Permit b1 CITY OF TIGARD ELECTRICAL PERMIT
COMMUNITY DEVELOPMENT Permit #: ELC2013 -00020
Date Issued: 01/10/2013
TIGARD 13125 SW Hall Blvd , Tigard OR 97223 503 718 2439 Parcel: 2S1028C01800
Jurisdiction: Tigard
Site address: 10330 SW WALNUT ST
Project: Swinford Subdivision: NORTH TIGARDVILLE ADDITION Lot: 27
Project Description: Bathroom remodel, (1) branch circuit
Contractor: CROSSROADS ELECTRIC Owner: SWINFORD, CLARK H &
32488 DEBERRY RD AMANDA K
CRESWELL, OR 97426 10330 SW WALNUT ST
TIGARD, OR 97223
PHONE: 541 - 729 -0914 PHONE:
FAX
FEES
Quantity Description, Date Amount
1 crt Branch Circuits wo /Purchase 01/10/2013 $56 18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/10/2013 $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 oth p • e law All • will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if • • •en.ed for - e the 180
days ATTE ON gon law requires you to follow the rules adopted by the Oregon Utility Notification Cent -' - -s -re se orth in i
952- 001 -001 through OA 952 -' 41 -r 09' You may obtain a copy of the rules or direct questions to OUNC by calling 503 232 ' : - Jr 34 •
Issued By: ip / Permittee Signature: . / _. J .JL•�/
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease or rent 11111W
OWNER'S SIGNATURE Date:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC' / Date:
: i f - —
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 A 1' 1 FOR ( f 'il E: I sf llNl,1
keened / Primp N,. e --�'r
I
City of Tigard ttell■
— "
• 131 Hall Blvd . Tigard.URRR1212 Plan Rtsua t11hc, p.m,' 503.718 2439 Fax: 5031198`19 U 2 013 t)ata•Its` M = for
T I G,� R D Inspection Line: 503 639 4175 '°
Ixite Reads /Hy t" D al laforn+ a �o"
Internet: wow CITY tigard or gov C' TIG� NW.fintMct _— _� — P— - -- ,
Tl'� _._— Pl�► REYIF;W e low)
❑ New construction ddition/altemtion/rc laeement incase check all that lipids (.uhmn j sett of plans w: ileitis ehee►td
p ❑ Sc' s ice of (cede, 400 anr14. more ❑ Budding .over three +urt+
O Demolition ❑ Other: where the mailable fiudt current ❑ Marinas and (tmisarda
-
CATEGORY OF CONSTRUCTION
merits 10.000 amps at 1'0 colts of ❑ Homing buildmga n cullural
lea+ to pound. rt tweeds 14,000 ❑ Commpetalmic as
and 2- family dwelling El Commercial/industrial ❑ Accessory building amps lot all other nisnallations Mnldulgs '
❑ Multi- family ❑ Master builder ❑ Other: Ohm pump ❑ Installation .0 75 ►OVA or
l separate!) .lensed system
❑ Fme,gency as strm
JOB SITE INFORMATION AND LOCATION ❑ Addition of new motor 1031114 ❑ "A" "t " ' l I - t"
I11011P or more occupancy
Job no.: Job site address: 0 33 a 5 Z ❑ Recreational vehicle parks
❑ Sir or more residential onus
,1,� ❑ Health-care facilities
❑Supply vnttage Cur more than
City/State/ZIP: (---- \ � /
"" ' mxt snits nominal
J ( t`t�w ❑ Seivice or J ❑ Scrve .x (ratio o00 amps or more Suite/bldg./apt. no.: Project name: Urn-�� FEE SCHEDULE: rcl
Cross street/directions to job site: Description Qrs. r r». [ Total
- New residential single- or multi - family dwelling unit.
Includes attached garage.
Subdivision: Lot no.:
1 3)00 sq 0. or loss M 168 S4 4
- - - fa addi 5011 sq. Il, or portion 33 92 1
Tax map /parcel no:: Limited energy. residential 75 (!n 2 ,
DESCRIPTION OF WORK _ (with above sq. tl 1
e Lumted energy. muht- family 7500 ' 2
6 ( �1 / residential (with above sq tl )
2 1-4 !� ( +' D o ...1 % t ` "�"` Services or feeders installation, alteration, and/or relocation
200 amps or lea 100 70 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: ( ) I Fax: ( ) 200 amps or lea 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 stops 168 54 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701.
Branch circuits - new, alteration, or extension, per panel
Owner signature: Date: A. Fee for branch circuits with
❑ APPLICANT 1 ❑ CONTACT PERSON above service or feeder fee. 7 42 2
each branch circuit
Business name: R Fee for branch circuits without
.40. C �. '. , " service or feeder fee, first 1 56 IS
Contact name: •
branch circuit 56.18 2
a jr, / 1 ..- , h add'l branch circus 7 42 2
Address: a Q , j - - sr • _ o' Miscellaneous (service or feeder not included) ^ • Each manufactured or modular 67 84
City/State/ZIP: __ C' ,� dwelling, service and/or feeder 2
, Phone: (30 3) 3 G 7 - 0(4 • Fax:: ( )
Reconnect only 67.84 2
Pump or irrigation circle 67.84 2 -
E Signor outline l ighting 67 84 • 2 —
CONTRACTOR Signal arcuit(s) or limited-energy
Business name: /� - el alteration or extension. Pa e 2 2
Each additional inspection over _ �:� In i arm . _
Address: _ �, Additional inspection (I hr min) 6625/hr
City/StateJZIP:(� 5 /_all q 7 y 2 6 Industnal plant (I hr m
Invesngation (I hr mm) 6625/hr
" ' C . m) 78 1 B/ hr
Phone: ( & ( ) 7z Q 2 / 1( Fax: ( 7 ) 4 Inspections for which no fee s 90 00! hr
�45 / 7 / C5� / 5472S specifically listed ( L ECTRICAL PER hr mm)
CCB Lic.: Electrical ic.: C prv. Lic.: FEES '
Suprv. Electricia i fe 9 required. - /p /j _ S ubtotal' _ n . / °
Plan review (25% of permit fee).
Print name I6 , ..e IA ^ r Date: ( / v / j 3 _ State surcharge (12% of permit fee): 4-7 LE
_ _9Jr_ TOTAL PERMIT FEE:
Authorized signature: J;
This permit application expires if a permit is not obtained witDin 180
Print name: p a days after it has been accepted as complete.
` • Number of inspections allowed per permit
I usePermnfELC•PsrmiApp de- 07/01/10
4404615T(11l05/COMtWEB