Permit CITY OF TIGARD ELECTRICAL PERMIT
' . COMMUNITY DEVELOPMENT Permit #: ELC2013 -00121
TIGARD 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 02/20/2013
Parcel: 2S103DA05300
Jurisdiction: Tigard
Site address: 10695 SW COOK LN
Project: Hughs Subdivision: FANTASY HILL Lot: 6
Project Description: (2) branch circuits for A/C wiring and outlet
Contractor: WEST SIDE ELECTRIC CO INC Owner: HUGHS, JAMES R JR
1834 SE 8TH AVE SUSAN CLARE
PORTLAND, OR 97214 10695 SW COOK LN
TIGARD, OR 97223
PHONE: 503 - 231 -1548 PHONE:
FAX: 503 - 736 -0677
FEES
Quantity Description Date Amount
2 crt Branch Circuits wo /Purchase 02/20/2013 $63.60
Specifics: Service or Feeder
1 ea 12% State Surcharge - 02/20/2013 $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 OAR 2- 01 -0090 You may ob in a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: / A Lti Permittee Signature: DA PPLj CAT? o,(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.
RECEIVED c9-t ae) 1/ 3 51— iii_e__ .2 o 1 3 - ootal
_ iri LiTii 3.6j.J;j.tiiIJ _
TI GARD F 1 9 9 n13 . Read y/By: Ms: El See Page 2 for
Internet: www.tigurd-or.gov Notificd/Method: < C.: Supplemental Information
? l l',WirOgal M tliNtMnic'..;W:::
0 New construction g! Addition/al , t 1 if - 3 . , V ent • Please check all that apply (submit a sets of plans w/items checked below):
0 Service or feeder 400 amps or more 0 Building over threo StOries
El DeMOlitiOrl El Other: whcro the available fault current CI Marinas and boatyards.
1 . '' aRgq0 : 701:1R I gt`ntqngirttrAitt.W. , .nt'"0,NOM,VA: exceeds 10,000 amps et ISO yaks or 0 Floating buildings,
less to ground, or exceeds 14,000 Cl Cemmereial-use agricultural
and 2 dwelling 0 Commercial/industrial 0 Accessory building amps for all other installations. buildings.
0 Multi-family 0 Master builder 0 Other: 0 Firo pump. 0 Installation of 75 KVA or
atyA.mmor,.:mweoii:.go*ci,w:o -, :o d o t o k *.totiotoica : 4 ; :ntififeWfi. 19 EA"ZirroYfg.Y.,Etemme• tor 1.0d of 0 . system.
Job no.(3110KM Job site address: • tbk0 61 Sl.b 6.1Z \C 1_,N) • 100HP or more,
0 six dr mom residential units, occupancy.
0 Recreational vehicle parks.
City/State/ZIP: - tka k CkIrd 1 ctl'-a-2,- o • Health-care facilities, 0 Supply volinge for more than
0 Hazardous locations, 600 volts nominal.
Su ite/bldg./apt. no.: 1 [ Project name: IAAIAS\ avao_A4e . 0 Service or feeder 600 amps or more.
Cross street/direction to job site:
oats Lsay. 1 iree.
....—_,
New residential single.. Or multi-family dwelling unit.
Includes attached garage.
Subdivision: Lot no.: L000 sq. ft. or loss
168.54 4
Ea. tald'I 500 sq. R. or portion 33.92 1
Tax map/parcel nO.:
Limited energy, residential
7 44:04 . 040gg":00 : iAgA`lit,': . , -. °°,',,,II ' ' ,t ,_..(..,Vitil..above sq • ft) 75.00 2
- - , . Limited energy, multi-family
, _ . i 1 . ■—■ •
\ r ,.. C.- residential (with above sq. ft.)
75. 00 2
L.. kk \ 4 A Services or feeders installation, alteration, and/or relocation
200 amps or less 100.70 2
mmtglawowfvoioioggio, i, ,,,11041 pag:401.07 201 amps to 400 amps 133.56 _ F
401 amps to 600 amps 200J4 2
Namc: —__________
601 amps to 1,000 amps 301.04 2
Address: Over 1,000 amps or volts , 552.26 _ 2
Temporary services or feeders nstallation, alteration, and/o
City/State/ZIP:
relocation
Phone: ( ) Fax: ( ) - i00 amps or les
201 amps 10 400 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 T
' : 2 ! : : : MiagVi s PI:19,004.60TE, ItitadiS gga '. ". ? . iXtb''.q. above service or feeder fee,
742 2
each branch circuit _.
Business name: B. Fee for branch circuits without
— service or feeder fee, first 1 56,18 Slo .12) 2
%
Contact name: branch circuit
Each add"l branch circuit t 7.42 I 1.14 / 2
Address:
IV, icellat2cots serviCLO■L_. feeder not inauded
Each manufactured 0r modular 2
City/State/ZIP: 67,84
dwellity, service and/or feeder ,
Phone: ( ) Fax: : ( ) Reconnect only .. 67.84 2
Pump or irrigation circle 67.84 2
E ....
Sign or outline lighting 67,84 2
t Signal circuit(s) or limncd-
Business name; West Side Electric Co., Inc. _panel, alteration, or extension, , Page 2 2 s
Each additional inspection over allowable in anypf the above
Address; 1834 SE 8' Ave. Additional Inspection (1 hr min) . . . 66.25/ hr
—
Investigation (I hr min) . 66,25/ hr
City/State/ZIP: Portland/OR/97214
Industrial plant (I hr min) I 78.I8/hr
Phone: (503) 231-1548 Fax: (S03) 736 Inspections for which no fee is:
90.00/ hr
specifically listed (Y. hr min)
CCEI Lic.: 13306 Electrical Lie.; 26 Suprv. Lie .: 4654 'i‘,"MtIlP?;' FEES:::
Subtotal: is '.-3 . WO ,
Suorv. Electrician signature, rcquirc , fi 1 .. "--...A . " . .
/4417774e44.qpi,25ACqer" Plan review (25% of permit fee):
Print name; Randall F Roberts Date: 2 • I L4. I 0 State surcharge (1 VA of permit fee): '1 .Cfi —
TOTAL PERMIT FEE: 1 1 .d
Authorized signature:
This permit application expires if a permit is Oat obtained withinT80
days after it has been accepted as complete.
Print name: Date: 4 Number of inspections allowed per permit.
1 Alkuldirypertn itiNELC.PermitApp.dot 07/01/10 440.1615T(11/05/CPMAVED
/ [ # L866LECOSf 096[.869C09: o!..11.3813 ap!s 1.sem:woJdf