Permit A CITY OF TIGARD ELECTRICAL PERMIT
IN
' ' .COMMUNITY DEVELOPMENT Permit #: ELC2013 00075
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 01/30/2013
Parcel: 2S103DD05600
Jurisdiction: TIGARD
Site address: 10915 SW GARDEN PARK PL A
Project: Ottoman Subdivision: GAARDE PARK Lot: 39
Project Description: Replace electric furnace
Contractor: BOB'S ELECTRIC , Owner: OTTOMAN, NORMAN R TRUST
2700 NE'BURTON ROAD STE A BY OTTOMAN, NORMAN R TR
VANCOUVER, WA 98662 PO BOX 1569
SHERWOOD, OR 97140
PHONE: .360725477200
PHONE: 503 - 625 -7735
FAX: 360 - 254 -8219
FEES
Quantity Description Date Amount
1 crt Branch Circuits wo /Purchase 01/30/2013 $56.18
Specifics: Service or Feeder
1 ea 12% State Surcharge - 01/30/2013 $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 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 OAR',•5 - 001 -009'. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. , /
Issued By: A l / - . L - Permittee Signature: D /V P���C� , ' "'-
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 (TUE) 29 2013 19: 26 /ST. 19: 24 /No. 9302926369 P 1
Electrical Permit Application • I U R ()I. I : 1 1 l (i \ I.1
71 City of Tigard RECEIVED Received ! 30 / 3 sl Permit No.: Li(� p� 3 - r7
Date/F1 .
: i 131 25 S W Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.15V y .] ® �' s : Other Permit:
Tit . \ 1: D Inspection Line: 503.639.4175 J r , , t! Date Ready/By: huis: f IZ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: / %C Supplemental Information
., a ■ !
`i Fl. ill IA w i Please check all that apply (submit sets of plans w /items checked below):
❑ New construction ® Addition/. 1 ( ent
❑ Demolition E] Other ❑ Se or feeder 400 amps or more ❑ Building over tutee stories.
where the available fault current ❑ Marinas and boatyards.
li ,
_ - I ' ' exceeds 10,000 amps at 150 volts or ❑Floating buildings.
13 1 - and 2- family dwelling ❑ Commercial/industrial ❑ Accessory building amps for all other or e ons. ❑ buildings.
mmercial -use agrkcultiasl
��Y g arms for all o installations. bu
❑ Multi- family ❑ Master builder ❑ Other: ❑ Fire pump. ❑ Installation of 75 KVA or
.t } , . ❑ Emergency system larger separately derived system
k72:1'1.:,;„ !.`'': s., . _? . ❑ Addition ofnew motor load of ❑ " .. " -2 ,. " -3 "
Job no.: 13 -213 Job site address: 10915 SW Garden Park Pl. A 1001T2 or more. mmipwwy.
❑Six or more residential units. ❑ Recreational vehicle parka.
City/State/ZIP: Tigard, OR 97224 ❑ Health-care facilities. ❑ supply voltage for more than
❑ Hazardous locations. 600 volts nominal.
Suite/bldg./apt. no.: Project name: ❑ Service or feeder 600 amps or more.
Cross street/directions to job site: Dehoipmn 0y • F.e• Tom
New residential single- or multi- family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: 1,000 sq. It. or less 168.54 4
Ea. add'I 500 sq. ft. or portion 33.92 1
Tax map /parcel no energy, residential
_ Limited = (with abo 1 67.84 2
Limited energy, multi- family 67.84 2
1 ckt for furnace reconnect residential (with above sq. ft) _
Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
201 amps to 400 snips 133.56 2
...,. _ Ottoman :: 401 s to 600 am p s 200.34 2
."
N ame. an - . . 601 amps to 1,000 amps 301.04 2
Address: 10915 SW GAr . en ' .. Place U i Over 1,000 amps or volts 552.26 - 2
Temporary services or feeders installation, alteration, and/or
City/StateJZIP: Ti: and OR 97224 relocation
Phone: ( ) Fax:( ) 200 amps or Less 59.36 1
503 625— 73 201 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 amps 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
above service or feeder fee,
each lxanch circuit 7.42 2
Business name: B. Fee for branch circuits without
service or feeder fee, first 1 56.18 56.18 2
Contact name: branch circuit
Each add'I branch circuit 7.42 2
Address: Miscellaneous (service or feeder not included)
City/State/ZIP: Each manufactured or modula 67.84 2
dwelling, service and/or feeder
Phone: ( ) Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E
o tin 67.84 2
Sign r outline lighting
E ' - -- __ ..... ,< ,.L „. ... Si c or lim energy
Business name: t panel, alteration, or extension. Page 2 2
Bob' s Electric Each additional inspection over allowable in any of the above _
Address: 2700 NE Burton Rd. Ste. A Additional inspection (1 hr min) 66.25/ hr
Investigation (1 hr min) 66.25/ hr
• * • • - Industrial plant (1 hr min) 78.18/ hr
Phone: ( 360 )254 -7200 Fax: ( 360 )254 -8219 Inspections for which no fee is
90.00/ hr
s. ficall listed %a hr min)
MINIEMI
Electrical Lic.: 37 — IC Suprv. Lic.: 4322S
. .: • . '. .. . n . . . . , . ..-t
Subtotal: 56.18
Suprv. Electrician signature, required: Plan review (25% of permit fee):
Print name: Kevin Broselle Date: 1/29 13 State surcharge (I2% permit fee): 6.74
Authorized signature: TOTAL PERMIT FEE: 62.92
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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