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Permit • CITY OF TIGARD ELECTRICAL PERMIT COMMUNITY DEVELOPMENT Permit #: ELC2013 -00044 TIGARD • 13125'SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/22/2013 Parcel: 2S112BD02500 Jurisdiction: Tigard Site address: 14875 SW 79TH AVE Project: Barnett Subdivision: DURHAM ACRES Lot: 49 Project Description: (2) branch circuits for A/C and Furnace Contractor: GRF ELECTRIC Owner: BARNETT, MARY E 15460 S PARADISE LN 14875 SW 79TH AVE MULINO, OR 97042 TIGARD, OR 97224 PHONE: 503 - 829 -4146 PHONE: 503 - 620 -2168 FAX: 503 - 829 -5747 FEES Quantity Description Date Amount 2 crt Branch Circuits wo /Purchase 01/22/2013 $63.60 Specifics: Service or Feeder 1 ea 12% State Surcharge - 01/22/2013 $7.63 Type of Use: SF Electrical Class of Work: ALT Type of Const: Occupancy Grp: • • Total $71.23 • 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 9 2 -001 -0 90. You m obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800..332.23 / Issued By: t� t C i Permittee Signature: Oj . C�I� 2. ! f//^+- / 4P 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 603.639.4176 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. 2013 -01-17 18:21 GRF ELECTRIC 5038295747» 5035981960 P 112 Electrical Permit Application (`1 RIVED OFFICE USE f)Vl,, City of Tigard RECE Received Date/3v; ' 0 - ( 9 Permit No o1a3 —ow - • 13125 SW Hall Blvd., Tigard, OR 97223 Ptah Review • Phone: 503.639,4171 Fax: 503.598.19¢© . 1 2013 Date/By: Other Permit: 1' I i; n t: n Inspection Line: 503.639.4175 Dale Ready/By runs: ®See PAge 2 for Inttet: w.rigardor.gov OFTIGARD Nat,Redmetltod; ��� Supplemental Information _ TYPE OFF INC IZIVISiON PLAN REVIEW ❑ New construction ddition/elreratlorl/rep)aoemcnt Please check all that apply (submit 2 sets of plans w /items checked below): ❑ Service or feeder 4 00 amps or more ❑ Building CI Demolition • 1:1 Other: 4 g over three stories - where the available fault cantor 1:1 Marinas and boatyards. CATEGORY OF CONSTRUCTION exceeds 10,000 amps at 150 volts or ❑ Floating buildings. and 2 - family dwelling ❑ CommerciaUindustrial ❑ Accessory building less to ground, or exceeds 14.000 ❑ Commercial -use agricultural amps for all other installations. buildings. ❑ Multi - family ❑ Master builder ❑ Other: ['Fire pump, [] Installation of 75 K V A or JOB SITE INFORMATION AND LOCATION ❑ Emergency system. larger separately derived Sys! cm ❑ Addmon of new motor toad of Q'A "E ', "I .7•• "1 •3 - . Job no.: Job site address: p 100HPormore. occupancy. {' 1 i _ Q Six or more residential units. El Recreational vehicle parks • City/State/ZIP: T I !� rl / M 7 7.--L t�` ❑ Health.eare facilities. ❑ Supply voltage for more than • Q Hazardous locations. 600 volts nominal. Suite/bldg. /apt. no.: Project name: ❑ Service or feeder 600 amps or more. Cross street/directions to job site: FEE SCHEDULE D�e y(We � P . I total r New residential single- or multi - family dwelling unit. Includes attached garage. Subdivision: Lot no.: 1,000 sq. R. or less 168.54 Tax map /parcel no.: Ea. add'! 500 s ft. or portion 33.92 I 4 I _ Limited energy, r esidential - - DESCRIPTION OF WORK (with above sq. ft) 67 '$ 4 2 Limited enemy, multifamily 61.64 2 2 ,1y " .�� residential (wilt above sq. ft.) Services or feeders installation, alteration, and/or relocation 200 amps or less 100.70 2 ROPERTY OWNER /t i © TENANT 201 amps t0 400 amps 133.56 2 Name: /� /i r µ _401 amps to 600 amps 200734 2 Address: ! - t �} I - 601 amps to 1,000 amps _ 30104 2 l d `, W 11 i 4 / Over 1.000 amps or volts 552.26 2 City/State/ZIP: -cm/ services or feeders installation, alteration, and/o • relocation Phone: (, o 1 / _ / , _ 2,4 4, p' F ax: ( ) 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, accordinsr to ORS 447, 449, 670, and 701. 401 amps to 599 amps — 16g 54 • 2 I Branch circuits - new, alteration, or extension, • er panel I Owner signature: — Date: A Fee for branch circuits with ❑ APPLICANT ❑ PERSON above service or feeder fee, each branch circuit 742 2 Business name: B. Fee for branch circuits without Service or feeder fee, first Contact name: branch circuit = 2 Address: - Each add'I branch circuit in 7.42 mays Miscellaneous service or feeder not included City/State /ZIP: Each manufactured or modular dwelling, service and/or feeder 67 $ 2 Phone: ( ) I Fax :: ( ) Reconnect only 67.84 2 E -mail: — Pump or irrigation circle 67.84 2 CONTRACTOR - Sign or outline lighting 6744 Signal circuit(s) or limited-energy Business name: r/ /� panel, alteration, or extension. 2 J` r ( -r ' J t- _ Each additional ins' ection over allowable in an of' the above 2 Address: Litt, Add itional inspection 1 hr min it r s P . (k rCt ( .. let ( ) Ill 66.25/ hr City/Stara /ZIP: u l � L � r � ' ` L Investigation (I hr min) �� 66.25/ hr r Industrial plani (I hr min) I= 78.18/ hr MI Phone: ( tom 9 i zA - (�I �f-(� Fax: ( x.13 I �' 5 ' 4_, 7 Inspections for which no fees El i CCB Lic.: 1 0 S Iectrical Lic.: _specificallylist 90.00/hr _'11 -tC t<4 C Suprv. Lie.: i t - ELECTRICAL PERMIT FEES I Suprv. Electrician signatii c. requir d: t Subtotal: Plan review (25 % of permit fee): - • Print name: ti.V I. l Date: State surcar a 12 %of 1 I /� ra S r lr, i y'!, 7 h l e € ( permit fee a nuthoriied sign attirr. TOTAL PERMIT : _t • This permit application eapirts if a permit is not obtained wi I In 180 Print name: I Date: days after It has bees accepted as complete, - • Number of inspection allowed per permit