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Permit CITY OF TIGARD ELECTRICAL PERMIT 1111 - COMMUNITY DEVELOPMENT Permit#: ELC2013-00055 TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Date Issued: 01/23/2013 Parcel: 2S104AA07400 Jurisdiction: Tigard Site address: 12745 SW KATHERINE ST Project: Walpole Subdivision: BELLWOOD NO.2 Lot: 111 Project Description: Replace 200 amp panel. Contractor: MPD ELECTRICAL CONTRACTORS Owner: WALPOLE,THOMAS J & DENISE PO BOX 173 12745 SW KATHERINE ST OREGON CITY,OR 97045 TIGARD,OR 97223 PHONE: 503-657-9173 PHONE: FAX: FEES Quantity Description Date Amount 1 ea Services or Feeders-200 01/23/2013 $100.70 Specifics:, amps or less 1 ea 12%State Surcharge- 01/23/2013 $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 bject to the regulations contained in the Tigard Municipal Code, State of OR Specialty Codes and all other applicable law. All work will be done i 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. ENTION: Oregon la •uires you to follow the rules adopted by the Oregon Utility Notificatio Center. Those rules are set forth in OAR 952-00 -0010 through OAR 9 -101-00+r. ou may obtain a copy of the rules or direct questions to OUNC,by .= ''--' -1987 or 1.800.332. •44. Isau d By: d\ ! ( Pennittee Signe: _'�� /'_ 1 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. 01/22/2013 TUE 9: 14 FAX 5036557140 MP3D Electrical Systems 2002/002 Electrical Permit Application REcENED FOR OFFICE USE.ONLY City Datc Il Received ��i� Ov Cit of Tigard Dalen3 : / 1 Permit No.. iLe... , .p y 13125 SW Hall Blvd.,Tigard,OR 97223 'AN 2 2 2013 Plan Review I Phone: 503.718.2439 Fax: 503.598.1960 Date/[iy: Other Permit: TI G A It D Inspection Line: 503.639.4175 n A D Date Ready/By: Atria 0 Ste Page 2 for Internet: www.tigard-or.gov CITY OFTIGARD Notified/Method: Supplemental information TYPE OF.4 ©ING DIVISION PLAN REVIEW Please check all apply(submit z sets of whims checked below): ❑New construction ®Addition/alteration/replacement ❑Service or feeder 400 amps or more ❑Building over three stories. ❑DCnt01 itiOtt ❑Other: where the available fault current 0 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10.000 amps at 150 volts or ❑Floating buildings. less to ground,or exceeds 14.000 ❑Comntercial-use agricultural ® I-and 2-family dwelling ❑Commercial/industrial ❑Accessory building amps for all other installations. buildings. ❑Multi-family ❑Master builder ❑Other: ❑Fire pump. 0 installation of 75 KVA or JOB SITE INFORMATION AND LOCATION ❑Emergency system. larger separately derived system. ❑Addition of new motor load of / 1001-IP or more. occupancy. Jobno.: Q00(0)0 Job site address: f)-795 5L i vs"„I.L?J ihJ ❑Six or more residential units. ❑Recreational vehicle parks. City/State/ZIP: "1 ; 0\G C� 0 Q i a, ❑Health-care facilities. El Supply voltage for more Than ( ❑Hazardous locations. 600 volts nominal. Suite/bldg./apt.no.: Project(tame: ['Service or feeder 600 amps or more. FEE SCHEDULE Cross street/directions to job site: Description i Qty. I Nee. i Total i • New residential single-or multi-family dwelling unit. ' Includes attached garage. Subdivision: Lot no.: 1,000 sq.11.or less 168.54 4 Tax map/parcel no.: Ea.add'I 500 sq.Il.or portion 33.92 1 Limited energy,residential 75.00 2 DESCRIPTION OF WORK (wish above sq.R.) /t, Limited energy,multi-family 75.00 2 V-C c(lqC.0 DOUG W e tit 1 residential(with above sq.II.) Services or feeders installation,alteration,and/or relocation 200 amps or less 1 100.70 i0o;7O 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 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.Fee for branch circuits with ❑ APPLICANT I f R CONTACT PERSON above service or feeder fcc, 7.42 P'() l 5 each c Business name:: f I.0 (�_( ,C�\ S.y5-E�r ft,t. B.Fee for branch circuits without / service or feeder fec,first Contact name: -.7:76IA rJ G--c,1■1 , 50-) branch circuit 56.18 2 • Each add'1 branch circuit 7.42 2 Address: yv Ci j,.y A. 1-73 Miscellaneous(service or feeder not included) Each manufactured or modular City/State/ZIP: I 1 ( 0- 67.84 2 y /(P� O, C_. 4--/t a h dwelling,service and/or feeder _ e Phone:( ) Fax::( ) Reconnect only 67.84 2 Pump or irrigation circle 67.84 2 E-mail: CONTRACTOR Sign or outline lighting 67.84 2 Signal circuit(s)or limited-energy Business name: M 2j ' l panel,altaalion,or extension. Page 2 2 ���� '(i� �/s-[-e,-,c Each additional inspection over allowable In any of the above Address: � O ' J? � Additional inspection(I hr min) 6625/hr _ Investigation(1 hr min) 66.25/hr City/State/ZIP: d!Q to ti c , } / U g 76 L 1 J� Industrial plant(I hr min) 78.18/hr Phone:(5-o3) fo 6-7- oi ('7 72 Fax:(5-0 3) C 5-- --:._ —NO} Inspections for which no fee is specifically listed(V1 hr min) 90.00/hr CCB Lic.: 1'1Cj`� o J,Ele yt rical L{,�,,,•jSuprv.Lie.: 5�S`1_ ELECTRICAL PERMIT FEES ryy(ty Jy /obit Subtotal: 100,i 0 Suprv. Electrician signature,required: 1� � ��� ` Plan review(25%of permit fee): Print name: C' i 1/-� U{• -1 `,k L i ate: 1 i. /1 State surcharge(12%of permit fee): i,)-J% J TOTAL PERMIT FEE: i 0,-7V Authorized signature: This permit application expires if a permit is not obtained within 180 04(.../ Print name: Date: ° days after it has been accepted as complete. Number of inspections allowed per permit. I:Duiding,Permitsuu.c.PermitApp.doe 07h01/10 440.46t5T(11/05/COM•W[D