CT WILSONVILLE, OR 97070 TIGARD, OR 97223 PHONE: 971 - 563 -8211 PHONE: FAX: 503 - 266 -1349 FEES Quantity Description Date Amount 1 crt Branch Circuits wo /Purchase 12/18/2012 $56.18 Specifics: Service or Feeder 1 ea 12% State Surcharge - 12/18/2012 $6.74 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: Total $62.92 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 OA 52 -001- 090. You ► mmyy obtain a py of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. Issued By: �" —` ' 4 Permittee Signature: DtJ Aet' /e4i7okt_ 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. Electrical Permit Applicatio ,EC EIVED FOR OFFICE USE ONLY City of Tigard Received _ Darcy / J-) k ' - t Permit Ne LC )0l �- 007 / `? , . 13 (25 SW Hall 13Ivd., '1 Tigard, OR 97223 DE 1 7 Plan Review Phone: 503.639.4171 Fax: 503.598.1960 2012 Dale/By: Other Permit. T[Gnl> [?' Inspection Line 503.639.4175 t Date Ready/13y: Jgti _, / ® See Pagel for Internet: www.:igard- or.gov �[ CIT [ YO � F - TIGARD ` Notificd/Mclbod: I I 10 Supplemental Informat TYPE OE WVRR INCIDJVT I()N PLAN REVIEW - ❑ New construction Addition/alteration/replacement Please dlcck all that apply (submit 2 sets of plans wlitems checked below): ❑ Scrvice or feeder 400 amps or more ❑ Building ever three stories. ❑ Demolition ❑ Other: %here the available fault current ❑ Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 1% volts or ❑ Pleating buildings. less to ground, or exceeds 14,000 ❑ Commercial-use agricultural Iro 1 - and 2- family dwelling 0 Commercial /industrial ❑ Accessory building amps for all other installations. buildings. ❑ Multi- family ❑ Master builder ❑ Other: El Fite pump. ❑ Installation of75 KVA or JOB SITE INFORMATION AND LOCATION El Emergency m, larger separately derived system. ❑ Add of new of new motor load of ❑ "A ", "B ", "1 � ", "1 -3 ", site address: ) 11 �- 100HP or more. occupancy. Job no.: Ja 3 7 7 7 `SW �Al(�J /et") C_.. ❑ Six or more residential units. ❑ Recreational vehicle parks. City /State/ZIP: ❑ Health facilities. ❑ Supply voltage :or more than CI Hazardous locations. 6C0 volts nominal Suite/bldg. /apt. no.: I Project name: ❑ Service or feeder 600 FEE SCHEDULE Cross street/directions to job site: { Qty. f F t • Dne (lien 1 - F ez Tow! New residential single- or multi- (amity dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. ft. or fess 168.54 4 Tax map /parcel no.: Ea. add'I 500 sq. It or portion 33.92 l Limited energy, residential 6784 2 DESCRIPTION OF WORK (with above sq. R.) Limited energy, multi - family 67.84 2 � S � / / )Q i $ rv-e(.) Co (t} pra,riz, e t tL tc---- residential (with above sq. It.) j YST��1 Services or feeders installation, alteration, and/or relocation I 200 amps or Ices 100.70 — _ PROPERTY OWNER 0 TENANT 201 amps to 400 amps 133.56 2 Name: .3 r (2-61 ?� 401 amps to 600 amps 200.34 2 Y 601 amps to 1,000 amps 301.04 2 Address: 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 Branch circuits— new, alteration, or extension, per panel Owner signature: _ Date: —_ A. Pee for branch circuits with ❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee, 7.42 2 each branch circuit Business name: . - B_ Fee for branch circuits without service. or feeder fcc, 1 Contact name: first branch circuit l 56.58 r I 2 Each add'I branch circuit 7.42 2 Address: Miscellaneous (service or (ceder not included) City /StatclZlP: Each manufactured or modular 67.84 I 2 dwelling, service and/or feeder ' Phone: ( ) Fax: : ( ) Reconnect only 67.84 2 E - mail: Pump or irrigation circle 67.84 2 CONTRACTOR Sign or outline lighting 67.84 2 n c: ©�] 1:5:(1\ y Signal circuit(s) or limited- Bus iness no __ LP\ � c 0..1 L C`E Vl energy panel, alteration, or Address: ' . D 6 , CI t4 q extension. Describe: Page 2 I 2 t , City/State /ZIP 0 ri 7 c 0 Each additional inspection over allowable in antof the ah o' - �Js.t5oltiY�lle_ i Per inspection 66.25 ' Phone` ( I) 5I 5311 I I Fax: ( 553) 2-1,0(o (3(.( Cl Investigation per hour (I hr mill) 66.25 CCB Lic.: , Electrical Lie.: — coo(` Suprv. Lie - : 51 07. 5 Industrial plant per hour I 78.18 ELECTRICAL PERMIT FEES Suprv. Electrician signature, required: 1 , �__ ! — 12 Subtotal: 1�1t I` kJE-- A)' V r ` I I Date: I ii y '`,0� �, Plan review (25% of permit fee): State surcharge (12% of permit fcc): ' (p . 74-1 Authorized signature: _ TOTAL PERMIT FEE: 1 -Z._ '92_ This permit application expires if a permit is not obtained,rithin 150 Print name: _ v Date' days after it has been accepted as complete. ` Number of inspections allowed per pcnnit. 1 Vnailding14rmits1r•1L- 1 A pp. doe 10/01/07 .140- 1615T(I 1 1O51COM/WE0 Z 6•£199Z£O9 °u1°ala T! °.i!D aid °££:L0 Zl 96 °ea