Permit 'F ;
i .y ..,
p CITY OF TIGARD ELECTRICAL PERMIT
Ihi
, - -.- COMMUNITY DEVELOPMENT Permit #: ELC2013 -00168
T f GARD' 13125 SW Hall Blvd., Tigard OR 97223 503.718.2439 Date Issued: 03/14/2013
Parcel: 1 S 136AD00100
Jurisdiction: Tigard
Site address: 11205 SW 65TH AVE
Project: Briggs Subdivision: VILLA RIDGE NO.2 Lot: 1
Project Description: (1) 200 amps or less service
Contractor: INDUSTRIAL COMMERCIAL ELECTRIC COMPANY Owner: BRIGGS, JOSH
29030 SW TOWN CENTER LOOP E, STE. 202 11205 SW 65TH AVE
#159 PORTLAND, OR 97219
WIILSONVILLE, OR 97070
PHONE: 503 - 981 -2383 PHONE: 503 - 267 -7224
FAX: 503 - 981 -0053
FEES
Quantity Description Date Amount
1 ea Services or Feeders - 200 03/14/2013 $100.70
Specifics: amps or less
1 ea 12% State Surcharge - 03/14/2013 $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 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 9 , -r 11-0096 You may btain a cop of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344.
Issued By: ' , Permittee Signature: D O PP L 6� ►�v 0_
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.
Thls 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.
MAR -14 - 2013 11:50 AM ICEco 5039810053 P. 2
Electrical Permit Application RECEIVED 1•t lc t1i :i;ii'I: lisP. 1)NI.1
City of Tigard Received Sr -
D„ Tigard, OR 97223 , MAR 14 2013 Dire) : - 3/ t4 I s . Permit No. :F ' 01 — vo i W •
II-- 131 SW Hall lvd
Plan Review
Phone: 503,718.2439 Fax: 503.598.1 /� D�B Other Permit:
I I , , i I , Inspection Line: 503.639,4175 Li TIGARD Date RcadyI8y: Lai see page 2 for
Internet: www.dgard- or.gov . BUILDING DIVIS I ■ Notificd/Method: Supplemental leformsaoo
. �:. i xi f1 :..lr ,���'f, x ; a '� r t ' 7 .t�y y !t A� �f" 4S 1 '�,� 'n rv - t rt .. S-c y, r j� "� ,�.
' :.1 ��`-a, ...d,11 L, . l ai _ ... f . - - :..:.:. . ...
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❑ New construction t., m � s
L
— ^ F: Addition /alteration/replacement Pease check all that apply (submit a seta of plans w /Items checked below):
❑ Service or Areder 400 amps or more 0 Building over three stories,
❑ Demolition ❑ Other: where the available fault current 0 Marinas and boatyards,
'� ;,, n- ='i. ° °l I , �'f ; i`' Tw ` i i44 > � " j I` y t exceeds 10,ann amps at 150 volts or ❑ Flossing buildings.
...111_—,...... __ . 4 i _ __. .z
__.. ........• _. a '.•_t ' : " .... z4.��,1 .;� _ .. . less to ground. or exoeeds 14,000 ❑ Commercial.use agrioulnaal
�/ 1 - and 2- iitmily dwelling ❑ Commercial/industrial ❑ Accessory building
Imps for ell other installatigns, buildings.
0 Multi= family ❑ Master builder ❑ Other: 0 Fire pump, ❑ installation of 75 ICVA or
hi r : ,l x , AS f ; o larger separate! derived
n t ' 1 t 1 s i , rJ `' � t a Fy .+ ;,,rr 0 s ystem. lei Y sY stem.
�. ' YA ❑ ew motor load of 0 "A ", "E", "I - 2" "1 ",
. ._ . _... ._. __ .�! , _ _. = - � ; _ _ , _...: �r.::� em ..'lt. t 1 L � � � __ "_. Addition of n
Job no.:Ice- 543 lob site address j1 5 S W ( 5114 l 10oHP or more. �cWaacy.
0 Six or more residential units. 0 Recreational vehicle parka.
City /State /ZIP: N . \ rAin. 4 pg.., q 1. Z ll ❑ Heahh-eare flleilities. 0 l
Suppy voltage for more than
❑ Harairdous locations 600 volts nominal
Suite/bldg. /apt. no.: I Project name: Sery (t U iiirrowle 0 Service or feeder 600 amps or Moro
• I r ;. t,j } x. r1.r ,; J ; ,(M11. _4, � li.:" a 7.,
Cross street/directions to job site: Desc O Pea Tet -
New residential single or multi family dwelling unit.
includes attached garage.
• Subdivision: I Lot n0.: 1,000 sq. ft. or less — 168,54 4
Ea. add'/ 500 sq. ft, or portion 33.92 1
QQ Tax map /parcel no.: - Limited energy, residential
, lea x'tr4T } D ud ( r �,L' ' li d I n °c Yhf1` rl p, 4,V 1i; (with above so. ft) 75.00 2
__.:3__ _ ' f1_a, .. .. ... u , .r.:, e.:._ -L. ...._t_� .. +r.']iL,: }n.1
. Limited energy, multi•fiunily
V :: c... • 1 It 20 d L ti.i. - ' A.); ce residential (with above sq. ft.) 73,00 2
Services or feeders installation, alteration, and/or relocation
200 amps or lass 1 100.70 100 .10 2
r n -,Cr,I J I r i ,. 111 I , ' r.I �r" y 1: r .r^�.•i 201 am ernes
k
.- , ,, t . r � , 1 + t l r . Pa to 400 em 13356 2
u
�.. ......_ • �,:� ..._ _ _ r ..::._ - .._:_..� .. ..1. ± _��.� *. Zti� x.: Vii' .. ��.. 401 amps to 600 amp 200.34 2
Name: _, , 1,...i. S 601 am to 1,000 amps 301.04 2
Address: i`'LQ 5 ,c, (j f 1k PtVe. Over 1,000 amps or volts 552.26 2
City /State /ZIP: ro Qh pl , ag. r 2)t 1
Temporary services or feeders i nstallation, alteration, and/o
Phone: (ch 0.7 -1-1.1±4 Fax: ( ) 200 amps or less 59.36 1
Owner installation: This installation is being made on property that I own which is not 201 am to 400 am 125.08 2
401 amps to 599 amps 1 58,34
Intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 2
Branch circuits- new, alteration, or extension, per panel
Owner signature:. . Date: A. pee for branch circuits with
°"✓ "' szf r r i ' ` NI .7 '• I """' above service or feeder fee,
Vi e;„'t 4 S± i La's _: ` L• '_ ...,..._..- - -`--... . 2.. �W s:. ' tl . tt+' ` -_.a 1 ._,_� each branch circuit 7,42 2
Business name: B. Fee fbr branch circuits without
service or feeder tbe, first 36,18 2
Contact name: branch circuit
Each add'/ branch circuit 7.42 2
Address: Miscellaneous (service or feeder not Included)
•
City /State/ZIP: Eachmanufactnredormodular 67.84 2
dwelling, service and/or feeder
Phone: ( ) I Fax: : ( ) Reconnect only 67.84 2
Pump or irrigation circle 67.84 2
E mail Si or outline II tin -
" it -„:,, r , i . - Bb J> 67.84
a1,.' 1 . ".. ; ., y , .ai^ • ,'.. " . r .:..:;,. , t � ` i4s ; _ •,'!".
__ � _.. ; ' . ? 4 Signal circuit(a) or limited -energy - _ -7
. Business name: \ t s..‘,.'•‘0,\ (e ME�rac \ etei.'4rn e. panel, alteration, or extensoion. Peke 2_
Each additional inspection over allowable in any of the above
Address: Zetyip Sig 'Ro Co imp E She 2o2 4 f Additional inspection (I hr min) 66.25/ hr
imp Inveatigatign (1 hr min) 66,23/ hr
City/Slate/ZIP: like Oft 910 .
1 / r Industrial plant (1 h min) 78.18/ hr
Phone: ( ) ((1 b , Fax: (R) ) O\ - 0Q53 Inspection for which no fee is
1.I1M, I e ecrficall listed lib hr min
CCB 90.00 / hr
Lic.. I W 1 O � SSuprv. LIC.:56 : h .. r _. t r . • r . ' . - 4v., - .t. • J lr r..= ai r u , ���� t
7 t I �/ • p 3 Subtotal: •
Suprv. Eke ' ■ a re,rcquired: _ ..I, 4 _ ��ry 2 r t Plan review %ofpermitfee): 160
Print name. , Ca Date: 3 1 4 State surcharge (12% of permit tbe): 11_,D171
Authorized signature: 4 .. • • J� TOTAL PERMIT FEE: I IL .31
1 i �..`/ This permit application expires If a permit is not obtained within 180
Print name: -MAD € ' gf ,:p Date: 31 irk 1 13 days after It has been accepted as complete.
• Number of InSeeotions allowed per permit.
t; 1BulltiMperniiis1ELC- Pcnnhnpp,doe 07/01/10 440- 9615T(11/05,COWARa